Perimenopause uncertainty is far more common than employers assume: a major new study finds many women with symptoms are unsure whether they have entered this stage at all.
Most conversations about menopause at work start from an assumption: that the employee knows what is happening to her. New research published in Menopause, the journal of The Menopause Society, suggests that assumption is frequently wrong.
She knows something has changed. She just doesn’t know what — and that uncertainty follows her into every workday.
What the Study Found
The 2026 study, published by The Menopause Society, included more than 7,600 U.S. women aged 35 and older. Researchers found that:
- Roughly a third were unsure of their reproductive stage.
- Uncertainty rose among women aged 40 to 44 — the group most likely to be early in the transition and least likely to expect it.
- Even among women reporting severe symptom burden, more than a third were still unsure.
That last finding is the one that should stop people. Severity did not resolve perimenopause uncertainty. Women with the heaviest symptom load were not meaningfully more likely to know what was happening to them.
Why Perimenopause Uncertainty Persists
The most common driver was not an absence of symptoms. It was symptom confusion — difficulty interpreting bodily changes and distinguishing perimenopause from other possible causes. That accounted for the majority of responses.
It is not hard to see why. Changes in sleep, concentration, mood, menstrual cycles, energy, and body temperature tend to arrive gradually rather than announcing themselves. Each one, taken alone, resembles something else: stress, depression, a thyroid problem, or simply getting older.
There is also no single blood test that definitively confirms perimenopause. Symptoms can begin before menstrual cycles noticeably change, which is precisely why education and knowledgeable clinical care matter so much at this stage.
What Uncertainty Costs at Work
Perimenopause uncertainty does not stay outside the office. Consider what it actually looks like: an employee managing fatigue, brain fog, anxiety, and disrupted sleep, while simultaneously wondering why she no longer feels — or performs — like herself.
She is not requesting an accommodation, because she does not know what she would be requesting an accommodation for. She may not be seeking care, because she is not sure what kind of care to seek. She may be quietly concluding that something is wrong with her rather than that something is changing in her.
Organizations see the downstream version of this: reduced engagement, unexplained performance dips, increased sick time, and experienced employees stepping back from stretch roles. The cause never surfaces, because the employee herself cannot name it.
What Employers Can Do
Employers cannot diagnose perimenopause. They can do something about perimenopause uncertainty that turns out to matter nearly as much — make sure employees are not left to figure it out alone:
- Name the transition early. Education that reaches women in their late thirties and early forties — starting with what perimenopause actually is — not only those already deep into symptoms.
- Describe the full symptom picture, including the cognitive and emotional changes that are most easily misattributed.
- Provide access to clinicians with menopause training, who can evaluate properly rather than defaulting to a guess.
- Train managers to respond to a performance change with curiosity rather than conclusions, which is where workplace silence starts to break.
- Make the accommodation process usable before an employee has a diagnosis to point to.
Women should not have to spend years wondering what is happening to their own bodies. Replacing perimenopause uncertainty with education, access to care, and practical workplace support is well within an employer’s reach.
Replace Confusion With Clarity
TeltraCare helps employers give employees credible education, informed clinical access, and practical workplace support — starting well before symptoms become severe enough to force the question.
Source: The Menopause Society, “Many Women Still Confused About Perimenopause,” July 2026; study published in Menopause. This post is expanded from a LinkedIn reflection by Katy Khalili, Co-Founder of TeltraCare.