For decades, the conversation around menopause has been framed as a singular moment: the end of menstruation. But for millions of women across the United States, the most disruptive and confusing phase isn’t menopause itself, it’s the years leading up to it, known as “perimenopause”.
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Despite affecting women for up to a decade before menopause, perimenopause is one of the least understood and most under-discussed stages of reproductive health. The result is a silent struggle, where symptoms are misinterpreted, dismissed, or simply endured, often without medical support.
What is Perimenopause?
Perimenopause typically begins in a woman’s 40s, though it can start earlier. It is marked by fluctuating hormone levels, which can trigger a wide range of physical, cognitive, and emotional symptoms.
Yet many women enter this stage completely unprepared. A recent survey* revealed that a striking 50% of women report that they don’t even know what stage of menopause they are in. For a life phase that can last several years, this lack of awareness highlights how women are simply guessing about what is happening inside their own bodies.
They may experience fatigue, brain fog, anxiety, or low mood. But instead of recognizing these as hormonal changes, they attribute them to stress, aging, or lifestyle factors. For others, symptoms like low libido or irregular periods are brushed off as “just part of life”.
The Cost of Misunderstanding
This confusion has real consequences. More than half of women (55%) say they have never sought medical support for their symptoms during perimenopause, as many believe what they’re experiencing is normal and not serious enough to warrant medical attention.
This normalization of discomfort reflects a broader cultural tendency to minimize women’s health concerns, particularly when they are tied to hormonal changes. What’s more concerning is that many women are experiencing lesser-known symptoms without connecting them to perimenopause at all.
Joint pain (35%), heart palpitations (18%), and urinary urgency (25%) are increasingly reported during this stage, yet they are rarely recognized as hormonally driven. These symptoms can interfere with daily functioning, from concentration at work to sleep quality, yet they often go unaddressed.
Even among more commonly recognized symptoms, there is a disconnect between awareness and action. While women report relatively high awareness of issues like fatigue, insomnia, irregular periods, brain fog, anxiety, low mood, headaches, and difficulty concentrating, this awareness does not necessarily translate into them looking for help.
Living in the “In-Between”
Perimenopause occupies an ambiguous space: not quite reproductive, not yet postmenopausal. This “in-between” status contributes to its invisibility.
Women are often still managing careers, families, and caregiving responsibilities during this time, making it even easier to overlook or deprioritize their own health.
The data reflects this tension. While 25% of perimenopausal women say they don’t feel fully prepared for menopause, a majority (56%) say that expert advice would help them better manage this stage.
In other words, the demand for support is there, but the pathways to accessing it are unclear or underdeveloped.
Perimenopause Symptoms Mapped Across the US
Perimenopause is not a uniform experience, and emerging data show significant variation in symptoms and support across different states.
In Alabama, for example, women report the highest rates of weight gain (55%), while in Arkansas, night sweats are most prevalent (56%). California has high levels of insomnia (51%), and Connecticut reports the highest incidence of hot flashes (59%).
Cognitive symptoms also vary geographically. In Iowa, 38% of women report forgetfulness or difficulty concentrating, a hallmark of perimenopausal brain fog. Meanwhile, Massachusetts leads in reports of urinary urgency (26%), and Minnesota has the highest rates of urinary incontinence (29%).
These variations may reflect differences in lifestyle, healthcare access, environmental factors, or even cultural attitudes toward symptom reporting. They also underscore the need for localized, tailored approaches to menopause care, rather than a one-size-fits-all model.
Regional Knowledge Gaps and Bright Spots
When it comes to understanding menopause, not all states are equal. Massachusetts emerges as the most knowledgeable state, with 83% of women reporting a strong understanding of menopause stages, symptoms, and expectations. At the other end of the spectrum is Missouri, where only 42% of women report similar levels of knowledge.
This disparity highlights how access to education and resources can shape women’s experiences and their health outcomes.
The same pattern appears in asking for help. In Kentucky, 61% of women actively seek medical support and resources for menopause, suggesting a more proactive approach to care. In contrast, Arizona has the lowest levels of support-seeking, with 85% of women reporting that they do not seek help.
The reasons are complex and deeply rooted. Some women feel their symptoms aren’t serious enough. Others report embarrassment or a belief that menopause is something they simply have to endure. This mindset that suffering is inevitable is still one of the biggest barriers to care.
What Women Actually Want?
Despite these challenges, women are clear about what would help them feel more supported during perimenopause.
In South Carolina, 68% of women say that expert advice from healthcare professionals would make a meaningful difference. In West Virginia, 61% are looking for product recommendations to help manage symptoms.
Maine residents point to digital solutions, with 59% saying online tools for tracking symptoms and health would improve their experience. In Utah, community matters most as 60% of women believe peer support groups would help them navigate this stage more effectively.
Meanwhile, in Virginia, a smaller but significant group (11%) highlights the role of workplace guidance in supporting women through perimenopause, an often-overlooked aspect of women’s health.
Taken together, these insights reveal a critical truth: women don’t just need information, they need accessible, practical, and personalized support.
Reframing Perimenopause
Perimenopause isn’t just misunderstood; it’s being overlooked in a way that has real consequences.
When women don’t recognize their symptoms, they’re far less likely to find help, and that gap in care can quietly impact everything from mental health to daily life. For a stage that affects so many, the lack of clarity and support simply doesn’t add up.
The urgency is clear: more than half of women aren’t seeking medical advice, and many don’t even know where they are in the menopause journey. But the solutions aren’t a mystery; women are already asking for better guidance, practical tools, and more open conversations.
Now, it’s about listening and actually responding because this isn’t just about symptom management; it’s about making sure women feel informed, supported, and confident through a major life transition that, for too long, has been left in the shadows.
*The research was conducted by Censuswide on behalf of TENA, surveying a sample of 2,000 women aged 18 and over across the US.
This article was written for WHN by TENA, providing incontinence products that help people stay secure, dry, and odor-free. A global leader and trusted expert offering superior solutions that help manage urinary incontinence, leakage, and bladder weakness, day and night.
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