New Flo Health and Mayo Clinic Study Reveals American Women Are Falling Behind in Perimenopause Awareness

A groundbreaking new study from Flo Health and Mayo Clinic is shedding light on a troubling gap in women's health knowledge, and the findings suggest that American women may be more in the dark about perimenopause than many of their global peers.

Published in Menopause, the official journal of The Menopause Society, the research represents the first large-scale digital study of its kind. More than 17,000 women across 158 countries participated through the Flo Health app, answering questions about their knowledge, experiences, and attitudes surrounding perimenopause. The results paint a picture of widespread misunderstanding about a biological transition that affects the vast majority of women over 40.

Perhaps most striking is the United States' position in the global rankings. Despite a growing cultural conversation around menopause, fueled by celebrity advocacy, workplace policy changes, and media coverage, American women ranked sixth overall in perimenopause knowledge. Countries including the United Kingdom, Ireland, Canada, Australia, and the Netherlands all scored higher.

"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 study revealed that while many women could identify the most commonly discussed symptoms like hot flashes, sleep problems, and weight gain, broader symptoms were far less recognized. Fatigue, irritability, and digestive changes, all of which are frequently reported by women in perimenopause, were often overlooked as part of the transition.

This disconnect between perception and reality matters. Among women aged 35 and older who reported being in perimenopause, the most commonly experienced symptoms were physical and mental exhaustion (95%), fatigue (93%), irritability (91%), sleep problems (89%), and depressive mood (88%). These numbers suggest that the day-to-day reality of perimenopause is far more complex than the hot-flash-centric narrative that dominates public discourse.

The knowledge gap isn't just an American problem, however. Globally, women in higher-income countries demonstrated greater symptom recognition than those in lower- and middle-income countries, though overall awareness remained low across all income levels. The lowest knowledge scores were reported in Nigeria, France, and parts of Latin America.

Interestingly, the study also uncovered regional differences in symptom experiences. Digestive issues ranked among the top three reported symptoms in Nigeria, South Africa, India, France, Ireland, and several Latin American countries, while mood-related symptoms like anxiety and depressive mood were more prominent in Germany, Spain, the Netherlands, and India.

Dr. Mary Hedges, the study's Principal Investigator at Mayo Clinic, emphasized the clinical implications: "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."

For Flo Health, the world's most-downloaded women's health app with 77 million monthly active users, the study underscores the platform's broader mission to close the gap in women's health literacy. As the first European femtech unicorn, Flo has long positioned itself as a resource for evidence-based health information, and this research with Mayo Clinic represents a significant step toward bringing clinical rigor to a conversation often driven by anecdote rather than data.

The findings serve as a call to action for healthcare providers and patients alike: perimenopause education needs to better reflect the lived experiences of women going through it.