Women are hearing more about menopause than ever before, but a recent study shows many don't recognize one of the most significant transitions of midlife — perimenopause. As a result, they may experience confusing symptoms that can affect their health, work and the overall quality of their lives. More than one in three women over age 35 aren't sure where they are in the transition to menopause, the study found, a surprising gap in knowledge.

Perimenopause, the years leading up to menopause, typically begins during a woman's mid-40's; it can, however, begin earlier. During this transition, fluctuating hormone levels may trigger symptoms ranging from hot flashes and night sweats to anxiety, mood changes, sleep problems and vaginal dryness. Yet, unlike many medical conditions, there's no laboratory test that can definitively tell a woman she's in perimenopause, making a diagnosis challenging.

With nearly two million American women entering perimenopause each year, recognizing the signs earlier could help many navigate the normal life transition with greater understanding, confidence and support.

To better understand just how widespread this uncertainty is, researchers surveyed more than 7,600 women across the country who were 35 years of age or older. The mixed-methods study not only measured how many women were uncertain about their reproductive stage, but also analyzed their written responses in order to understand why. Participants were grouped according to age and symptom severity to determine whether certain women were more likely to experience confusion over their condition.

Overall, 34 percent of participants reported that they weren't sure whether they were premenopausal, perimenopausal or menopausal. The confusion was greater among women ages 40 to 44, with 42 percent reporting uncertainty. Women experiencing the most severe symptoms also reported high levels of uncertainty.

The researchers identified a major reason for their confusion. More than half of the participants, 56 percent, said they had trouble recognizing whether their physical or emotional changes were related to perimenopause or to another condition.

The findings highlight an important misconception: many women expect menstrual changes to be the first sign of perimenopause. In reality, emotional, cognitive and physical symptoms may appear before a woman's menstrual cycles become noticeably irregular. As a result, relying solely on changes in periods may delay recognition and treatment.

During this transition, fluctuating hormone levels may trigger symptoms ranging from hot flashes and night sweats to anxiety, mood changes, sleep problems and vaginal dryness.

For this reason, healthcare professionals also have an important role to play in helping women recognize the early signs of menopause. Because perimenopause symptoms overlap with conditions such as thyroid disorders, depression, anxiety and premenstrual syndrome. Instead of focusing primarily on menstrual changes, clinicians should consider the broader pattern of symptoms surrounding the transition to menopause. Greater awareness among both patients and providers could help women receive answers and support earlier.

The findings should reassure women that their uncertainty about perimenopause is common rather than unusual.

“This large study showed that one in three women aged older than 35 years are not sure whether they are in perimenopause,” Dr. Stephanie Faubion, medical director of The Menopause Society and one of the study's authors, said.

“Further, the study highlights that symptom confusion, misconception, and barriers to care are leaving many women without the clarity and support they need during the menopause transition. Recognizing perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to navigate this natural life transition with confidence.”

The researchers hope their study encourages more open conversations about perimenopause and better education for both women and healthcare providers. With nearly two million American women entering perimenopause each year, recognizing the signs earlier could help many navigate the normal life transition with greater understanding, confidence and support.

The study is published in Menopause: The Journal of the Menopause Society.