Participants & Methods

• Population: 242 perimenopausal women in China
• Tool: Greene Climacteric Scale (a validated menopause symptom questionnaire)
• Analysis: Network analysis using R software
  • Nodes = individual symptoms
  • Edges = strength of relationships between symptoms
  • Identified:
    • Core symptoms: Highly connected, influential symptoms
    • Bridge symptoms: Connect different symptom clusters (e.g., mood ↔ physical)

They also tested the stability and accuracy of the network to ensure findings were reliable.

Key Findings

Most Common Symptoms

• Fatigue / low energy
• Irritability
• Excitability (feeling keyed-up, on edge)

Core Symptom

⭐ Irritability
This symptom had the strongest connections to others — meaning if irritability flares, many other symptoms tend to worsen. It was the most central node in the network.

Bridge Symptom

⭐ Excitability
This symptom linked anxiety and depressive symptom clusters.
Translation: feeling edgy or over-stimulated may be the domino that triggers anxiety and depressive symptoms.

Symptom Cluster Insight

• Emotional and psychological symptoms were more central than vasomotor or physical symptoms.
• Depression-related symptoms formed a tight cluster at the core of the symptom network.

Clinical & Real-World Implications

• Target irritability first — supporting emotional regulation may reduce multiple perimenopausal symptoms indirectly.
• Address excitability (nervous system over-activation) to stop emotional symptoms from cascading between anxiety and depression.
• Psychological and emotional symptoms deserve equal or more attention than hot flashes and sleep in perimenopause care.
• Reducing stigma around mood changes is essential — they play a central biological role, not a “failure to cope.”

Strengths

• Modern statistical approach reveals symptom interconnections, not just frequency.
• Offers actionable insight for clinical priority setting.

Limitations

• Cross-sectional study — can’t prove causation, only associations.
• Single-country sample — generalizability may vary across cultures.
• Based on self-report symptom questionnaires.

Perimenopausal symptoms don’t act in isolation — they form a network.

Irritability is the “hub,” and excitability acts as the critical messenger between mood systems.

Supporting emotional regulation during perimenopause (via hormone balancing, nervous-system support, lifestyle strategies, therapy, and stress modulation) may meaningfully shrink the whole symptom web, not just single complaints.

The Study: Zhang, T., Wan, Y., & Geng, L. (2024). Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis. Menopause, 10-1097.