First of its kind study explores symptom prevalence across the menopause transition

Almost 40 percent of perimenopausal women in a Monash University-led study had untreated and potentially debilitating vasomotor symptoms (VMS) such as hot flushes, night sweats.

Published in The Lancet Diabetes & Endocrinology, the study, believed to be the first of its kind, explored in detail the similarities and differences between women across each of the stages of menopause, identifying the symptoms which best differentiate menopause onset.

Senior author Professor Susan Davis AO, who heads the Monash University Women’s Health Research Program in the School of Public Health and Preventive Medicine, said this study shows moderate to severe VMS and moderate to severe vaginal dryness to be the most defining symptom of perimenopause, being five and 2.5 times more prevalent, compared with premenopause.

The study involved 5509 women aged 40-69 years recruited between 2023-2024. Of the 5509 women involved in the study, 1250 were classified as premenopausal, 344 were early perimenopausal, 271 were late perimenopausal, and 3644 women were classified as postmenopausal.

“We already knew that VMS symptoms like hot flushes and night sweats are typical menopausal symptoms; however, our study clearly shows that a new onset of VMS is highly specific to perimenopause, being nearly five times more likely than in premenopause,” Professor Davis said.

“Less variation was found for other symptoms including poor memory and low mood; however, vaginal dryness was the most discriminative sexual symptom from premenopause to perimenopause.

“While other symptoms might emerge in the perimenopausal stage, they lack specificity to that stage as these other symptoms are also common in premenopausal women, e.g; poor memory was only 1.7 and 1.3 times more likely in early and late perimenopause compared with premenopause.

“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, for example, after a hysterectomy or endometrial ablation, or, for women with a hormonal IUD.

“A major finding was that women with regular cycles, but with changed menstrual flow and VMS, who are presently classified as premenopausal, had a similar severity of a wide range of symptoms as early perimenopausal women who, by definition, have cycles that become shorter or longer by at least a week.

“This finding supports the likelihood of perimenopause commencing before menstrual cycles vary by at least a week, and that women whose periods have become much heavier or much lighter and who also have VMS should be considered as having entered their perimenopause.”

First author Dr. Rakib Islam, from Monash University’s School of Public Health and Preventive Medicine said, “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. This level of detail is essential to improve how we identify and manage the menopause transition.”

“Current approaches for classifying women by menopause stage overlook women with regular cycles and women who no longer menstruate, e.g. after a hysterectomy. Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care,” Dr. Islam said.

Professor The Hon Jill Hennessy, Chair, Monash Women’s Health Alliance said the research would help transform women’s health treatment. “This landmark study reinforces just how critical it is to listen to women and take their symptoms seriously,” Professor Hennessy said. “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.

“Menopause is a major women’s health issue that has been overlooked for too long. 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 well-being.”