Vasomotor symptoms key to perimenopause diagnosis

A national study of more than 5000 Australian women has called for a redefining of the diagnostic criteria and treatment for perimenopause, arguing that moderate to severe vasomotor symptoms (VMS) are ‘the most defining symptom’.
 
Published in The Lancet, the findings out of Monash University challenge the current criteria – a change to a woman’s usual menstrual cycle by at least a week, either shorter or longer – for classifying women as perimenopausal.
 
‘Our study clearly shows that a new onset of VMS is highly specific to perimenopause, being nearly five times more likely than in premenopause,’ said the study’s senior author and Head of Monash University’s Women’s Health Research Program, Professor Susan Davis.
 
‘These findings suggest VMS should be considered a diagnostic criterion for perimenopause or postmenopause when menopause can’t be determined by a woman’s bleeding pattern, such as after a hysterectomy or endometrial ablation, or, for women with a hormonal IUD.
 
‘This finding supports the likelihood of perimenopause commencing before menstrual cycles vary by at least a week.’
 
The study involved 5509 women aged 40–69 years, recruited from across Australia in 2023–24 for the Australian Women’s Midlife Years study.
 
Of those women, 1250 were classified as premenopausal, 344 as early perimenopausal, 271 as late perimenopausal, and 3644 women as postmenopausal.
 
Almost 40% of perimenopausal women in the study had untreated and potentially debilitating VMS such as hot flushes, night sweats and vaginal dryness.
 
First author Dr Rakib Islam, from Monash’s School of Public Health and Preventive Medicine said the breadth and detail of the study is ‘essential to improve how we identify and manage the menopause transition’.
 
‘Current approaches for classifying women by menopause stage overlook women with regular cycles and women who no longer menstruate,’ he said.
 
‘Our findings support a more symptom-based approach, enabling earlier recognition of perimenopause and more timely care.’
 
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