New Global Flo Health Study Reveals Mental Health Issues are 1.5x More Severe for Perimenopausal Women

Among thousands of Flo app users, those in perimenopause reported higher rates of physical and mental exhaustion, irritability, depressive mood, and anxiety

NEW YORK--(BUSINESS WIRE)--New research published in Menopause: The Journal of the Menopause Society by Flo Health — the #1 OB-GYN-recommended women’s health app — reveals perimenopausal women experience psychological symptoms more than 1.5x more severely than premenopausal women worldwide. This research is part of a series of papers on perimenopause in a global landmark study by Mayo Clinic and Flo Health. The survey of 7,975 Flo app users assessed the severity of four self-reported symptoms: depressive mood, irritability, anxiety, and physical and mental exhaustion.

The research compared experiences of women aged 35 and older from 20 different countries. Respondents were asked to rate each psychological symptom’s severity using the Menopause Rating Scale (MRS), a validated clinical questionnaire used widely in menopause research. Each symptom is scored from 0 to 4, giving a total psychological domain score of 0 to 16. Higher scores mean more severe symptoms.

Perimenopausal women reported an average psychological domain score of 7.3, which was 1.5x higher than the 4.8 score from the premenopause group. Every individual symptom — depressive mood, irritability, anxiety, and exhaustion — was significantly higher in the perimenopause group, with exhaustion having the largest difference.

"We know that anxiety and depression get a lot of attention when it comes to perimenopause, and for good reason — they matter. But what stood out to us in this study was the scale of the difference in exhaustion and irritability between the perimenopause and premenopause groups," said Adam Cunningham, PhD, Lead Research Scientist at Flo and co-first author of the study. "These are symptoms that can have a real impact on daily life and work, and they deserve to be part of the conversation."

Notably, these differences remained significant after researchers adjusted for a wide range of other factors, including age, education, income, ethnicity, existing diagnoses of anxiety or depression, BMI, smoking, and alcohol consumption. Across the board, perimenopause was still independently associated with higher psychological symptom scores.

The study included more than 2,000 women in perimenopause from 20 countries across six continents, allowing us to explore international differences in psychological symptom burden. We found significant differences between countries across all four symptoms and in the overall domain score. Nigeria had the lowest mean psychological domain score — 3.5 — followed by Venezuela (4.8), Chile (5.1), Germany (5.3), and Colombia (5.4). The highest scores were seen in Brazil (8.8), the UK (8.4), Australia (8.1), Canada (8.0), and the United States (7.9).

"One of the strengths of this study is its international reach," said Liudmila Zhaunova, PhD, Director of Science at Flo and senior study author. "Including women from 20 countries allowed us to begin exploring how psychological symptoms during perimenopause may vary across populations. While these findings are exploratory, they reinforce the need for more globally representative research to better understand women's experiences and inform future education, research, and care."

KEY DATA POINTS

• This cross-sectional study compared psychological symptom scores using the validated Menopause Rating Scale among 7,975 Flo app members aged 35 and over, across 20 countries and 4 languages, comparing women in perimenopause with those not yet in perimenopause.
• Psychological symptoms (physical and mental exhaustion, irritability, depressive mood, and anxiety) were an average total of 1.5x higher in the perimenopause group, with exhaustion showing the greatest difference.
• These findings persisted after adjusting for age, education, income, ethnicity, pre-existing anxiety or depression, BMI, smoking, and alcohol consumption.
• An exploratory international analysis found significant variation in psychological symptom burden across countries, with Nigeria reporting the lowest scores and Brazil, the UK, Australia, Canada, and the US reporting the highest.

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.

Survey Methodology

A total of 7,975 Global Flo Health users aged 35 and above, who use the app in English, French, Portuguese or Spanish, were included in an online cross sectional survey. Users taking hormonal contraception or hormone therapy were excluded. The Menopause Rating Scale, a validated measure of the severity of menopause symptoms, was used to measure menopause symptom burden, with a focus on the psychological domain and its individual symptoms of depressive mood, irritability, anxiety and exhaustion.