The Symptoms Are Real. The Diagnosis Is Missing: What Miyara’s Data Reveals About (Peri)Menopause in South Asian Women
A new Miyara Health dataset reveals a significant gap between what South Asian women experience during midlife and what they recognise as perimenopause — and why looking beyond hot flushes matters.
For decades, the menopause conversation has often centred around one symptom: hot flushes.
But what happens when a woman isn't having them?
What if her first signs are exhaustion, brain fog, anxiety, digestive problems, hair fall, joint pain or changes in mood?
What if her periods are changing, but she still believes she is "premenopausal"?
And what if she has a metabolic or other health condition that makes her symptom burden even greater?
New insights from Miyara Health's South Asian women's cohort suggest that this is happening more often than we recognise.
The data tells a clear story:
The symptoms are real. The diagnosis is missing.
The menopause awareness gap is bigger than we think
One of the most striking findings from the Miyara Health dataset is the gap between experiencing symptoms and recognising perimenopause.
Almost every woman in the cohort reported symptoms:
97.6% reported symptoms
94.7% reported menstrual changes
Yet 49.7% described themselves as "premenopausal" or "not sure" about their stage
The most striking finding?
85.1% of women who identified themselves as "premenopausal" were actually already in perimenopause.
And among women who said they were "not sure," 73.4% were assessed as perimenopausal.
Across the two groups combined, 78.6% were already in perimenopause.
This points to a fundamental problem.
Women aren't necessarily missing the symptoms.
They're missing the connection between the symptoms and perimenopause.
Perimenopause doesn't always look like menopause
If you've ever heard someone say:
"I'll know when I'm in menopause because I'll get hot flushes."
The data suggests we need to rethink that assumption.
The most commonly reported symptoms in the Miyara dataset weren't hot flushes.
They were:
Exhaustion — 83.1%
Depressive mood — 79.3%
Digestive issues — 79.0%
Hair fall — 76.6%
Irritability — 76.0%
Brain fog — 75.1%
Anxiety — 73.7%
Joint pain — 73.4%
These symptoms can easily be attributed to other things.
Stress.
Work.
Poor sleep.
Family responsibilities.
Ageing.
Diet.
Thyroid problems.
"Just having a lot going on."
And sometimes those factors may genuinely contribute.
But when several symptoms appear alongside menstrual changes, perimenopause needs to be part of the conversation.
The hot flush myth could be delaying recognition
Only 53.8% of women in the dataset experienced vasomotor symptoms — hot flushes and/or night sweats.
That means nearly half of the women assessed did not report these classic symptoms.
Yet they were experiencing other significant symptoms.
This matters because hot flushes have become almost synonymous with menopause in popular culture.
But menopause is not one symptom.
And perimenopause is not one experience.
For many women, particularly those whose symptoms don't match the stereotypical picture of menopause, the transition can remain invisible for years.
Waiting for hot flushes may mean waiting too long.
If exhaustion, mood changes, digestive issues, hair fall, brain fog or anxiety are treated as completely separate problems, the underlying pattern can be missed.
Perimenopause is a multi-system experience
The Miyara data reinforces another important point:
Perimenopause doesn't stay in one lane.
The cohort reported symptoms across multiple domains:
Symptom domain | Women affected |
Physical | 94.7% |
Urogenital | 86.4% |
Psychological | 84.9% |
Cognitive | 82.0% |
Vasomotor | 53.8% |
This means the experience of perimenopause can extend far beyond reproductive health.
It can affect how a woman feels physically, thinks, sleeps, functions and experiences her overall wellbeing.
And that creates a challenge for a healthcare system that often separates these areas into different conversations.
A woman may see one doctor about fatigue.
Another about digestive symptoms.
Another about anxiety.
Another about hair fall.
Another about irregular periods.
But the woman is experiencing all of these things in the same body.
The healthcare conversation needs to connect the dots.
What happens when metabolic health enters the picture?
The Miyara data also points to an important relationship between midlife symptoms and metabolic health.
Women with certain metabolic or health conditions showed substantially higher symptom scores than women without those conditions.
The dataset found:
Cholesterol: 29.80 vs 22.51
PCOS: 28.07 vs 22.81
Hypertension: 25.03 vs 23.29
Hypothyroidism: 24.92 vs 23.06
Diabetes: 24.04 vs 23.41
Women with metabolic conditions had symptom scores up to 32% higher than those without.
This doesn't mean that perimenopause causes these conditions, nor does it mean that every symptom in a woman with one of these conditions is caused by menopause.
It highlights something more important:
Midlife health cannot be understood through menopause in isolation.
Hormonal transition, metabolic health, existing conditions, lifestyle and wellbeing can intersect.
That makes a whole-person approach to midlife health particularly important.
BMI and symptom burden: another piece of the puzzle
The Miyara cohort also found a statistically significant relationship between BMI and symptom burden:
Pearson r = 0.207, p < 0.001
and
Spearman ρ = 0.188, p = 0.0006.
