THE ARISING · Longevity & Healthspan
Flo App Survey of 17,494 Women Finds Gaps in Perimenopause Knowledge
Most women know hot flashes can signal perimenopause. But a large global survey suggests the symptoms women say they actually have are often different: fatigue, exhaustion and irritability.
The study, published in 2026 in the journal Menopause, is a cross-sectional survey. That means it took a snapshot of women at one point in time. It cannot show that perimenopause caused any symptom. It included 17,494 women from 158 countries, all users of Flo, an international mobile health app. The survey was offered to users aged 18 and older.
Perimenopause is the time leading up to a woman's last menstrual cycle, plus the 12 months after it. The authors note that studies systematically comparing perimenopause symptoms across different cultural and geographic settings are lacking. This survey set out to help fill that gap.
The researchers measured two things. First, all participants were asked what they knew about perimenopause symptoms. Second, participants aged 35 and older reported which symptoms they were experiencing.
On knowledge, hot flashes were the most commonly recognized symptom, named by 71% of women. Sleep problems followed at 68%, and weight gain at 65%.
The symptoms women reported having told a different story. Of the participants, 12,681 were aged 35 or older. In this group, the most common symptoms were fatigue (83%), physical and mental exhaustion (83%), irritability (80%), depressive mood (77%), sleep problems (76%), digestive issues (76%) and anxiety (75%).
The pattern was similar among women who said they were in perimenopause. Symptom rates there were higher than among women who said they were not.
The authors conclude that the survey shows a discordance between what women know about perimenopause and what they experience. Hot flashes were the bestknown sign. Fatigue, exhaustion and irritability were the most commonly reported among women 35 and older.
There are limits. Fatigue, poor sleep and low mood are common for many reasons, so these results do not show that any one woman's symptoms come from perimenopause. App users are also a self-selected group and may not represent all women.
The main message is about awareness. If people expect only hot flashes, other changes may go unrecognized. Further research that compares regions in more detail will show how far these gaps in knowledge vary around the world.
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