A “Perimenopause Guessing Game”: Flo Health Study Reveals 1 in 3 Women Age 35+ Are Unsure of Their Reproductive Stage

NEW YORK--(BUSINESS WIRE)--A groundbreaking study by Flo Health, the #1 OBGYN-recommended women’s health app, published today in Menopause: The Journal of the Menopause Society, reveals that a staggering 34% of U.S. women aged 35 and older were unsure of their reproductive stage, including whether the symptoms they were experiencing indicated they had entered perimenopause.

The research, conducted in collaboration with the Center for Women’s Health at the Mayo Clinic, also uncovered a frustrating contradiction: women aged 40-44, the age when many women are approaching the onset of perimenopause and are often experiencing the most severe symptoms, reported the highest levels of uncertainty. In fact, 42% of this group did not know if they were perimenopausal.

7,640 U.S. women aged 35 and older participated in the mixed-method study, which evaluated symptoms using the Menopause Rating Scale (MRS) as well as open responses. The new study builds on Flo’s existing research, presenting a pattern of the barriers to access medically-backed perimenopause information and care.

After analyzing open responses from participants who were uncertain of perimenopause, researchers identified three primary drivers of perimenopause uncertainty:

1. Symptom confusion and attribution (56% of responses): Many women reported severe physical or mental symptoms but doubted they were in perimenopause because their menstrual cycles remained largely regular. Others struggled to separate perimenopause from pre-existing conditions like endometriosis, postpartum weaning, or stopping hormonal birth control.
2. Knowledge gaps and conflicting information (28% of responses): A significant number of participants admitted they did not know what perimenopause meant, which symptoms qualified as perimenopausal, or incorrectly believed they were “too young” to experience it. Relying on family, peers, or the internet often yielded conflicting advice, deepening the confusion.
3. Barriers to diagnostic care (16% of responses): Even when seeking help from healthcare professionals, some women felt their concerns were dismissed or attributed symptoms to a different condition.

“This study highlights that helping women navigate perimenopause isn't only about developing new treatments—it's also about helping them recognize the transition earlier,” said Liudmila Zhaunova, PhD, Flo's Director of Science. “At Flo, we're committed to advancing perimenopause research while also providing medically backed education and support to help women navigate this stage with greater confidence.”

KEY FINDINGS

• One in three women (34%) reported being unsure of their reproductive stage, peaking at 42% among those aged 40 to 44 and rising with symptom severity.
• Among women who were uncertain of perimenopause, the most common driver of uncertainty was symptom confusion and attribution (56%), followed by knowledge gaps and information seeking (28%) and barriers to confirmation or care (16%).
• Younger women (35-39) were more likely to cite knowledge gaps, while health care barriers were highest among women aged 40 to 44.
• The findings reveal a paradox: women entering the menopausal transition and experiencing the most severe symptoms are often the least likely to recognize that they are in perimenopause.

Survey Methodology

Researchers surveyed 7,640 U.S. women aged 35 years and older in a mixed-methods study. Participants completed an anonymous survey between December 2024 and May 2025, reporting their reproductive stage, symptoms, and demographic information. Participants who said they were unsure of their reproductive stage were also invited to explain why in their own words. Researchers performed qualitative content analysis of 409 free-text responses to identify the main drivers of perimenopause uncertainty.

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.