Perimenopause symptoms, severity, and healthcare seeking in women in the US

A total of 5136 individuals accessed the survey. Out of these, 4624 consented to participate, and 4432 participants completed all survey sections and were included in the final analysis. A breakdown of perimenopause status, and the presence of a 12-month absence of periods is provided in Table 1. The mean age of participants was 42.6 years (standard deviation (SD) = 9.4 years), with the majority of respondents reporting being White, European American, or Caucasian (60.3%).

Table 1 Summary of age group, ethnicity, presence of an absence of period for 12 months or more

Table of Contents

Analysis 1—perimenopause status by age group

A total of 908 (20.7%) respondents had consulted a medical professional about perimenopause or menopause. Among the respondents who had seen a medical professional, 275 (30.3%) were aged under 46 years. The rates of seeing a medical professional about menopause or perimenopause differed by age group (χ² = 803.98, p < 0.001), with the respondents in the 56+ years age group having the highest rate of consultations (51.5%) (Table 1). Of the respondents who consulted a medical professional about menopause, 612 (70.8%) were told they were in perimenopause at the time of consultation. Overall, perimenopause status differed by age group (χ² = 227.79, p < 0.001), with the highest rate of confirmed perimenopause received in the 51–55 year-olds (42.6%), Table 1.

Analysis 2—perimenopause symptoms by perimenopause status

Certain symptoms were more likely to be reported by participants with confirmed perimenopause as determined by a medical professional compared to those without. The unadjusted log odds ratios and corresponding confidence intervals (CI) and p values for these symptoms were as follows: absence of a period of at least 12 months (log odds = 1.85; 95% CI = 1.38–2.38; p < 0.001), a period absence of 60 days in the last year (log odds = 1.58; 95% CI = 1.19–1.98; p < 0.001), hot flashes (log odds = 0.81; 95% CI = 0.45–1.17; p < 0.001), vaginal dryness (log odds = 0.61; 95% CI = 0.25–0.97; p = <0.001), pain on initial penetration during sexual activity (log odds = 0.60; 95% CI = 0.23–0.98; p < 0.001), recent cycle length irregularity (log odds = 0.49; 95% CI = 0.11–0.87; p = 0.012), heart palpitations (log odds = 0.45; 95% CI = 0.06–0.85; p = 0.028), and frequent urination (log odds = 0.44; 95% CI = 0.08–0.82; p = 0.019). Other symptoms did not differ between the two groups, as can be seen in Fig. 1.

**Fig. 1: Magnitude of association between perimenopause symptoms and visiting a medical professional about perimenopause.**

Analysis 3—MRS score by age group

We used the MRS to measure symptom burden in respondents. The median total score (H = 91.50, p < 0.001, η² = 0.02), and the medians of the three domain scores of urogenital symptoms (H = 177.17, p < 0.001, η² = 0.04), psychological symptoms (H = 55.70, p < 0.001, η² = 0.01), and somato-vegetative symptoms (H = 209.07, p < 0.001, η² = 0.05) differed by age group. The MRS total score and the somato-vegetative domain score were highest in the 51–55 years age group, while the psychological domain score was highest in the 41–45 years age group and the urogenital domain score was highest in the 51–55 years and 56+ years age groups (Table 2).

Table 2 Menopause rating scale total scores, severity levels, and subscale scores by age group

The MRS score has cutoffs to indicate categorical levels of severity of menopause-related symptoms. The proportion of respondents falling into the different severity categories differed by age, with the highest percentage (39.0%) of individuals falling into the severe category being 51–55 years old. Notably, in this survey, high rates of moderate or severe symptoms are seen even in the youngest age groups, with 55.4% of 30–35 year-olds falling into the moderate or severe categories (Table 2).

Analysis 4—MRS scores and severity by perimenopause status

Kruskal Wallis Tests indicated that MRS total (H = 190.46, p < 0.001, η² = 0.04), urogenital (H = 251.82, p < 0.001, η² = 0.06), psychological (H = 45.37, p < 0.001, η² = 0.01) and somato-vegetative domain scores (H = 254.98, p < 0.001, η² = 0.06) differed by perimenopause status. Median MRS total score and psychological domain scores were highest in the “premature menopause” group. Median urogenital scores were highest in the “I was diagnosed with something else”, “perimenopausal” and “post-menopausal” groups. The median somato-vegetative domain score was highest in the perimenopausal and premature menopause groups (Table 3).

