June 29, 2026 – A new study published in Climacteric by Flo Health, the #1 OB-GYN-recommended women’s health app, reveals that financial insecurity is the strongest socioeconomic factor associated with more severe perimenopausal symptoms among women worldwide.
Flo’s science team, together with collaborators from the Mayo Clinic’s Center for Women’s Health, surveyed 12,382 Flo app users aged 35 and over to better understand how social determinants of health (SDOH), which include income and education level, health care access, race and ethnicity, influence perimenopause symptoms.
The survey measured respondents’ symptom severity using the Menopause Rating Scale (MRS), a validated tool that scores symptoms across three areas: psychological (mood, anxiety, sleep, and memory changes), somatic (physical symptoms including hot flashes, joint pain, and heart palpitations), and urogenital (vaginal dryness, bladder symptoms, and changes to sexual function). Higher scores indicate more severe symptoms. Building on previous evidence that hormonal fluctuations contribute to perimenopausal symptoms, Flo scientists found that social determinants of health can also compound symptom severity.
Researchers concluded that more severe perimenopause symptoms are linked with insufficient household income, lower education level, and poor access to health care. These particular factors can widen the information gap and make it more difficult to access treatments, issues that the majority of women in perimenopause already face, as reported in Flo’s existing research.
“Flo members in perimenopause who are navigating financial insecurity report symptom scores that are, on average, five points higher on the Menopause Rating Scale than those who have sufficient household income. This difference reflects a shift from moderate to severe symptom burden, and we saw it consistently across physical, psychological, and urogenital symptoms,” said Yella Hewings-Martin, PhD, lead research scientist at Flo and lead study author. “It tells us that for many users, their perimenopause experience is shaped by the material realities of their lives, in addition to their hormones.”
“Our research adds to a growing body of evidence that perimenopause is a health equity issue," said Liudmila Zhaunova, PhD, Flo’s Director of Science. "Income, healthcare access, education, and ethnicity are all linked to how severely women experience perimenopause symptoms. Of course, they are not the only factors at play, but they do clearly matter. We hope this work contributes to a shift in how health systems think about midlife female health."
This survey demonstrates the need to address health inequity when researching and treating perimenopause. By centering efforts on the patients experiencing the most severe symptoms, the medical industry can make even greater strides in improving the lives of women worldwide.
Key findings:
- Among the subset of 2,618 participants in perimenopause, income insufficiency had the strongest association with symptom burden.
- Lower educational attainment was consistently linked to higher symptom severity. Those with doctorate degrees had the lowest average MRS scores, and those who hadn’t completed high school had the highest scores.
- Significant racial and ethnic differences were observed. After accounting for income, education, and healthcare access, Asian, Black, and Hispanic/Latina participants demonstrated significantly lower symptom burden compared with white participants, with patterns varying across symptom domains.
About Flo Health
Flo Health is the #1 Health and Fitness app worldwide and the #1 OB-GYN-recommended platform for period and cycle tracking. In 2024, Flo became the first European femtech unicorn following an investment from General Atlantic and now supports 80 million monthly active users (MAUs) worldwide. Powered by a network of over 100+ medical experts, Flo guides women through every stage of their health journey – from menstruation to conception, pregnancy, and menopause – offering curated cycle and ovulation tracking, personalized health insights, daily educational content, and a private community for users to share questions or concerns. Through its Pass it on Project, Flo has donated 28M Flo Premium subscriptions to improve health literacy to women in need, aiming to reach up to one billion. A leader in privacy and security, 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 as part of the company's commitment to privacy.
For more information, please visit https://flo.health.
Survey Methodology
A total of 12,382 Global Flo Health users aged 35 and above, who use the app in English, Spanish, Portuguese or French responded to an online cross sectional survey. The Menopause Rating Scale, a validated measure of the severity of menopause symptoms, was used to measure menopause symptom burden, and respondents also answered questions on income status, education and other social determinants of health.