Global study finds gap between expectations and the reality of perimenopause

A new international study, believed to be the largest of its kind, examined what people know about perimenopause and what symptoms they experience. The results reveal a clear gap between what perimenopause symptoms people expect and what they experience.

Mayo Clinic researchers published a collaborative research study with Flo, a women’s health application, to assess the perimenopause symptoms of 17,494 people from 158 countries. The study results are published in Menopause, the official journal of The Menopause Society.

Perimenopause marks the time leading up to the final menstrual period and includes the year after it ends. This transition can begin as early as the 30s and last for several years. Although it affects health and daily life, researchers have studied it far less than menopause.

“This study shines a light on how little we still understand about perimenopause and how much it affects people’s daily lives,” says first author Mary Hedges, M.D., a community internal medicine physician at Mayo Clinic in Florida.

“At Mayo Clinic, we’re working to expand that understanding so we can improve awareness and guide care that truly meets the needs of each patient.”

Among more than 12,000 participants over age 35, the most common reported symptoms were fatigue (83%), exhaustion (83%), irritability (80%), low mood (77%), sleep problems (76%), digestive issues (76%) and anxiety (75%).

When asked what they associate with perimenopause, participants most often named hot flashes (71%), sleep problems (68%) and weight gain (65%). However, for those who said they were in perimenopause, 95% reported exhaustion and 93% reported fatigue, far higher than the rate of hot flashes. Exhaustion is a general decrease in performance, impaired memory, decreased concentration, and forgetfulness, whereas fatigue is physical exhaustion.

These findings show that fatigue, mood changes and sleep-related issues are central to many people’s perimenopause experiences, the study authors say. Hormone changes may affect the body’s natural rhythms and restorative sleep, while mood changes can be influenced by hormones, inflammation and diet.

The research highlights that perimenopause symptoms can significantly affect daily life, relationships and work. Responsibilities such as care giving and coexisting health conditions may add to the strain, increasing fatigue and emotional stress.

Mayo Clinic researchers say the study underscores the importance of rethinking how clinicians approach midlife health. They emphasize that understanding what people are truly experiencing, not just what is traditionally expected, is essential to improving care and communication during this life stage.