Millions of women face years of disruptive symptoms, yet there is still no dedicated ICD-10-CM code for perimenopause, and disparities in care persist.
Key Takeaways |
|
At any given time, approximately 8 million women in the U.S. are perimenopausal — meaning they are in the transitional hormonal phase that precedes menopause and marks the end of reproductive cycling. This phase typically lasts around four years, though some women experience symptoms for up to eight years. Hormonal shifts during perimenopause can cause a wide range of symptoms, including sleep disturbances, mood changes, and anxiety — many of which can significantly impact quality of life. However, perimenopause remains widely underdiagnosed, and symptoms are misattributed.
One major barrier to care is the lack of physician education. Recent research found that only 30% of OB/GYN residency programs include menopause instruction, and nearly two in three residents answered a basic menopause treatment question incorrectly.
Perimenopause also lacks a dedicated medical code, which limits visibility and treatment. Currently, it’s classified under broad ICD-10-CM diagnosis codes that include both menopause and perimenopause. For this analysis, we looked at the two most frequently used codes: N95.1 (Menopausal and female climacteric states) and N95.9 (Unspecified menopausal and perimenopausal disorder). While menopause and perimenopause are not diseases, they are clinically relevant conditions that are physiologically distinct; some symptoms overlap, others do not. This conflation limits visibility of perimenopause for providers, as well as, research, and proper treatment pathways, increasing the likelihood of mismanagement.
We analyzed data for nearly 29 million women ages 45-51 between 2019 and 2023, limiting the cohort to those with either of two perimenopause/menopause diagnoses codes while excluding conditions that cause early menopause. We used Komodo’s MapView™ Cohort Report Template and custom analytics built from the MapLab® healthcare analytics platform to discover and analyze patterns based on age, race, payer channels and state.
Here is what we found:
Perimenopausal women rarely received an official diagnosis; White women and those with commercial insurance were most likely to receive one.
Only 7% (2 million women) in this age group had a documented perimenopause/menopause diagnosis. This was similar to women ages 52-58 (the seven years following the average age of menopause), where the diagnosis rate was only slightly higher at 8%. Because the lower 7% included some women who had already transitioned to menopause earlier than average, the true rate of perimenopause diagnosis is likely even lower.
Diagnosis also varied by insurance type and race:
- 8% of commercially insured women received a diagnosis compared to 5% of women on Medicaid.
- White women were more likely to be diagnosed, at 11%, compared to women identified as Hispanic (10%), Other (10%), AAPI (8%), and Black (8%).
Even when women sought care for common perimenopausal symptoms, diagnosis rates remained low.
- Among women ages 45-51 who sought care for irregular bleeding, only 22% received a perimenopause diagnosis. Rates were similar for those newly diagnosed with less direct but common perimenopausal symptoms: mood disorders (20%), sleep disturbances (28%), and headache/migraines (19%).
Prescription rates for hormone therapy (HT) varied widely by state and by race and ethnicity.
Between 2019 and 2023, among women ages 45-51 with a new perimenopause diagnosis:
- 22% received HT treatment.
- Women in Wyoming (36%) were the most likely to receive HT treatment, while those in New York (14%) were the least likely.
- White women and women who identified as “Other” for race and ethnicity were most likely to receive HT, at 24%, followed by Black women (20%), Hispanic and Latino women (19%), and Asian and Pacific Islander (17%).
Treatment Rates After Perimenopause Diagnosis by Geographic Region
Specific, dedicated codes and expanding physician education are essential to closing the gaps in perimenopause care. Understanding how symptoms present across diverse populations, improving diagnostic criteria, and increasing access to effective therapies will help ensure broader relief and better outcomes for millions of women.
Komodo Health’s real-world data and analytics can illuminate these disparities, offering the insights needed to drive informed decision-making, improve patient care, and support policy changes. By leveraging comprehensive patient-centric insights, we can improve perimenopausal care and help bridge the gap between overlooked symptoms and appropriate treatment.
To see more articles like this, follow Komodo Health on X, LinkedIn, or YouTube, and visit Insights on our website.
