Flo Health and Mayo Clinic publish global perimenopause awareness study

The US ranks sixth for perimenopause knowledge, behind the UK, Ireland, Canada, Australia and the Netherlands, research by the Mayo Clinic and period tracker Flo has revealed.

Perimenopause is the transition leading up to a woman’s last menstrual cycle and includes the 12 months afterwards, after which menopause is established as hormone levels change.

It typically happens in the mid-40s and lasts an average of six years, though symptoms may start in the 30s.

The study surveyed more than 17,000 women aged 18 and over across 158 countries about their knowledge of perimenopause symptoms.

The US ranked sixth overall, despite growing public discussion of menopause linked to celebrity advocacy and new workplace policies.

Participants most often recognised common symptoms such as hot flushes (71 per cent), sleep problems (68 per cent) and weight gain (65 per cent).

Broader symptoms, including fatigue, irritability and digestive changes, were far less likely to be identified as part of the perimenopause transition.

Among women aged 35 and over who reported being in perimenopause, the five most common symptoms were physical and mental exhaustion (95 per cent), fatigue (93 per cent), irritability (91 per cent), sleep problems (89 per cent) and depressive mood (88 per cent).

Dr Anna Klepchukova, chief medical officer at Flo, said: “We need to normalise conversations around perimenopause and menopause, so women feel empowered to have honest conversations with their doctors and other support systems.

“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.”

International differences

Perimenopause knowledge scores were highest in higher-income countries such as the UK, Ireland and Australia.

Lower scores emerged in Nigeria, France and parts of Latin America.

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 in Germany, Spain, Venezuela, the Netherlands and India.

Dr Mary Hedges, principal investigator at Mayo Clinic, said: “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.

“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.”

The survey ran from 6 December 2024 to 16 May 2025.