A global survey of 17,494 women from 158 countries found that hot flashes were the best-known perimenopause symptom, but fatigue, exhaustion and mood changes were far more common in day-to-day life. Published in Menopause and built from Flo app survey data collected between December 6, 2024 and May 16, 2025, the paper shows a clear gap between what women recognise and what they actually feel.
The study, the first in a planned Mayo Clinic and Flo Health series, asked both about knowledge and lived experience. Among all respondents, 71% identified hot flashes, 68% pointed to sleep problems and 65% to weight gain. But among the 12,681 participants aged 35 and over, the most common symptoms were fatigue and physical and mental exhaustion, both at 83%, followed by irritability at 80%, depressive mood at 77%, sleep problems at 76%, digestive issues at 76% and anxiety at 75%. The symptom pattern was similar among people who said they were in perimenopause, but higher than among those who did not.
For UK readers, the pattern matters because it matches what NHS and professional guidance already says but many women still do not hear clearly enough. The NHS says perimenopause symptoms can begin in the 30s and that ethnic background can affect how severe they are and how long they last. NICE’s menopause guideline, NG23, was last updated on April 15, 2026. RCOG also describes perimenopause as the phase when periods have not stopped but menopausal symptoms are present, and says it can affect relationships and work.
That wider framing matters in a country where NHS England has cited about 13 million peri- or menopausal people, roughly a third of the female population, and where the government has linked menopause support to recruitment and retention of older women. The House of Commons Women and Equalities Committee has already put menopause at the centre of workplace policy, which is why survey data on symptom recognition can influence everything from employer education to app-based screening prompts.
What the study does not show is a random global picture of all women in midlife. It captures Flo app users, which means the sample is digital, self-selected and likely tilted towards people already looking for health information on a smartphone. Women without app access, without English-language fluency, or who do not use menstrual or menopause tracking tools are less likely to be represented. That is a real limit on how far the findings can be generalised.
Even so, the direction is hard to ignore: women may know the headline symptom, but many are living through a much broader cluster of fatigue, mood change, sleep disruption and digestive problems. For UK care, that means the conversation has to move beyond hot flushes and weight gain, and into the full symptom picture women are describing in clinic, at home and at work.