Table 3 Menopause rating scale total scores, severity levels, and subscale scores by perimenopause status

Post-hoc Dunn tests (Supplementary Table 2) indicated that the “Did not see a clinician” group had a lower MRS total score than the “not perimenopausal”, “perimenopausal”, and “premature menopause” groups.

The “did not see a clinician group” also had a lower urogenital domain score than the “not perimenopausal”, “I was diagnosed with something else,” “perimenopausal”, “post-menopausal”, and “premature menopause” groups. In addition, the non-perimenopausal group had a lower urogenital domain score than the perimenopausal group.

For the psychological domain score, the “did not see a clinician” group had a lower score than the “not perimenopausal”, “perimenopausal” and “premature menopause” groups.

Finally, for the somato-vegetative domain score, the “did not see a clinician” group had a lower somato-vegetative symptom score than all other groups, and the “not perimenopausal” group had a lower score than the “perimenopausal” group.

When considering the categorical symptom severity thresholds, we found an overall difference in MRS symptom severity across perimenopause status groups (Table 3). A chi-squared test between the not perimenopausal and perimenopausal groups revealed no difference in the proportion of individuals in each of the MRS severity categories between the two groups (χ² = 0.075, p = 0.784). However, there was a higher proportion of individuals in the severe and moderate categories in the perimenopausal group compared to the “did not see a clinician” group (χ² = 149.41, p < 0.001).

Analysis 5—MRS scores and severity by cycle symptom categories

Cycle irregularity and amenorrhea are key indicators of perimenopause. A “persistent” variation of 7 or more days in consecutive cycle lengths is indicative of early perimenopause, while amenorrhea of at least 60 days in the last year is indicative of late perimenopause. The absence of a period for at least 12 months indicates that a person is post-menopausal. When using these criteria to categorize respondents, we observed differences in MRS scores between these groups (Table 4). Kruskal Wallace tests revealed that the MRS total score (H = 118.85, p < 0.001, η² = 0.03) and all domain scores (Urogenital: H = 193.65, p < 0.001, η² = 0.04; Psychological: H = 45.37, p < 0.001, η² = 0.004, Somato-vegetative: H = 183.91, p < 0.001, η² = 0.04) differed between individuals with no-cycle symptoms, irregular cycles, a 60-day absence or a 12-month absence (Table 4).

Table 4 Menopause rating scale total score, severity levels, and subscale scores by cycle symptom categories

Total MRS scores were highest in the 12-month absence, 60-day absence, and irregular cycles groups with post-hoc Dunn tests showing that the irregular cycles (Z = 6.35, adj.p < 0.001), 60-day absence (Z = 6.39, adj.p < 0.001), or 12-month absence (Z = 8.69, adj.p < 0.001) group scores differed from the no-cycle symptoms group.

Median urogenital scores were highest in the 60-day absence and 12-month absence groups, with the 12-month absence group differing from the 60-day absence (Z = 6.71, adj.p < 0.001), irregular cycles (Z = 4.01, adj.p < 0.001) and no-cycle symptoms group (Z = 13.04, adj.p < 0.001), while the 60-day absence (Z = 6.71, adj.p < 0.001) and irregular cycles (Z = 4.81, adj.p < 0.001) groups differed from the no-cycle symptoms group.

The median psychological score was highest in the irregular cycles and 60-day absence group, with the irregular cycles group differing from the no-cycle symptoms group (Z = 4.15, adj.p < 0.001), and the 12-month absence group (Z = 3.04, adj.p = 0.012).

Finally, somato-vegetative scores were highest in the irregular cycles, 60-day absence, and 12-month absence groups, with the no-cycle symptoms group having lower somato-vegetative scores than the 12-month absence (Z = 11.15, adj.p < 0.001), 60-day absence (Z = 8.08, adj.p < 0.001), and irregular cycles groups (Z = 7.17, adj.p < 0.001).

The percentages of individuals falling into MRS symptom severity categories differed by cycle irregularity (χ² = 114.91, p < 0.001), with more individuals reaching criteria for moderate or severe symptoms in the irregular cycles (76.5%; χ² = 40.23, p < 0.001), 60-day absence (73.7%; χ² = 70.94, p < 0.001), or 12-month absence (χ² = 12.11, p = 0.007) groups than in the no-cycle symptoms group (60.9%) (Table 4).