When most people think of perimenopause, hot flashes are usually the first thing that comes to mind. But a new global study from Flo Health and Mayo Clinic suggests that the most common symptoms of the menopausal transition look very different from what many women have been led to expect.
The research, published in Menopause, the official journal of The Menopause Society, surveyed more than 17,000 women in 158 countries through the Flo Health app. The results revealed a significant disconnect between the symptoms women associate with perimenopause and those they actually experience.
While 71% of participants recognized hot flashes as a perimenopause symptom, making it the most widely identified, the data tells a different story when it comes to what women are actually going through. Among women aged 35 and older who self-reported being in perimenopause, the top symptoms were physical and mental exhaustion (95%), fatigue (93%), irritability (91%), sleep problems (89%), and depressive mood (88%). Hot flashes, while present, didn’t rank among the top lived experiences.
This gap between expectation and reality carries real consequences. Women who don’t recognize their symptoms as part of perimenopause may delay seeking care, attribute their struggles to stress or aging, or simply push through without understanding the hormonal changes at play.
“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,” said Dr. Mary Hedges, Principal Investigator at Mayo Clinic.
Fatigue and exhaustion, in particular, emerged as near-universal experiences. Among all women over 35, regardless of whether they identified as being in perimenopause, 83% reported fatigue and physical or mental exhaustion as symptoms they were experiencing. Irritability followed at 80%, along with depressive mood (77%), sleep problems (76%), digestive issues (76%), and anxiety (75%).
The study also highlighted how symptom profiles vary across regions. Digestive issues ranked among the top three most commonly reported symptoms in Nigeria, South Africa, India, France, Ireland, and several Latin American countries. Mood-related symptoms like depression and anxiety were especially prominent in Germany, Spain, Venezuela, the Netherlands, and India. Sleep disturbances ranked among the top three symptoms in Nigeria.
These regional differences point to the complex, multifaceted nature of perimenopause, and underscore why a one-size-fits-all approach to education and treatment falls short.
For Flo Health, which supports 77 million monthly active users and is backed by more than 100 medical experts, this study reflects a core commitment to closing knowledge gaps in women’s health. The app, recognized as the number-one OB-GYN-recommended tool for period and cycle tracking, has increasingly expanded its focus to support women through every stage of their reproductive health journey, from menstruation through menopause.
“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 Health.
The takeaway from this research is clear: perimenopause is far more than a single symptom. The sooner women and healthcare providers recognize the full spectrum of changes that accompany this transition, the better equipped they’ll be to manage them, and the better outcomes women will see in their overall health and quality of life.