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Psychological symptoms during perimenopause: a global perspective
Adam C Cunningham1, Mary S Hedges2, Yella Hewings-Martin1
1Flo Health, Inc., London, United Kingdom.
Menopause (New York, N.Y.)
|July 28, 2026
Summary
Women in perimenopause report significantly higher psychological symptoms, including exhaustion, compared to premenopause. These symptom burdens and differences vary by country, highlighting the need for localized support during this transition.
Area of Science:
- Reproductive endocrinology and women's health.
- Psychological well-being during midlife transitions.
Background:
- Perimenopause is associated with psychological health changes, but direct comparisons with premenopause are limited.
- Understanding these differences is crucial for targeted interventions and support.
Purpose of the Study:
- To assess and compare psychological symptoms in perimenopausal women versus premenopausal women.
- To investigate geographical variations in psychological symptom burden across different countries.
Main Methods:
- Analysis of data from Flo app users aged 35+ not using hormonal contraception or therapy.
- Utilized the Menopause Rating Scale (MRS) psychological domain and specific symptom subscales (depressive mood, irritability, anxiety, exhaustion).
- Compared perimenopausal participants with a premenopausal control group, adjusting for confounders like pre-existing anxiety or depression diagnoses.
Main Results:
- A total of 7,975 women were included (2,353 perimenopausal, 5,622 premenopausal).
- Perimenopausal women reported significantly higher overall psychological MRS scores (7.3 vs. 4.8) and individual symptoms (P<0.001 for all), with exhaustion showing the largest difference.
- Significant variations in psychological symptom burden were observed across 20 countries on 6 continents.
Conclusions:
- Perimenopausal women experience a substantially greater psychological symptom burden compared to premenopausal women.
- Exhaustion emerged as the most pronounced individual symptom differentiating the two groups.
- Geographical location plays a role in the reported psychological symptom burden during perimenopause.
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