Women over 40 face a confusing medical reality where a major life transition is often misidentified or overlooked entirely. A recent study found that more than one in three women over age 35 aren’t sure where they stand in the transition to menopause, creating a significant gap in awareness that can delay proper care.
Uncertainty Over Symptoms
Researchers surveyed more than 7,600 women across the country who were 35 years of age or older to measure this uncertainty. The mixed-methods study not only measured how many women were uncertain about their reproductive stage, but also analyzed their written responses to understand why. Overall, 34 percent of participants reported that they weren’t sure whether they were premenopausal, perimenopausal or menopausal.
The confusion was greater among women ages 40 to 44, with 42 percent reporting uncertainty. Women experiencing the most severe symptoms also reported high levels of uncertainty. They identified a major reason for their confusion. More than half of the participants, 56 percent, said they had trouble recognizing whether their physical or emotional changes were related to perimenopause or to another condition.
Many women expect menstrual changes to be the first sign of perimenopause. In reality, emotional, cognitive and physical symptoms may appear before a woman’s menstrual cycles become noticeably irregular. As a result, relying solely on changes in periods may delay recognition and treatment. The study notes that fluctuating hormone levels may trigger symptoms ranging from hot flashes and night sweats to anxiety, mood changes, sleep problems and vaginal dryness.
Diagnosis is difficult. There’s no laboratory test that can definitively tell a woman she’s in perimenopause, making a diagnosis challenging. With nearly two million American women entering perimenopause each year, recognizing the signs earlier could help many understand and manage this life transition with greater confidence and support.
Healthcare professionals have an important role to play in helping women recognize the early signs of menopause. Because perimenopause symptoms overlap with conditions such as thyroid disorders, depression, anxiety and premenstrual syndrome. Instead of focusing primarily on menstrual changes, clinicians should consider the broader pattern of symptoms surrounding the transition to menopause. Greater awareness among both patients and providers could help women receive answers and support earlier, which is essential for patient safety.
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This widespread confusion is not a personal failing but a systemic issue. It mirrors the historical pattern of medical conditions that affect women often being dismissed as psychological or emotional rather than physiological. The fact that one in three women feel unsure about their own bodies suggests a failure in current medical education and patient communication rather than a lack of knowledge on the part of the patients themselves.
Dr. Stephanie Faubion, medical director of The Menopause Society and one of the study’s authors, said, “This large study showed that one in three women aged older than 35 years are not sure whether they are in perimenopause. Further, the study highlights that symptom confusion, misconception, and barriers to care are leaving many women without the clarity and support they need during the menopause transition. Recognizing perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to handle this natural life transition with confidence.”
The study’s findings should reassure women that their uncertainty about perimenopause is common rather than unusual.
The researchers hope their study encourages more open conversations about perimenopause and better education for both women and healthcare providers.
The study is published in Menopause: The Journal of the Menopause Society.
