Findings highlight the United States’ significant gap in understanding and awareness compared to peer nations

LONDON, Jan. 28, 2026 /PRNewswire/ — While perimenopause is a lived experience for most women over 40, new global research reveals that American women are far less informed about the transition period than expected. This is according to the first in a series of papers in a new study by Mayo Clinic and Flo Health, the #1 women’s health app worldwide.^[1] The United States ranks sixth in overall knowledge of perimenopause symptoms, while other countries such as the United Kingdom, Ireland, Canada, Australia and the Netherlands rank ahead.

Published in Menopause, the official journal of The Menopause Society, Global Perspectives on Perimenopause: A Digital Survey of Knowledge and Symptoms using the Flo Application is the first digital study of its kind, with more than 17,000 women – ages 18 and over – participating across 158 countries on their general knowledge and symptoms and attitudes toward perimenopause, the latter of which will be published at a later date.

Perimenopause is the transition period leading up to a woman’s last menstrual cycle – and includes the one year afterward, when menopause is established and women start to experience symptoms due to changing hormone levels. The study finds that among women over 35 who reported they were in perimenopause, the symptoms were significantly higher than among women who reported they were not yet in perimenopause. Fatigue, physical and mental exhaustion and irritability were the most common self-reported symptoms experienced during perimenopause.

“We need to normalize conversations around perimenopause and menopause, so women feel empowered to have honest conversations with their doctors and other support systems,” said Dr. Anna Klepchukova, Chief Medical Officer at Flo. “This study demonstrates a prolonged commitment from both Flo Health and Mayo Clinic in helping women better understand their bodies and advocating for their health through perimenopause, and every other phase of their health journeys, through medically-backed insights and advice.”

Key findings from the global study Include:

Widespread Lack of Symptom Awareness: Participants most often recognized common perimenopause symptoms such as hot flashes (71%), sleep problems (68%) and weight gain (65%). However, broader symptoms such as fatigue, irritability, and digestive changes, were far less likely to be identified as part of the perimenopause transition. Participants in the United Kingdom scored highest in symptom knowledge, while the lowest scores were reported in Nigeria, France and parts of Latin America.
International Knowledge Differences: Perimenopause knowledge scores were highest in higher income countries such as the United Kingdom, Ireland and Australia. Lower scores emerged in Nigeria, France, and parts of Latin America. Overall, women in high-income countries demonstrated broader perimenopause symptom recognition than in low- and middle income countries, though overall knowledge scores were low across all regions.
Symptoms Regardless of Reproductive Stage: Among women 35+, the most commonly reported symptoms experienced regardless of reproductive stage were fatigue (83%), physical and mental exhaustion (83%) and irritability (80%), followed by depressive mood (77%), sleep problems (76%), digestive issues (76%) and anxiety (75%).
Perimenopause Symptom Experiences: However, for women 35+ who reported being in perimenopause, the top five symptoms were physical and mental exhaustion (95%), fatigue (93%), irritability (91%), sleep problems (89%) and depressive mood (88%).
International Differences: Digestive issues ranked among the top three reported symptoms in Nigeria, South Africa, India, France, Ireland and several Latin American countries, while mood symptoms, such as depressive mood and anxiety ranked among the top three reported symptoms in Germany, Spain, Venezuela, the Netherlands and India. Sleep disturbance ranked among the top three in Nigeria.

Even as U.S. conversations about menopause grow louder, from celebrity advocacy to new workplace policies, the study suggests many women may lack the foundational knowledge needed to identify early symptoms and seek timely care.

“There is a mismatch in knowledge and expectations of perimenopause and actual symptoms experienced during perimenopause. Many women in perimenopause may not yet be experiencing hot flashes, and are more likely to be experiencing the cognitive and physical symptoms of fatigue, exhaustion, mood, sleep, or even digestive changes,” said Dr. Mary Hedges, Principal Investigator at Mayo Clinic. “The findings from this study illustrate the need to advance perimenopause research and education, so that we can equip both patients and healthcare clinicians with the knowledge and skills needed to address symptoms and improve the quality of care we provide to women.”

Survey Methodology
From December 6, 2024, to May 16, 2025, 17,494 Flo Health users in 158 countries participated in a study on the app. Users aged 18-34 answered questions on perimenopause knowledge, menopause attitudes, demographics, and lifestyle. Users 35 and older completed additional questions about symptoms, healthcare, doctor visit results, and treatments.

Media Note: Download high-resolution images and survey graphics HERE . Photos may be credited to Flo Health.

References

Sensor Tower, July 2025, iOS & Android, by total downloads worldwide
Global Perspectives on Perimenopause: A Digital Survey of Knowledge and Symptoms using the Flo Application, January ’26. “Perimenopause is the transition period leading up to a woman’s last menstrual cycle and includes the 12 months afterward, after which menopause is established.(1) Typically occurring in the mid-40s, and lasting on average six years, symptoms may begin as early as the 30s and persist for a decade.”

About Flo Health
Flo Health is the leading app in the Health & Fitness category; it is the #1 OB-GYN-recommended app for period and cycle tracking and is the first European femtech unicorn following an investment from General Atlantic in July 2024. The company supports 77 million monthly active users (MAUs). With over 100 medical experts, Flo is committed to supporting women at every stage of their health journey, from menstruation to conception, pregnancy, and menopause. It provides curated cycle and ovulation tracking, tailored health insights, daily bite-sized visual content, and a private community for users to share their questions and concerns. As part of its mission to build a better future for female health, Flo’s Pass it on Project aims to improve health literacy by providing up to 1 billion women in need with free access to Flo Premium and has donated 20M subscriptions to date. Flo prioritizes safety and focuses on being the most trusted digital source for women’s health information. Flo Health’s Anonymous Mode feature was recognized as one of TIME’s Best Inventions 2023 and also named a finalist for Fast Company’s 2023 World Changing Ideas Awards in the Rapid Response category as part of the company’s commitment to privacy. For more information, please visit https://flo.health.

PR Contacts
Samantha Wannemacher
Flo Health
[email protected]

Sunshine Sachs Morgan & Lylis
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