September 2025
Bothersome vasomotor symptoms mark the start of perimenopause, finds study
By Dr Sasha Ellery BM BCh
Bothersome vasomotor symptoms (VMS), including hot flushes and night sweats, are reliable indicators of the onset of perimenopause, according to findings from the Australian Women’s Midlife Years Study published in The Lancet Diabetes & Endocrinology.
The cross-sectional study surveyed 5509 women aged 40 to 69 years, assessing the prevalence and severity of menopausal symptoms across premenopause, early perimenopause, late perimenopause and postmenopause.
Symptom prevalence for each menopausal stage was found using the Menopause-specific Quality of Life domains. The vasomotor domain showed the greatest difference in symptom prevalence reporting, with vasomotor symptoms of any severity ranging from 43.1% for premenopausal women to 75.6% for late perimenopausal women. Among moderately-to-severely bothersome symptoms, hot flushes showed the greatest change in prevalence from premenopause (8.8%) to late perimenopause (37.3%). VMS effectively distinguished women undergoing the menopausal transition from those who were premenopausal or postmenopausal, researchers noted.
Professor Susan Davis AO, senior author of the study and Head of the Monash University Women’s Health Research Program, Melbourne, explained that the findings unequivocally showed that new-onset VMS combined with changes in menstrual patterns signalled perimenopause. She highlighted that VMS appearing in women without menstruation – due to factors such as hysterectomy, hormonal intrauterine devices or endometrial ablation – were also reliable indicators of the start of perimenopause.
The findings challenged the common clinical reliance on menstrual irregularity alone to identify perimenopause, underscoring the need for a symptom-based approach. Professor Davis noted that ‘women who present with VMS and change in flow but still have regular cycles… have started their perimenopause and need care.’
Early identification of perimenopause was crucial for managing long-term health risks. ‘Rapid menopause-related bone loss starts about two years before the final menstrual period,’ Professor Davis said. ‘Taking note of the onset of VMS will help doctors identify perimenopause earlier in women without menses. This could prevent a lot of bone loss if these women are treated in a timely manner.’
In addition to bone health, cardiovascular disease risk factors such as lipids levels and glucose tolerance also change with menopause, she said. ‘Identifying early perimenopause will enable these CVD risk factors to be picked up and managed earlier.’
Professor Davis emphasised that treatment during perimenopause must be carefully tailored. Standard menopausal hormone therapy was not appropriate because women were still ovulating, and it could worsen symptoms such as bleeding and breast tenderness. She recommended treatments that offered cycle control and symptom relief, as well as contraception when needed.