Liudmila Zhaunova talks global Flo app data on perimenopause and activity

Liudmila Zhaunova on a global Flo app study linking higher physical activity to lower perimenopause symptom burden. Perimenopausal women who are more physically active report a lower symptom burden, according to a global study using data from the Flo menstrual tracking app and one of its authors, Liudmila Zhaunova of Flo Health in London, United Kingdom.

Zhaunova discussed the findings in an interview at The Menopause Society Annual Meeting 2026 in San Diego, California, where the study was presented. 1 Perimenopause is a natural reproductive transition often accompanied by symptoms such as brain fog, anxiety, irritability, and sleep problems that affect quality of life, Zhaunova said, and physical activity is a modifiable everyday behavior with broad health benefits.

A global look at activity and symptom burden The cross-sectional study included 1808 Flo users aged 35 years or older who self-identified as perimenopausal, across 87 countries and six continents, with a mean age of 45 years. 1 Participants reported physical activity frequency on a five-level scale and completed the Menopause Rating Scale (MRS).

1 Mean total MRS scores fell as activity increased, from 17.46 among those who were not physically active to 13.77 among those active 5 or more days per week ( P < .001), with the same pattern across the somatic, psychological, and urogenital domains. 1 After adjustment for confounders including age, BMI, smoking, comorbidities, healthcare access, and a country-level Socio-Demographic Index, higher activity remained inversely associated with total MRS scores (β = −0.57; P < .001).

1 Zhaunova said the Flo dataset allowed the team to look beyond the high-income, largely European and US-populations that dominate menopause research. “We wanted to reach global samples,” she said, noting that the study included middle- and low-income countries such as the Philippines, South Africa, Nigeria, and Brazil, and multiple languages.

Even small increases may help The most encouraging finding, Zhaunova said, was that the largest difference in symptom burden appeared between women who did not exercise at all and those who exercised only a few times a month. “If you are not physically active, even small increases in your everyday activity could be really beneficial,” Zhaunova said, adding that a few times per week or month “is already better than none.” The evidence could inform further research into whether physical activity can serve as a non-medication approach to perimenopause care, she said.

Zhaunova also noted a key limitation: because participants were users of a menstrual-cycle tracking app, the sample may not be representative of all women in each country. Reference Cunningham A, Castillo Silva J, Hewings-Martin Y, et al. Physical activity frequency and perimenopause symptom burden: global insights from the Flo app.

Presented at: The Menopause Society Annual Meeting. October 20-24, 2026. San Diego, California.

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