Flo Health has published new research in npj Women’s Health revealing that perimenopause symptoms begin much earlier than commonly recognized, with psychological effects often preceding physical symptoms.
The study, co-authored by Dr. Jennifer Payne, Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia, examined symptom patterns across 4,400 U.S. women aged 30 and older, uncovering two significant findings that challenge current understanding of perimenopause.
First, the research revealed that nearly two-thirds (64.3%) of women aged 36-40 experience moderate to severe perimenopause symptoms, yet only 8% of these women seek medical help, with most waiting until their mid-50s before consulting healthcare providers.
Second, the study found that mood symptoms like anxiety and irritability peak in early perimenopause (ages 41-45), while physical symptoms such as hot flashes become more prominent in later perimenopause (ages 51-55)—a progression pattern not previously demonstrated in research.
“These findings indicate that perimenopausal symptoms vary in different age groups. For example, mood symptoms are most prominent in early perimenopause (age 41 to 45), and vasomotor and other physical symptoms are more prominent in later perimenopause (age 51 to 55), which has not been demonstrated before,” said study coauthor Dr. Jennifer Payne. “Knowing this type of progression of perimenopause-associated symptoms can help both women and their doctors know what to expect as women enter the perimenopausal portion of their lives,” she continued.
The research also found that perimenopause symptoms affect women much younger than typically recognized. Over half (55.4%) of women aged 30 to 35 self-reported symptoms that met the criteria for moderate or severe symptom burden according to the Menopause Rating Scale (MRS).
“We had a significant number of women who are typically thought to be too young for perimenopause tell us that they have high levels of perimenopause-related symptoms,” said Liudmila Zhaunova, PhD, director of science at Flo. “It’s important that we keep doing research to understand better what is happening with these women so that they can get the care they need.”
The study highlights a critical gap in perimenopause research and education. Over 90% of women have never received education about menopause in school, and more than 60% feel uninformed about what to expect. This knowledge gap extends to medical training, with only 20% of OB/GYN residents reporting that their programs include a formal menopause curriculum.
“Physical and emotional symptoms associated with perimenopause are understudied and often dismissed by physicians. This research is important in order to more fully understand how common these symptoms are, their impact on women and to raise awareness amongst physicians as well as the general public,” added Dr. Jennifer Payne.
According to a report from Harvard Medical School, less than 1% of published medical studies focus on menopause, indicating that perimenopause is likely even more neglected in research. The Flo study represents an important step toward addressing this gap and calls for increased research and support for women experiencing perimenopause.
The study used the Menopause Rating Scale (MRS) questionnaire to assess symptoms and their severity. While the findings provide valuable insights, the researchers note that the study relied on self-reported symptoms, and further longitudinal research will be necessary to fully understand the progression of perimenopause symptoms.
