When we started Women Living Better in 2016 we were surprised to find how little was known about the underlying hormonal changes that happen in our late 30s/early 40s as ovarian supply (eggs) diminishes.
After all, this normal reproductive transition has been happening to people with ovaries forever. Yet, it turns out that research focusing on perimenopause is relatively recent.
This article by Debroah Kwolek, MD from 2003 is helpful in understanding why this is. These same factors contribute to healthcare providers that don’t recognizing symptoms as related to perimenopause — particularly before noticeable menstrual cycles changes.
Excerpts from the article:
Prior to 1990, women’s health, as we now know it, did not exist in the collective consciousness of internal medicine physicians as a topic to be highlighted in medical education….
The American Board of Internal Medicine has recommended that women’s health core competencies be covered in residency curricula, but at present this is treated as a suggestion rather than as a requirement. Women’s health education programs exist within some academic centers, but are essentially non-existent in others.
This was 1990 – WOW!
The good news is that more women’s health research is underway with longitudinal studies like The Study of Women Across the Nation (SWAN).
Update July 2026
There has been an explosion of attention to perimenopause in the past several years — both in research and the media.
We did a “scoping review” of what research has been done on the late reproductive stage in 2021 and learned there hadn’t been much.
With contributions from the WLB community we’ve helped fill data gaps with our own research.
There have been major investments in women’s health but it will take time to get results that will be incorporated into clinical practice.
[…] The researchers say they hope that the new findings begin to fill the research gaps into women’s health in midlife and specifically into perimenopause. […]