Exploring prevalence and drivers of perimenopause uncertainty among US Women: a mixed-methods study.

Authors

Yihan Xu, Deirbhle Fergus, Yella Hewings-Martin, Mary Hedges, Carley Prentice, Adam Cunningham, Liudmila Zhaunova, Chrisandra Shufelt, Stephanie Faubion

Published in

Menopause (New York, N.Y.). Jul 14, 2026. Epub Jul 14, 2026.

Abstract

Perimenopause is an under-recognized life stage that is often accompanied by complex and fluctuating symptoms. We aimed to quantify the prevalence of perimenopause uncertainty and explore the underlying drivers.
We conducted a mixed-methods study using a cross-sectional survey of US women aged 35 years and above (N=7,640). We estimated the prevalence of perimenopause uncertainty and examined subgroup differences by age and symptom severity. Content analysis of free-text responses (n=409) identified key uncertainty drivers.
Overall, 34% (95% CI: 33%-35%) of participants reported being unsure of their reproductive stage. Uncertainty varied by age and symptom severity (P < 0.001), peaking at 42% (95% CI: 41%-43%) among those aged 40-44 and 37% (95% CI: 36%-38%) among those with severe symptom burden. Content analysis revealed three main uncertainty drivers. Symptom confusion and attribution were the most common (56%), reflecting difficulties interpreting bodily changes and distinguishing perimenopause from other causes. Knowledge gaps and information seeking accounted for 28% of responses, highlighting limited health literacy, age-based assumptions, and active searches for evidence. Barriers to confirmation and care (16%) described dismissive health care encounters and reluctance to acknowledge perimenopause. Younger women (35-39 y) were more likely to cite knowledge gaps, while health care barriers peaked in the 40-44 age group (P = 0.05).
Perimenopause uncertainty is a prevalent and clinically meaningful phenomenon. Conceptually distinct from illness-focused uncertainty, this universal transition frequently involves ambiguity and limited validation. Clarifying symptom patterns, addressing knowledge gaps, and reducing barriers to confirmation may support women during perimenopause.

PMID:
42445976
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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