If you've hit your late 30s or 40s and started wondering why you're suddenly so tired, so irritable or so anxious for no clear reason, new research says it's not in your head or the result of a late-night social media scroll…or rather, it is in your head, but it's backed by data. A global study published in Menopause: The Journal of the Menopause Society found that women in perimenopause report psychological symptoms more than 1.5 times as severe as women who haven't yet entered that transition.
The research, conducted by Flo Health in partnership with Mayo Clinic, surveyed 7,975 users of the Flo app across 20 countries and four languages. All participants were 35 or older, and none were on hormonal contraception or hormone therapy at the time. Using the Menopause Rating Scale, a clinically validated tool, researchers scored four psychological symptoms: depressive mood, irritability, anxiety and physical and mental exhaustion, each rated 0 to 4, for a possible total of 16.
Perimenopausal women averaged a psychological domain score of 7.3, compared with 4.8 for premenopausal women. Every symptom was significantly elevated in the perimenopause group, but exhaustion showed the widest gap.
"We know that anxiety and depression get a lot of attention when it comes to perimenopause, and for good reason—they matter," said Adam Cunningham, PhD, lead research scientist at Flo and the study's co-first author. "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. These are symptoms that can have a real impact on daily life and work, and they deserve to be part of the conversation."
Researchers controlled for age, education, income, ethnicity, existing anxiety or depression diagnoses, BMI, smoking and alcohol use—and the link between perimenopause and higher psychological symptom scores held regardless.
The study also turned up notable geographic variation. Among more than 2,000 perimenopausal participants across six continents, Nigeria posted the lowest average score (3.5), followed by Venezuela, Chile, Germany and Colombia. The highest scores came from Brazil (8.8), the United Kingdom (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 the study’s senior 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.”
The findings are part of a larger series of perimenopause papers from the Flo Health–Mayo Clinic collaboration, adding to a growing body of research pushing the psychological side of perimenopause further into the clinical and cultural conversation.
