The Perimenopause Symptoms Women Don't Expect

Millions of women are living with perimenopause without knowing that is what it is.

A study published earlier this year in Menopause, the journal of The Menopause Society, has found a striking gap between the symptoms women associate with perimenopause and the symptoms they actually experience. The research, conducted in collaboration with Mayo Clinic and the women's health app Flo, surveyed 17,494 women from 158 countries and is the largest global study of perimenopause knowledge and symptoms conducted to date.

What women think perimenopause looks like

When asked which symptoms they associated with perimenopause, the most commonly recognised were hot flushes, cited by 71% of participants, followed by sleep problems at 68% and weight gain at 65%. These are the symptoms most often discussed in public health messaging and media coverage of the menopause transition.

What women actually experience

Among the 12,681 participants aged 35 and over, the picture looked considerably different. The most commonly reported symptoms were fatigue and physical and mental exhaustion, each reported by 83% of women in this group. Irritability was reported by 80%, depressive mood by 77%, sleep problems by 76%, digestive issues by 76% and anxiety by 75%.

Hot flushes, the symptom most strongly associated with perimenopause in public awareness, did not feature at the top of the list of what women were actually experiencing.

Why this gap matters

Perimenopause is the transition leading up to a woman's final menstrual period. It can begin as early as the mid-thirties and usually last for 3-10 years, yet it remains significantly under-researched compared to menopause itself. When women do not recognise fatigue, low mood, anxiety or digestive changes as potential hormonal symptoms, they are less likely to seek support, less likely to receive an accurate diagnosis and more likely to have their symptoms attributed to stress, depression or other causes entirely.

Dr Stephanie Faubion, medical director of The Menopause Society and a co-author of the study, described the findings as demonstrating a clear gap between knowledge about perimenopause and the symptoms women are living with day to day.

The study also identified significant differences in both symptom awareness and symptom experience between countries. The UK, Ireland, Canada, Australia and the Netherlands ranked higher than the United States on overall perimenopause knowledge, with the US placing sixth. These regional differences suggest that public health education around perimenopause is inconsistent globally and that cultural context shapes which symptoms women learn to recognise and report.

What the study cannot tell us

The data was collected through a health tracking app, which means the sample is self-selected and may not fully represent women without access to digital health tools or those who do not actively track their health. The study is cross-sectional, meaning it captures a snapshot rather than tracking women over time. It cannot establish causation or confirm that the symptoms reported were directly attributable to hormonal changes rather than other factors.

The findings do, however, provide the most geographically diverse picture of perimenopause symptom experience published to date, and they reinforce a consistent pattern seen in smaller studies: the symptoms women are most likely to dismiss or attribute elsewhere are often the ones perimenopause most commonly causes.

Reference

Hedges MS et al. Global perspectives on perimenopause: a digital survey of knowledge and symptoms using the Flo application. Menopause. 2026. doi: 10.1097/GME.0000000000002730

Editorial Note

This article is for informational purposes only and is not a substitute for professional medical advice. If you have concerns about your health, speak to a qualified healthcare professional.