New Flo study reveals the global reality of perimenopause

Perimenopause is the transition period leading up to your last menstrual cycle and includes the 12 months that follow. At this point, you’re postmenopausal. 

While perimenopause typically starts in your mid-40s, symptoms can begin as early as your 30s and persist for up to a decade.

Even though perimenopause is a universal female experience, this time period has received significantly less research attention than the postmenopausal years. 

As a result, there is a huge gap in knowledge about perimenopause among those experiencing it and the health care professionals who provide their care. 

To bridge this gap, Flo Health partnered with researchers from the Center for Women’s Health, Mayo Clinic, to conduct a large global survey of Flo app members to better understand what they know about potential perimenopause symptoms and which ones they experience.

Published in the journal Menopause, the flagship publication of The Menopause Society, the study involved 17,494 Flo app members across 158 countries. 

The disconnect between expectation and reality

One of the most striking findings of the study was the mismatch between what our respondents thought were possible perimenopause symptoms and actual symptom experiences. 

When the team asked participants of all ages to identify potential symptoms of perimenopause, the most commonly recognized one was hot flashes (71%). Sleep problems (68%) and weight gain (65%) were also widely identified as common symptoms.

However, among app members aged 35 and over who told us that they were in perimenopause, the symptoms told a different story. Hot flashes were far from the most common. 

Instead, the top reported symptoms were physical and mental exhaustion (95%), fatigue (93%), and irritability (91%). 

“There is a mismatch in knowledge and expectations of perimenopause and actual symptoms experienced during perimenopause,” Dr. Mary Hedges, lead study author and an assistant professor of medicine at Mayo Clinic, Jacksonville, Florida, commented on the findings. 

“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,” Dr. Hedges continued.

Does perimenopause look different around the world?

Because symptoms can be shaped by cultural norms, societal attitudes, and lifestyle, the team wanted to see if perimenopause differed by region. They found significant international variation in both knowledge and symptom experience.

Knowledge about possible symptoms was generally higher in high-income countries. On average, study participants in the United Kingdom, Ireland, and Australia had the highest level of knowledge regarding symptoms, while knowledge was lower in countries such as Nigeria and Venezuela. 

However, it’s important to note that levels of knowledge were low across the board. 

While fatigue and exhaustion were the top symptoms globally among all study participants aged 35 and over, other experiences varied by location. 

For example, digestive issues were among the top three reported symptoms in France, Nigeria, and several Latin American countries including Argentina and Mexico. Anxiety was a top-three symptom in India, while depressive mood ranked highly in Germany and Spain.

“The findings from this study illustrate the need to advance perimenopause research and education so that we can equip both patients and health care clinicians with the knowledge and skills needed to address symptoms and improve the quality of care we provide to women,” Dr. Hedges explained. 

Why this research matters

The gap between what women know and what they experience has real-world consequences. 

In a previous research study, the Flo team showed that even though significant numbers of women in their 30s and 40s have symptoms that are common during perimenopause, very few sought care from their doctor. 

“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,” Dr. Klepchukova concluded.