Almost 40% of Australian women in late perimenopause are living with untreated, moderately-to-severely bothersome vasomotor symptoms – a defining clinical sign of perimenopause that continues to go unrecognised, new national data reveal.
The findings, from the Australian Women’s Midlife Years (AMY) Study, also suggest perimenopause may begin earlier than current diagnostic criteria allow, with symptom profiles emerging before menstrual cycle length begins to vary – leaving many women misclassified, misdiagnosed, or simply missed.
“This landmark study reinforces just how critical it is to listen to women and take their symptoms seriously,” said Professor Jill Hennessy, Chair of the Monash Women’s Health Alliance. “Too many go untreated for debilitating symptoms like hot flushes and night sweats. Research like this is essential to ensure women get the timely, evidence-based care they deserve during perimenopause.”
“By defining the symptoms that truly mark this transition, this study empowers women and clinicians alike with better knowledge and tools to improve women’s health and wellbeing.”
Published in The Lancet Diabetes and Endocrinology [link here], the cross-sectional study is the largest of its kind, documenting the prevalence and severity of menopause symptoms across all stages of reproductive ageing in a nationally representative sample of more than 8000 women aged 40 to 69 years.
The survey, conducted between October 2023 and March 2024, recruited via both a national probability panel and a non-probability panel, with 5509 women included in the final analysis. Menopausal stage was determined using STRAW+10 criteria, and symptom severity was measured using the validated Menopause-specific Quality of Life (MENQOL) questionnaire.
Led by Monash University researchers, the study found vasomotor symptoms (VMS) – including hot flushes and night sweats – were nearly five times more common in women in late perimenopause than in premenopause. Vaginal dryness also became 2.5 times more likely during the transition, and both symptoms remained highly prevalent postmenopause.
Senior author Professor Susan Davis AO, head of the Monash University Women’s Health Research Program, said the findings should prompt a shift in clinical diagnostic approaches.
“Our study clearly shows that a new onset of VMS is highly specific to perimenopause, being nearly five times more likely than in premenopause,” she said.
“While other symptoms might emerge in the perimenopausal stage, they lack specificity… for example, poor memory was only 1.7 and 1.3 times more likely in early and late perimenopause compared with premenopause.”
Importantly, the study found that women with regular menstrual cycles, but who experienced changes in menstrual flow and vasomotor symptoms, were “symptomatically indistinguishable” from early perimenopausal women, despite being classified as premenopausal by current standards.
“This finding supports the likelihood of perimenopause commencing before menstrual cycles vary by at least a week,” Professor Davis said. “Women whose periods have become much heavier or much lighter and who also have VMS should be considered as having entered their perimenopause.”
Current international staging criteria, including STRAW+10, rely primarily on changes to menstrual frequency and exclude vasomotor symptoms from formal diagnostic criteria. Yet according to the AMY Study, these symptoms are not only prevalent but may be the earliest and most reliable clinical markers – and particularly in women who no longer menstruate due to hysterectomy, endometrial ablation or hormonal contraception.
“These findings suggest that classic VMS should be considered as a diagnostic criterion for perimenopause or postmenopause when menopause can’t be distinguished by the bleeding pattern,” said Professor Davis.
Lead author Dr Rakibul Islam said the study’s scope and methodological clarity offered a new clinical lens through which to view menopause care.
“This study stands out for its national reach and methodological depth… linking clearly defined menopausal stages with validated symptom profiles in over 5,500 women,” he said.
“Current approaches overlook women with regular cycles and women who no longer menstruate. Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care.”
The study also exposes a stark health-care gap, with most perimenopausal therapies remaining off-label or inaccessible under current regulatory frameworks – despite their clinical relevance.
“There are no specifically designed or approved interventions for perimenopause,” the authors wrote. “Menopause management guidelines typically focus on postmenopausal care, despite the burden of symptoms in the perimenopause.”
They noted that women with moderate-to-severe vasomotor symptoms were nearly three times more likely to report depressive symptoms and 2.5 times more likely to have poor work ability – further underlining the need for updated clinical and policy responses.
“The earlier-than-currently-recognised onset of perimenopause needs further attention to ensure highly symptomatic women are not dismissed,” the authors concluded.