A groundbreaking study has challenged long-held beliefs regarding the symptoms of perimenopause, particularly focusing on hot flushes and night sweats. Conducted by researchers from the University of Melbourne, the study found that 37.3% of women in late perimenopause experienced moderately to severely bothersome hot flushes. This startling figure makes clear that close to 40% of women going through perimenopause suffer from moderate to severe hot flashes and night sweats. This is in sharp contrast to the experiences of pre-menopausal women.
Scientific studies have revealed that flushes are five times more common in perimenopausal women 1. They are far less prevalent in pre-menopausal women. Severe vaginal dryness is 2.5 times more prevalent in perimenopausal compared to pre-menopausal women. This disturbing finding underscores a greater disparity in experiences for these two sets of individuals. These research results highlight the importance for healthcare professionals to identify these symptoms as key physiological signs of perimenopause.
Prof. Martha Hickey, chair of obstetrics and gynaecology at the University of Melbourne. As the chief investigator of one of many studies that were detailed in a series in The Lancet, she stressed how important these severe symptoms really are. She explained that moderate to severe vasomotor symptoms (VMS) were identified as the most distinguishing symptom of perimenopause.
Prof. Hickey explained that definitions of perimenopause and menopause have historically centered around menstrual cycles. This narrow view is both duplicitous and dangerous.
“More than a third of research in medical treatments is done by pharmaceutical companies. They traditionally have excluded perimenopausal women from the research because the perimenopausal women are still producing their own hormones in a sometimes unpredictable way, and it didn’t fit with the study design that they wanted,” – Prof Martha Hickey.
This exclusion is a major obstacle to learning about the distinct experiences of women as they navigate this transitional period. It’s often skeptical healthcare professionals who continue to reinforce the myth that if a woman is having regular menstrual cycles, she can’t be perimenopausal. Prof. Susan Davis, senior author of the study, noted that patients frequently question their general practitioners about whether their heavier periods and hot flushes are signs of perimenopause, only to hear the dismissive response:
“If you’re still getting regular cycles, you can’t possibly be perimenopausal.”
Dr. Rakib Islam, the third author of the study, argued for a more symptom-focused way in which to identify perimenopause.
“Our findings support a symptom-based approach, enabling earlier recognition of perimenopause and more timely care,” – Dr Rakib Islam.
Prof. Hickey’s question was indeed a good question. Such definitions exclude a significant proportion of women going through perimenopause, including those with regular cycles, women who have undergone endometrial ablation or hysterectomy and hormonal contraception users. She claimed that we need to move away from the “period” paradigm to identify symptoms instead of just asking about menstrual history.
As Prof. Hickey herself admitted there was an important caveat in their research methodology, in that it was a cross-sectional survey.
“It doesn’t tell us how these things change as women go through menopause,” – Prof Martha Hickey.
This study uncovers an important blind spot in women’s health research. It highlights how urgently we need more inclusive studies that take into consideration the diverse experiences of perimenopausal women. Ultimately, these findings call for a more nuanced understanding of menopause that lays the groundwork for more effective healthcare responses.
