"As a culture, women have been expected to suffer through symptoms..."

Progesterone also begins to decline during perimenopause. Because the hormone helps regulate sleep and mood, the drop can trigger sleep disruptions and cognitive changes long before the first hot flash.

The pattern, Dr. Rahman notes, echoes broader trends in women's healthcare in the United States. "We have a culture that expects us to bounce back and push through," she says. "Take, for example, the limited postpartum interventions, time off, and maternal care in the US."

The study also revealed that only 16% of women aged 35 and older self-identified as being in perimenopause, while 33% were unsure of their reproductive stage — suggesting that many women experiencing symptoms have no framework for understanding what's happening to their bodies.