Perimenopause, according to Johns Hopkins, is a pivotal transitional time in a person’s life. It isn’t quite menopause, which occurs when one reaches 12 consecutive months without menstruating, but it does mark a period of hormonal changes with symptoms that can significantly impact a perimenopausal person’s life. Still, mystery surrounds this natural bodily event because, like many areas of reproductive health, little research centers on it. A report by Harvard Medical School published in January says that 99% of preclinical aging studies ignore menopause, further widening the gap and preventing women from accessing information vital to their quality of life.
As defined by Columbia University Irving Medical Center, perimenopause means near menopause, a period when menstruators are in the process of transitioning from having regular periods to the end of ovulation, where ovaries will stop releasing eggs.
In an effort to highlight the importance of perimenopause, Oova, a women’s health platform offering at-home hormone tests to track fertility and reproductive health, collected information from over 700 U.S. women between the ages of 35 and 52, revealing startling details of their experiences.
According to Oova’s “The State of Perimenopause in 2024″ report, nearly 61% of women said they weren’t sure if they were in perimenopause.
Dr. Amy Divaraniya, founder of Oova, told Reckon that the report revealed the misinformation both women and doctors have in this area of health, including how early symptoms can start. Though it’s often pinned as a condition “older” people face, about 25% of respondents said their symptoms started before they turned 35.
“You think, ‘Oh, I’m too young. I’m not experiencing it yet.’ Even your doctors are gonna be like, ‘You’re too young, it’s not perimenopause.’ But now we’re seeing that when you actually look at when the symptoms started, it is before 35 and a lot of women are still trying to get pregnant during this period, right? So there’s such a gap of knowledge there,” she said.
Mental wellness coach Angela Hopper, 50, detailed some of her perimenopause symptoms she’s experienced for the past 9 years in a video posted to Tik Tok on Sept. 11, which she says no one prepared her for.
“Inflammation, bloating, GI issues,” she lists. “I was one moody mama. Everything, everything was annoying.”
Dr. Stephanie Jona Buehler, psychologist, certified sex therapist and director of LearnSexTherapy.com told Reckon about the mental symptoms of perimenopause.
“I don’t know that anybodyfully understands the link between estrogen and mood and anxiety, but I will say that women are more at risk for depression and anxiety than men are,” Buehler said, adding that symptoms that may have been mild before could be exacerbated by entering perimenopause. “When you add in low estrogen, now the symptoms become worse, so you have a larger number of women reporting that they have depression and anxiety.”
She said perimenopause can impact mental wellness and relationships, especially with male partners who her clients say don’t understand what they’re going through.
“They look at their female partner and they go, ‘Well, you look the same thing to me. Why is this happening?’ And, you know, you can look healthy on the outside and maybe there are a lot of things that are healthy on the inside, but your hormones are going down and so you feel crummy and irritable,” said Buehler.
Brandy Michelle Crittenden uses her Tik Tok platform to discuss perimenopause. On October 8 she posted a video asking her followers how they learned about perimenopause, because she didn’t learn until she Googled her symptoms– shoulder pain– which led her to think she was having a heart attack. According to the “State of Perimenopause” report, Google was the number one place women sought information about perimenopause and in general, only 14.4% reported only being able to find trustworthy answers to their questions most or all of the time.
“I’ve never had a doctor to talk to me about perimenopause or menopause and I still just want to know why,” said Crittenden.
Experts say part of the issue is that markers of perimenopause can be associated with other conditions and there isn’t a uniform timeline to when all women begin transitioning.
“I think what happens is that because there’s such a wide range of ages [at which] you can begin perimenopause, it becomes difficult to put a diagnosis on something,” said Barbra Hanna, DO, FACOG, NCMP and OB-GYN at MyMenopauseRx. Hanna is an expert in osteopathic medicine, menopause and obstetrics.
There’s also a misconception about perimenopausal symptoms, and which ones impact women most. Divaraniya pointed to hot flashes and vaginal dryness as some of the symptoms typically associated with the condition, but according to the report, only 53% of women said they had experienced these. Mood changes were the number one symptom (92%) with anxiety (90%), bloating (90%), difficulty sleeping (80%) and decreased interest in sex (80%) rounding out the top five.
According to Johns Hopkins, symptoms occur during perimenopause due to hormonal fluctuations. Symptoms similar to PMS occur when estrogen levels are high, and when they are low, one may experience hot flashes or night sweats.
Perimenopausal women forced to advocate for themselves
Women in the report described their perimenopausal experience as lonely and scary, with many reporting not being taken seriously when they describe their issues.
“Most physicians, because they’re not really tuned into the hormonal changes of a woman’s body, will then just say ‘you’re fine,’ but yet the woman still feels terrible,” said Hanna.
It can be a frustrating and isolating experience for women, who report not feeling validated by their doctors. Only 11.5% of participants said they were taken seriously by their providers, and only 4.4% said they felt assured that their clinicians knew how to treat their concerns about perimenopause.
“I feel let down by my OB-GYN and doctor for not taking my symptoms seriously, nor preparing me for how my hormones may behave…,” wrote one anonymous participant. “They aren’t interested in testing my hormones, so I feel I need to take this matter into my own hands to slow some of the cognitive issues I’m experiencing.”
Divaraniya says these feelings of dismissal can lead to deeper mistrust of medical professionals.
“When you get dismissed, you start feeling gaslit, you lose trust in the medical system, and it just snowballs from there. So I think what I’m hoping for is that this report is starting to shed light on the reality behind what women are truly experiencing,” said Divaraniya.
This isn’t an isolated experience. Women, especially women of color, have reported medical gaslighting and feeling like their concerns aren’t being addressed by medical professionals for decades. Medical gaslighting occurs when healthcare providers dismiss, downplay, or disbelieve patients’ symptoms, leading them to doubt their own experiences. For example, a woman reporting severe menstrual pain might be told she’s “overreacting” or that it’s “just part of being a woman,” rather than investigating potential conditions like endometriosis.
When it comes to menopause and perimenopause, Hanna suggests further education for health professionals is needed.
“I didn’t learn this in residency, and I didn’t learn this early on in my practice,” said Hanna. “And so when your medical community is not aware and not recognizing this stage of life and the symptoms that are around this stage of life, how on Earth can women themselves have validation of what they’re feeling?”
A 2023 University College London study of English-speaking women, mostly in the UK, found that 90% of postmenopausal women were not taught about menopause in schools, and 60% of them only started learning about it once they began having symptoms.
“When physicians don’t really understand something or they’re not tuned into it or they don’t have the answers, I feel like they dismiss women,” Hanna said.
She added that women have more options now with telehealth clinics and providers who specialize in perimenopause and menopause.
“I tell women you need to talk to a menopause specialist because they are going to understand where you are in your period health, they’re going to look at you comprehensively and offer you solutions that you know can help you manage and explain the process.”
According to the report, almost 75% of women don’t receive treatment for perimenopause. Buehler advises women and their partners not to dismiss complaints associated with perimenopause.
“I think that’s the biggest problem in women’s health today, that women just deal. We always put ourselves last when you’re going through this transition and it’s not a day or a month or a year, it could go up to a decade. Where’s the limit?” said Divaraniya.
It’s part of broader, gender-based expectations for women to avoid or be embarrassed about discussing their sexual and reproductive health needs. But Divaraniya says that’s changing, and she’s excited to hear people have these discussions because women of her mother’s generation, for example, were not encouraged to seek treatment.
“They dealt with it in silence. We’re the generation to actually ask questions and challenge and demand more. So I’m excited about the change that’s going to happen,” said Divaraniya.