At the same time, 54.9% of women in the cohort were above the healthy BMI threshold used for South Asian populations (≥23), with an average cohort BMI of 26.8.
These findings don't establish that a higher BMI causes greater perimenopause symptoms.
But they do point towards a pattern worth understanding.
And importantly, they reinforce why midlife health shouldn't be reduced to a single hormonal conversation.
The body doesn't experience health in separate categories.
Neither should we.
Why South Asian women's menopause experience needs its own data
For too long, women's health has suffered from gaps in research, awareness and representation.
South Asian women need menopause research that reflects their own experiences.
Not simply data imported from other populations.
Not assumptions based on the most visible menopause symptoms.
And not a one-size-fits-all approach to midlife health.
The Miyara dataset was developed to better understand how South Asian women experience the menopausal transition or perimenopause across multiple symptom domains.
And what emerges is a picture that is considerably more complex than the traditional menopause narrative.
Women are experiencing symptoms.
Their periods are changing.
Multiple systems are involved.
Health conditions can amplify symptom burden.
And many women don't recognise that they are already in perimenopause.
So what should women look out for?
Perimenopause doesn't necessarily announce itself with a single dramatic symptom.
Instead, it may look like a pattern of changes.
You might notice:
Your periods becoming irregular or changing in flow
Persistent exhaustion
Sleep disruption
Irritability or changes in mood
Anxiety
Brain fog or difficulty concentrating
Digestive changes
Hair fall
Joint pain
Hot flushes or night sweats
Changes in sexual or urogenital health
You don't need to have all of these symptoms.
And these symptoms can have many possible causes.
But if you're experiencing multiple changes at the same time — particularly alongside menstrual changes — it's worth considering whether perimenopause could be part of the picture.
A healthcare professional can help assess your individual situation and rule out other potential causes.
The first step isn't necessarily treatment. It's recognition.
Before women can make informed decisions about their midlife health, they need to recognise what is happening.
That starts with awareness.
It also starts with tracking.
Tracking your menstrual cycle and symptoms over time can help you move from:
"I don't feel like myself."
to:
"Here is what has changed, when it changed and how it's affecting me."
That creates a much more useful starting point for conversations with healthcare professionals.
And it gives women something that is often missing during midlife:
visibility into their own health.
The Miyara message
The findings from the Miyara Health dataset aren't simply about how many women experience fatigue, anxiety or brain fog.
They're about something bigger.
They're about the gap between what women experience and what they understand about their bodies.
A woman shouldn't have to wait for a hot flush to realise that her body is changing.
She shouldn't have to dismiss exhaustion as "just getting older."
She shouldn't have to navigate every symptom separately.
And she shouldn't be told that feeling different is simply something she has to accept.
Because "just get older" was never a diagnosis.
The data tells a clear story.
Now it's time to act on yours.
Frequently Asked Questions
What are the most common symptoms of perimenopause in South Asian women?
In the Miyara Health dataset, the most commonly reported symptoms were exhaustion (83.1%), depressive mood (79.3%), digestive issues (79.0%), hair fall (76.6%), irritability (76.0%), brain fog (75.1%), anxiety (73.7%) and joint pain (73.4%).
Can you be in perimenopause without hot flushes?
Yes. In the Miyara dataset, 53.8% of women experienced vasomotor symptoms such as hot flushes or night sweats. Other symptoms were substantially more common.
Can fatigue be a symptom of perimenopause?
Exhaustion was the most commonly reported symptom in the Miyara cohort, reported by 83.1% of women. However, fatigue can have many causes, so persistent or significant fatigue should be discussed with a healthcare professional.
How do I know if I'm in perimenopause?
Menstrual changes are an important part of the picture, but symptoms can vary widely. Tracking menstrual changes alongside symptoms such as sleep disruption, mood changes, fatigue, brain fog, anxiety and physical symptoms can help identify patterns. A healthcare professional can help assess whether perimenopause may be contributing.
Why is perimenopause often missed?
One reason is that many women don't experience the stereotypical symptoms associated with menopause. In the Miyara dataset, 78.6% of women who considered themselves premenopausal or were unsure were assessed as being in perimenopause.
Does BMI affect perimenopause symptoms?
The Miyara dataset found a statistically significant correlation between BMI and symptom burden. However, correlation does not establish causation, and BMI is only one factor within a much broader picture of midlife health.
About the Miyara Health dataset
The findings presented in this article come from the Miyara Health White Paper 2025, based on a South Asian women cohort. The assessment examined symptoms across five clinical domains: physical, urogenital, psychological, cognitive and vasomotor.
The findings are observational and should not be interpreted as establishing causation or replacing individual medical advice.
Miyara Health is building a more informed, personalised approach to women's midlife health — helping women understand their symptoms, recognise patterns and take action earlier.
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