42% of women entering perimenopause won't realize it, study finds

Everyone's talking about menopause. But millions of women don't know when it starts-even when they're living through it. 

A study published yesterday in Menopause: The Journal of the Menopause Society found that 42% of women aged 40-44 did not know if they were perimenopausal-despite being in the age range when many women experience severe perimenopause symptoms, including hot flashes, mood swings, weight gain, and decreased libido. (FYI: perimenopause can start as early as 35-so if you're in your 40s, you’re probably in it!)

In fact, more than 1 in 3 (34%) U.S. women age 35 or older weren’t sure of their reproductive stage at all, whether they were pre-menopausal, perimenopausal, or menopausal. And the women who reported the highest levels of uncertainty were right in that peri sweet spot of 40-44.

Researchers surveyed over 7,600 U.S. women ages 35 and older for the study, which was a collaboration between women’s health app Flo Health and the Center for Women's Health at the Mayo Clinic. What they found: midlife women are confused about their reproductive stage, and suffering because of it.

The study went a step further. Researchers found three primary issues behind the confusion:

• Barriers to diagnoses and care (16%): The women who did seek help from healthcare providers felt their concerns were being dismissed or misattributed. Women aged 40-44 were most likely to cite this as their reason for reproductive stage uncertainty.
• Symptom confusion and attribution (56% of responses): Some women doubted their mental or physical symptoms because their menstrual cycles were still regular, while others weren’t sure if symptoms were due to perimenopause or conditions like endometriosis or postpartum weaning.
• Knowledge gaps and conflicting information (28%): These women didn’t know what perimenopause was, didn’t know what symptoms qualified, or believed they were “too young” to experience it. They often got conflicting advice from loved ones, peers or the internet. Women aged 35-39 were most likely to cite this as their reason for reproductive stage uncertainty.

What’s clear is that women in perimenopause don’t just need new treatments; they need help even recognizing they’re in it.

If you're one of those feeling unsure (no judgment!), we're here to help. Here are the main reproductive stages of a woman's life:

• Pre-puberty: Your childhood, before your periods start.
• Puberty: The years right before and after your first period, when you start having a menstrual cycle and developing secondary sex characteristics (breast growth and hair in the armpits and around your genitals).
• Reproductive years: These are your adult years, when you're getting your period regularly (or not, if you use hormonal birth control).
• Perimenopause: Perimenopause includes the transitional years into menopause, when you start experiencing symptoms. Note that you can still have your period regularly and/or get pregnant during perimenopause, so there may be overlap with your reproductive years.
• Menopause: You're officially "in" menopause when you've gone a full year without a period.
• Post-menopause: These are the years after menopause, when the hormonal fluctuations driving many symptoms will begin to stabilize. This means relief from things like hot flashes, but lower estrogen levels mean many women will continue using things like estrogen patches to help with bone and cardiovascular health. 

Menopause is in the conversation now, and the taboo is fading (slowly). But years of silence, plus a lack of research and education, mean that many women still don't know what's going on with their bodies in midlife-which means we still have work to do.