Perimenopause — the transition leading up to menopause — remains one of the most significant gaps in modern medicine. For years, clinical criteria have focused on a woman’s bleeding cycle, rather than symptom patterns, but research shows that hormonal fluctations and neurological symptoms like anxiety, brain fog, and sleep disruption can occur years before a woman’s period becomes irregular.
Apple is striving to change this, adding menopause and perimenopause tracking to the Health app. Sitting under Cycle Tracking, users can track their symptoms and monitor their cycles. Many women don’t recognize they are in perimenopause, so with iOS 27, users aged 40 and over can receive a notification if a deviation in their logged cycle is suggestive of perimenopause. Users don’t need an Apple Watch to do this — they can use the Cycle Tracking feature on iPhone or iPad. There’s also a new Strong Through Menopause Fitness+ program designed to build strength, improve balance and mobility, and reduce stress.
I’ve been writing about the Apple Watch since before it could even track periods (a feature that was added in September 2019 for anyone wondering), so I was keen to sit down with Apple Health Director, Doctor Lauren Cheung, and Director of Fitness at Apple, Julz Arney, to find out more about its new Women’s Health features.
Why the focus on perimenopause and menopause now?
Dr. Cheung: From the beginning of our journey in health, we've designed the health ecosystem to meet people where they are throughout every stage of life. For us, it's been really important to help users turn their health information into meaningful insights they can better understand and act on. We believe everyone deserves powerful personalized health tools, and so we have a track record of focusing on health needs that have often been overlooked and building thoughtful solutions, whether that's for fall risk to hearing health, to heart rhythm notifications, and as you know, cycle tracking and women's health has been long, long been one of those areas of health that's been underserved.
And so cycle tracking is a feature that we design to grow with you from logging a first period to family building, to pregnancy, to ongoing health awareness, and what makes this powerful is that continuity. So it's a system that offers the right tool at the right moment. With our newest updates, we're extending that continuity into a life stage that, as you know, probably affects roughly half the world's population, but again has historically been underresearched, misunderstood, and very often stigmatized, and that's perimenopause and menopause.
What's changing in the Health app in iOS 27?
Dr. Cheung: So the health app is now adding new support and cycle tracking, so users can now log whether they're in perimenopause or menopause, they can track symptoms, and they can monitor their cycles over time.
This is a life stage that probably affects roughly half the world's population, but has historically been underresearched, misunderstood, and very often stigmatized, and that's perimenopause and menopause.
Apple Health Director, Doctor Lauren Cheung
And then we've added educational articles into the health app on perimenopause and menopause to help you better understand this new chapter, because it can be very bewildering for many people.
Perimenopause and menopause can impact so many aspects of health, including sleep, stress, and anxiety, and overall well-being. And starting during this phase of life, women's risk for diseases like cardiovascular disease increases. So regular movement and strength-focused fitness can help support both physical and mental health during this transition. And so we've developed some routines to help users better engage in their physical health.
How are you encouraging staying active during menopause?
Jules Arney: Staying active, it's one of the most powerful things you can do for your body and mind, especially during this transition, and we just really wanted to make sure we were showing up for users in this moment specifically. We've always believed that fitness should be accessible and welcoming for everyone, and so we looked at what users going through perimenopause and menopause actually mean.
And what we landed on is that it isn't about performance metrics necessarily in this stage of life. It's about resilience and finding ways to protect your health and feel strong and really feel more like yourself through the journey. So we designed a progressive 3-week program.
It hits 7 out of 7 clinical priorities for fitness in menopause in just three 20-minute sessions a week. It's built around yoga and strength training, and that's to support pelvic floor health, overall strength for your muscles, and even cardiovascular health, and we're just excited about supporting even more users to get active, stay active, and that's exactly what Fitness Plus was made for.
How many consecutive months of cycle data are required before the health app triggers a perimenopause alert?
Dr Cheung: We use a six-month window, and we look for essentially more than one abnormal occurrence. It's not abnormal for folks to have 1 or 2 cycles that might be off, for a variety of reasons, so we wanted to make sure that we are being responsible about when it is something that a user actually needs to pay attention to. So we look over a course of six months and then look to confirm it over more than one irregularity.
How does the tool differentiate between perimenopausal irregularities and other causes of erratic periods, such as PCOS?
Dr Cheung: We are using the FIGO guidelines — that’s the Federation of International Obstetrician-Gynecologists, and they have definitions for irregular and infrequent menses. Anyone at any age can get one of those deviations for an irregular or infrequent period, but once users are over the age of 40, it is more likely that one of those deviations is likely due to perimenopause.
Why is it restricted to users aged 40 and over when some research suggests that perimenopause can start as early as the late 30s?
Dr Cheung: Women in their late 30s can develop perimenopause, but it is less common. For anyone under the age of 40, we think it's really important that they still treat this as something that they need to go and talk to their physician about to confirm that it isn't something else that might be causing it.
How much does the tracking rely on the Apple Watch's wrist temperature tool vs manual logging?
Dr Cheung: It is all based on manual logging. However, what the temperature and heart rate data on Apple Watch do is improve the accuracy of our predictions. When someone uses temperature to better track and understand retrospective ovulation and their cycles in general, it improves the period predictions as well as the fertile window predictions.
Will the temperature sensors on the Apple Watch be used to detect symptoms night sweats/hot flashes, or do these rely on manual logging?
Dr Cheung: It will still be manual logging because the temperature sensor is designed to give one aggregated reading of relative temperature over the course of a night.
If a user reports things like night sweats, will this be linked to the sleep tracking features on Apple Watch to explain sleep disturbances?
Dr Cheung: They're not linked at this point in time, but what users can do is they can track symptoms in the cycle tracking room, including sleep changes, and then through the PDF, they can actually understand the symptoms they've logged in conjunction with the rest of their cycle and things like sleep changes and other symptoms that they have.
Jules Arney: Disrupted sleep is just one of the most annoying symptoms of this life stage for a lot of people, and as you know, exercise is such a great way to improve sleep, and I think that's what's so helpful about the ecosystem of having your Apple Watch with the sensors to do the sleep tracking is that you actually can see how exercise is positively impacting your sleep. It's like a reinforcing pattern, because you can see how your sleep score is improving, and then hopefully be more motivated to do a program like Strong Through Menopause.
I'm really interested in Apple’s Women's Health study. Will the data collected from these features be part of your research?
Dr Cheung: Any feature that we implement in cycle tracking, we then carry over to the Apple Women's Health Study, so absolutely. What what what is great about the Apple Women's Health Study is that we can supplement what we have in the feature set with other questions that we might want to ask users so that we can help better understand the signals, and then we work with our Principal Investigators (PIs) at the Harvard T.H. Chan School of Public Health, to make sure that we can publish on it. We have scientific evidence and things that we are discovering all the time, which is absolutely wonderful and of course, all of this is done with utmost privacy at the core.
What’s unique about Strong Through Menopause compared to other Fitness+ programmes?
Jules Arney: What's unique about this program, compared to others that you might find in a general fitness routine, is that the trainers are going to talk about that pelvic floor activation and help you feel confident in movement, which hopefully will scale to other things that you want to do after this program. You learn a new skill that helps you stay more active, hopefully for as long as you can, the rest of your life. It's progressive, so it builds up over time, and it's meant to be repeated.
The trainers themselves, you know, are in this stage of life, and so it's just really relatable. Some of the things that are built in that you are so important to talk about are things like incontinence, which is a big blocker for people doing any kind of movement. It's not that they are harping on the subject, but you just feel this real sense of like we're all in this together because they understand it as well.
