Study links perimenopause symptom burden to access, income and race

Perimenopause symptom burden tracked with healthcare access, income sufficiency, education and race or ethnicity in a June 29 study in Climacteric of 12,382 women aged 35 and older. Healthcare access showed the strongest association with total Menopause Rating Scale scores, followed by income sufficiency and education level.

The survey was completed in English, Spanish, Portuguese or French, and asked participants to rate symptoms on the validated Menopause Rating Scale while also reporting healthcare access, income sufficiency, education and race or ethnicity. Every social determinant the researchers examined was significantly associated with total scores and with psychological, somatic and urogenital domains, with p values below 0.001. Asian, Black and Hispanic or Latino participants had significantly different scores than White participants. In the subgroup of 2,618 women who said they were specifically in perimenopause, defined in the study as the time leading up to and including the first 12 months after the final menstrual period, income sufficiency was the strongest association.

The author list included researchers from Flo Health UK Limited and Mayo Clinic, including Stephanie S. Faubion and Chrisandra L. Shufelt. The findings sharpen an argument that midlife symptom care is not only about estrogen, progesterone or the right prescription, but about whether a woman can reach a clinician, pay for treatment, take time off work and be heard the first time she asks for help.

That broader pattern was already visible in a January 28 Mayo Clinic and Flo study of 17,494 people from 158 countries. Among respondents over 35, fatigue and exhaustion were each reported by 83 percent, irritability by 80 percent, low mood by 77 percent, sleep problems by 76 percent, digestive issues by 76 percent and anxiety by 75 percent. Mayo Clinic said that work was meant to examine the gap between what people expect perimenopause to look like and what they actually experience.

Clinical guidance is moving in the same direction. The British Menopause Society’s June 2026 practice standards say more than 75 percent of women experience menopausal symptoms, about a quarter describe them as severe and a third have long-term symptoms. The standards also say diagnosis should be based on symptoms alone, without confirmatory blood tests unless there is uncertainty.

A 2024 systematic review on U.S. menopausal care disparities found that clinicians’ knowledge gaps or implicit bias, insurance status and geographic location may all affect access to management and treatment. That makes the new findings relevant beyond hormone therapy, from multilingual digital tools and culturally competent triage to employer benefits, insurer design and specialist access. The Menopause Society’s June 2026 announcement of a $10 million Pivotal grant to expand menopause education in low-access areas shows how quickly access has become a policy and market issue.