Study Finds Perimenopause Linked to Higher Mental Distress

By: Women Entrepreneurs Review Team | Thursday, 30 July 2026

A new study published in Menopause: The Journal of the Menopause Society has found that women in perimenopause experience more than 1.5 times greater psychological distress than premenopausal women worldwide.

The research is from a series of papers on perimenopause as part of a global landmark study developed by Mayo Clinic and Flo Health. The survey was conducted on 7,975 individuals who used the Flo app and assessed the severity of four symptoms they reported: feeling depressed, feeling irritated, feeling anxious, physically and mentally exhausted.

The study compared the experience of women (aged at 35+) in 20 countries. The severity of each psychological symptom was evaluated using the widely used clinical questionnaire for study of menopause, the Menopause Rating Scale (MRS), which included 35 items and each participant rated the severity of each item. Scores in the psychological domain are added up, and range from 0-16. There is a positive correlation between symptom severity and scores.

The women in the perimenopause group had a higher psychological domain score than the women in the premenopause group (7.3 vs. 4.8, respectively). Each of the four individual symptoms—depressive mood, irritability, anxiety and exhaustion—was significantly greater in the group in perimenopause, and with the greatest difference in exhaustion.

Key Highlights:

• Perimenopausal women reported 1.5 times higher psychological distress than premenopausal women
• Exhaustion was the most severe symptom, followed by anxiety, irritability, and depression
• Psychological symptoms varied across countries, with the highest scores reported in Brazil, the UK, Australia, Canada, and the U.S

"We know that anxiety and depression get a lot of attention when it comes to perimenopause, and for good reason — they matter. 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," said Adam Cunningham, PhD, Lead Research Scientist at Flo and co-first author of the study. "These are symptoms that can have a real impact on daily life and work, and they deserve to be part of the conversation.

Importantly, these differences persisted after controlling for many other factors such as age, education, income, ethnicity, prior diagnoses of anxiety or depression, BMI, smoking, and alcohol intake. In all cases, higher psychological symptom scores were also independently linked to perimenopause.

More than 2,000 women in perimenopause in 20 countries from six continents were included, enabling us to examine differences between countries around the world in the burden of psychological symptoms in perimenopausal women. Results indicated the significant inter-country differences for all four symptoms in addition to the overall domain score. Nigeria recorded the lowest mean score of 3.5 for psychological domain followed by the South American countries namely, Venezuela (4.8), Chile (5.1), Germany (5.3) and Colombia (5.4). The highest scores were seen in Brazil (8.8), the UK (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 senior study 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,” added.