‘Ignoring hot flushes is wrong': study challenges assumptions about perimenopause symptoms

The Guardian

4 days ago

Almost 40% of women going through perimenopause experience moderate to severe hot flushes and night sweats but have no treatment options, new research has found.
The study, published in the Lancet Diabetes & Endocrinology, explored differences in symptom prevalence by menopausal stage among women aged 40-69 years.
More than 8,000 participants who self-identified as a woman completed the Australian women's midlife years (AMY) study.
After excluding women on medication or those who had undergone a procedure that would affect their hormones or symptoms, Monash University researchers analysed the remaining 5,509: 1250 were classified as pre-menopausal, 344 early perimenopausal, 271 late perimenopausal, and 3,644 postmenopausal.
Senior author, Prof Susan Davis, said while vasomotor symptoms (VMS) – such as hot flushes and night sweats – were already known to be typical of menopause, the study found moderate to severe VMS symptoms to be the most defining symptom of perimenopause, the time period leading up to the final menstrual period.
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Although other symptoms were commonly reported by perimenopausal women, including poor memory and low mood, analysis showed none differed in prevalence enough from pre-menopause to differentiate between menopausal stages.
The study found 37.3% of women in late perimenopause had moderately-to-severely bothersome hot flushes: meaning they were five times more prevalent among perimenopausal women compared with pre-menopause.
Severe vaginal dryness was 2.5 times more prevalent among perimenopausal women compared with pre-menopause.
Menopausal hormonal therapy (MHT, also known as HRT) is effective for treating VMS due to menopause, but there are no specifically designed or approved interventions for these symptoms for perimenopausal women, the researchers noted.
Treating perimenopause is not the same as treating post-menopause because women are still randomly ovulating, contraception needs to be considered, MHT can make bleeding heavier and progesterone worsens PMS, Davis said.
The study also challenged the assumption that menstrual irregularity is the earliest sign of perimenopause.
Davis said it is common for women to ask their GPs if their heavier periods and hot flushes are a sign of perimenopause, only for the doctor to respond: 'If you're still getting regular cycles, you can't possibly be perimenopausal.'
But when the study compared pre-menopausal women with VMS whose periods were still regular but had changes – becoming lighter or heavier – they were the same as women who had VMS but who'd started experiencing changes in period cycle frequency.
'So we're really saying ignoring hot flushes and night sweats is wrong,' she said.
Dr Rakib Islam, also a study author, said defining perimenopause and menopause by menstrual cycle overlooks women with regular cycles and those who no longer menstruate, such as those who have had an endometrial ablation or hysterectomy, and users of hormonal contraception.
'Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care,' Islam said.
Davis said it was 'critical' that women were recruited to the study with no mention made of menopause, so the sample was not biased.
Prof Martha Hickey, the chair of obstetrics and gynaecology at the University of Melbourne and lead author of last year's Lancet series on menopause called it an important study.
The study reached quite a large number of women and provided deeper insight into perimenopause, an area traditionally overlooked in menopause research,' she said.
'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,' Hickey said.
Hickey said the study's main limitation was that it was a cross-sectional survey. So while it was helpful for knowing what symptoms women categorised to a particular stage might experience, 'it doesn't tell us how these things change as women go through menopause'.