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The research behind it.
Every number on our site, with what it means and where it comes from. Figures are averages from published studies, not personal predictions.
Early changes
Before perimenopause.
PMOS, endometriosis and PMDD are not just monthly problems. Here’s what the research links them to.
Mechanism
High androgens and insulin resistance feed each otherIn PMOS (formerly PCOS), excess androgens make it harder for cells to take in glucose, and high insulin pushes the ovaries to make more androgens. That loop is why cycle, skin and weight symptoms often travel together.
Source2023 International Evidence-Based Guideline for PCOS (Monash University / ESHRE / ASRM).
Up to 75%
of lean women with PMOS have insulin resistanceIn a gold-standard clamp study, 75% of lean and 95% of overweight women with PMOS had insulin resistance. Being slim doesn’t rule it out.
SourceStepto NK et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic–hyperinsulaemic clamp. Human Reproduction, 2013;28(3):777–784.
3×
higher risk of type 2 diabetes with PMOSWomen with PMOS had about three times the diabetes risk of women without it, even after adjusting for weight. At a healthy weight the rate was about 4.7× higher.
SourceKakoly NS et al. The impact of obesity on the incidence of type 2 diabetes among women with PCOS. Diabetes Care, 2019;42(4):560–567.
1.7×
higher odds of cardiovascular disease with PMOSPooled data show 1.7× higher odds of cardiovascular disease and 2.5× for heart attack. Blood pressure, lipids and blood sugar are worth tracking from your 30s.
SourceMeta-analysis informing the 2023 International PCOS Guideline. Journal of the American Heart Association, 2024;13(16).
Linked
Endometriosis and autoimmune diseaseStudies that followed women over time found about 1.7× the risk of lupus. Links to Sjögren’s, rheumatoid arthritis and IBD have also been reported. The review rated the overall evidence as low quality.
SourceShigesi N et al. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Human Reproduction Update, 2019;25(4):486–503.
~5×
higher odds of depression in or after pregnancy with severe PMS or PMDDIn Swedish national data, women with premenstrual disorders had 4.8× the odds of perinatal depression, and the link ran both ways. Premenstrual disorders are also tied to higher rates of other mental-health conditions.
SourceThe bidirectional association between premenstrual disorders and perinatal depression. PLoS Medicine, 2024. Opatowski M et al. JAMA Network Open, 2024.
Perimenopause
The transition.
Perimenopause starts years before your last period. Here’s what happens in that window.
40%
higher risk of depression in perimenopauseAcross 7 studies and 9,141 women, depression risk was about 40% higher in perimenopause than before it. After menopause, risk was not significantly higher.
SourceBadawy Y et al. The risk of depression in the menopausal stages: a systematic review and meta-analysis. Journal of Affective Disorders, 2024.
39–47%
of women in perimenopause report sleep problemsNight sweats, 2 a.m. waking and lighter sleep are common through the transition. In postmenopause, 35–60% report sleep problems.
SourceNIH State-of-the-Science Conference Statement: Management of menopause-related symptoms. Annals of Internal Medicine, 2005;142:1003–1013.
Temporary
Brain fog in perimenopause is real, and usually temporaryMemory and processing speed can dip during the transition, then recover after menopause. Poor sleep and hot flashes make it worse, and treating them can help.
SourceGreendale GA et al. Effects of the menopause transition and hormone use on cognitive performance (SWAN). Neurology, 2009;72:1850–1857.
2.5% a year
spine bone loss, starting a year before your final periodBone loss begins about a year before the final period, before menopause is confirmed. The spine loses about 2.5% a year and the hip about 1.8% a year through the transition.
SourceGreendale GA et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort (SWAN). Journal of Bone and Mineral Research, 2012.
7.5%
rise in arterial stiffness in the year around your final periodArterial stiffness rose about 7.5% in the year around the final period, versus under 1% in the years before. Blood pressure and lipids are worth tracking now.
SourceSamargandy S et al. Arterial stiffness accelerates within 1 year of the final menstrual period (SWAN Heart). Arteriosclerosis, Thrombosis, and Vascular Biology, 2020.
Shift
After menopause, the gut microbiome looks more like men’sGut bacteria that recycle estrogen become less active, and these shifts were linked to less favorable heart and metabolic profiles. This comes from one study of U.S. Hispanic/Latino adults.
SourcePeters BA et al. Menopause is associated with an altered gut microbiome and estrobolome. mSystems, 2022.
31%
of OB/GYN residency programs have a menopause curriculum84% of program directors say their program needs more menopause training. That gap is why DiaFem clinicians are menopause-trained.
SourceNeeds assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause, 2023.
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