Why 1 in 3 women are unsure if they are in perimenopause

A recent new study from Flo Health discovered that 34% of women aged 35 and over in the United States are uncertain if they are in perimenopause and explored why higher levels of uncertainty are observed among those reporting more severe symptoms.¹

Perimenopause is characterized by hormonal variability, changes in menstrual cycle regularity, and a range of associated symptoms. This phase may last several years, in some cases up to a decade. Menopause is defined retrospectively following 12 months of amenorrhea, after which individuals are considered postmenopausal.

However, recognizing the onset of perimenopause can be challenging, particularly in its early stages when symptoms may precede clear changes in cycle patterns. A new study by Flo’s science team in collaboration with researchers at the Center for Women’s Health, Mayo Clinic, highlights the extent of this uncertainty, with many individuals reporting difficulty determining their reproductive stage.

The research is published in the journal Menopause, the flagship publication of The Menopause Society.

Who reports uncertainty about perimenopause? 

Participants were recruited via the Flo app for a study to assess perimenopause symptoms, knowledge, and attitudes. They were asked to self-report their reproductive stage with response options including perimenopause, postmenopause, neither, or unsure. Survey participants who selected that they were unsure about their reproductive stage were invited to provide additional context.

The research team found that a staggering 34% of study participants in the United States reported uncertainty of their reproductive stage.¹

This peaked among women aged 40 to 44, consistent with the typical onset of perimenopausal symptoms. In addition, uncertainty about being in perimenopause was highest among women who reported more severe symptoms.¹

The team conducted a thematic analysis of responses to identify key factors contributing to uncertainty regarding perimenopausal status.

Interpreting complex symptoms

The primary driver of uncertainty, accounting for 56% of responses, was symptom confusion and attribution.¹

While menstrual irregularity is a key feature of the perimenopausal transition, some individuals reported symptoms in the absence of changes in cycle patterns. This mismatch may contribute to uncertainty regarding perimenopausal status.

In other cases, preexisting health conditions, such as endometriosis, or other life events, such as postpartum weaning or discontinuing hormonal contraception, made it difficult to attribute symptoms specifically to perimenopause.

These findings highlight the uncertainty many patients experience when interpreting symptoms and determining whether they are related to perimenopause.

Understanding perimenopause knowledge and health literacy

The second most common reason for uncertainty was a lack of knowledge. This accounted for 28% of responses.¹

Some women were unable to distinguish between perimenopause and postmenopause, while others reported limited awareness of the term “perimenopause” or the range of associated symptoms. A subset of participants also perceived themselves to be “too young” to be experiencing perimenopause.

In response to their uncertainty, some participants actively sought clarification by gathering information about perimenopause from a variety of sources.

However, reliance on family history, peer conversations, or online sources often introduced inconsistent or conflicting information, which may have contributed to ongoing uncertainty and highlights gaps in perimenopause-related health education and underscore the need for clear, consistent, and evidence-based patient education.

Navigating uncertainty with clinical care

Finally, 16% of women reported that their uncertainty was driven by barriers to receiving medical confirmation or care.¹

For some, this reflected hesitancy to seek clarification, including reluctance to acknowledge perimenopause or concerns related to aging or fertility.

Others reported actively seeking help from health care professionals but described challenges in obtaining confirmation, including being told they were too young or that their symptoms were insufficient or attributable to other conditions.

Some women described feeling frustrated, unheard, and even more uncertain following these clinical encounters.

Supporting recognition and clinical assessment

Findings from this study highlight the complexity of recognizing perimenopause and the variability in symptom presentation.

Previous research conducted by the Flo team has identified a mismatch between commonly expected symptoms, such as vasomotor symptoms, and those more frequently reported in practice. In this study, commonly reported symptoms included physical and mental exhaustion, fatigue, irritability, and sleep disturbances.

Improving awareness of these symptom patterns may support earlier recognition and more informed clinical assessment of perimenopause.

Digital tools may offer an opportunity to support this process. Longitudinal symptom-tracking and educational self-assessment tools can help capture symptom patterns over time, providing additional context to support clinical discussions and reduce reliance on retrospective recall.

Supporting patient understanding between consultations 

Perimenopause is characterized by heterogeneous symptom presentation and variability over time, which can make assessment challenging within time-limited consultations.

Structured patient education combined with longitudinal symptom tracking may support pattern recognition. This can offer a clearer view of the patient's reported history, allowing for a more informed clinical assessment.

Want to recommend Flo to your patients? 

The Flo OB-GYN Co-Care Pack is designed for practicing health care professionals to support patient education and ongoing user-led reproductive cycle and symptom tracking between appointments.

By reinforcing education and encouraging regular cycle and symptom awareness between visits, the Co-Care Pack aims to support improved menstrual health literacy and more prepared follow-up consultations, consistent with findings observed in Flo’s randomized controlled trials.²

Learn more at med.flo.health/co-care-pack.