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Background Perimenopause is formally diagnosed by menstrual bleeding patterns. This study investigated whether symptoms in the late reproductive stage (LRS), characterised by changed menstrual flow, differ from earlier premenopause or from perimenopause in the absence of vasomotor symptoms (VMS).Methods The Australian Women’s Midlife Years Study (2023–2024) was a nationally representative cross-sectional study of 8096 women aged 40–69 years, who completed the Menopause-specific Quality of Life Questionnaire (MENQOL). The prevalence of moderate-to-severe symptoms in participants without VMS was analysed using generalised linear models with Gamma log link and modified Poisson regression with robust variance, respectively.Results The analysis included 1039 respondents without VMS, of which 63.5% (n=660) had regular menses with no change in menstrual flow, 20.1% (n=209) had regular menses with changed flow, and 16.4% (n=170) were perimenopausal (cycle variation at least 7 days). Premenopausal participants with unchanged flow were less likely to report poor memory (adjusted prevalence ratio (aPR) 0.60, 95% CI 0.43 to 0.83, p=0.043), ‘accomplishing less than used to’ (aPR 0.65, 95% CI 0.50 to 0.85, p=0.014), ‘feeling tired or worn out’ (aPR 0.78, 95% CI 0.68 to 0.90, p=0.009) and bloating (aPR 0.63, 95% CI 0.49 to 0.80, p=0.004) compared with LRS participants. The other 18 individual MENQOL symptoms did not differ between premenopausal LRS and early perimenopause.Conclusions Premenopausal women with regular menstrual cycles reporting changed menstrual flow but no VMS differ little from those without VMS and no change in menstrual flow. This indicates that change in flow alone is not a clear indicator of commencement of the menopause transition.