A national study with over 5,000 Australian women says we need to redefine how we diagnose and treat perimenopause. It argues that moderate to severe vasomotor symptoms (VMS) are “the most defining symptom” of the condition.
The findings, from Monash University and published in The Lancet, challenge the current diagnostic rule. Right now, women are classified as perimenopausal if their usual menstrual cycle changes by at least a week—either getting shorter or longer.
Professor Susan Davis led the study. She heads Monash University’s Women’s Health Research Program. “Our study clearly shows that new vasomotor symptoms are highly specific to perimenopause,” she said. “Women with these symptoms are nearly five times more likely to be in perimenopause than in premenopause.”
She added, “These findings suggest VMS should be a diagnostic criterion for perimenopause or postmenopause. This is especially true when we can’t tell based on a woman’s bleeding pattern—like after a hysterectomy, endometrial ablation, or for those using a hormonal IUD.”
The study also supports the idea that perimenopause may start before menstrual cycles vary by at least a week.
The research, part of the Australian Women’s Midlife Years study, included 5,509 women aged 40–69. They were recruited across Australia between 2023 and 2024.
Of these women, 1,250 were premenopausal, 344 in early perimenopause, 271 in late perimenopause, and 3,644 postmenopausal.
Nearly 40% of perimenopausal women in the study had untreated VMS. These symptoms—like hot flushes, night sweats, and vaginal dryness—can be disabling.
Dr. Rakib Islam is the first author of the study. He works at Monash’s School of Public Health and Preventive Medicine. He said the study’s breadth and detail “are essential to improve how we identify and manage the menopause transition.”
“Current ways of classifying menopause stages ignore women with regular cycles and those who no longer menstruate,” he noted. “Our findings back a more symptom-based approach. This would help recognize perimenopause earlier and provide care sooner.”
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