by Q: My parent’s generation didn’t seem to think menopause was a big deal. But my friends and I agree that the hot flashes and night sweats are extremely uncomfortable. Is menopause getting worse?
A: There has certainly been a cultural shift in how we frame menopause, but something seems to be changing biologically—especially in terms of hot flashes and night sweats.
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The strongest data looking at this issue comes from Sweden. Researchers investigated groups of women born in 1918 and 1930 and compared them to those born in 1954 and 1966. Over several years, they interviewed these women about their experiences with hot flashes when they turned 50 year old.
They found that women of the latest generation had hot flashes much more often than those born earlier. Thirty-five percent of women born later experienced daily hot flashes, compared to 24 percent of women from previous generations.
The question became: why?
Other studies have noted links linking certain aspects of health to hot flashes – for example, smoking and elevated BMI are associated with higher rates, and both factors have changed over the past 100 years. Stress level and medications such as contraception and hormone replacement therapy also play a role.
Therefore, the researchers built a statistical model to adjust for these possibilities among the cohort of Swedish women. If any of these factors could explain the difference in hot flashes over the generations, that change would diminish, or at least decrease.
But it wasn’t. Even after accounting for things like BMI and medication use, later-born women were almost twice as likely of daily hot flashes experience than in previous generations.
Susan Reed, a physician-scientist in women’s health and professor emeritus of obstetrics and gynecology at the University of Washington, agrees with the study’s conclusions that women today probably have more hot flashes than in previous generations. She believes it is driven by environmental, genetic and social factors that are difficult to disentangle.
“Menopause is like a big woven tapestry that brings many threads together. It’s not a straight line that connects any two things,” she said.
Why are hot flashes becoming more frequent?
One possibility is that women are becoming more likely to report hot flashes because the way we view menopause has changed. We have come a long way from the term “la menopause” invented by a 19th century French male doctor. (He wrote a whole section in his textbook about how menopause causes hysteria.)
Women are now encouraged to talk more openly about their symptoms than before.
But if we accept that the women in the Swedish study accurately reported their symptoms for the purpose of medical research, we are left searching for another explanation.
Much of what we know today about menopause comes from the Women’s Health Across the Nation Study. SWAN began in 1994 and sought to understand the menopausal transition in an ethnically and racially diverse sample of women across the United States. It enrolled 3,302 women between the ages of 42 and 52 whose menses had not yet stopped and who are still being followed today.
This study is significant in the world of women’s health – there are few studies like it (the Swedish study mentioned earlier involved mostly White, relatively lean women). From SWAN, we have learned that compared to White women, menstrual cycles go longer for those of Chinese and Japanese background, and that Black women go through a longer menopause transition – with symptoms of hot flashes and night sweats that last an average of about 10 years. The study also found that Black women were less likely to receive treatment for these symptoms than White women.
SWAN showed that a range of factors – such as a lower level of education and higher stress and anxiety – were associated with women experiencing hot flashes and night sweats for a longer period.
According to Reed, knowing these associations is helpful. For example, treatments known to relieve stress such as cognitive behavioral therapy can improve hot flashes and night sweats. Some scientists also argue that environmental changes such as pollution and global warming contribute to the perception of hot greens.
But these factors are not the end of the story, especially when it comes to intergenerational differences. Rather, they are probably markers of something else that science has yet to discover.
One of these possibilities is epigenetic changes – or changes to our DNA that occur during our lifetime.
“Our DNA is more complex than what is passed through our eggs and sperm,” Reed said. “There is no doubt that the complexity of our environment today is changing our DNA if we look at behavior over time and how organisms adapt.”
For example, she explained, babies born to obese mothers carry modifications to their DNA that may increase their own risk of obesity and cardiovascular disease later in life. Scientists have observed unique epigenetic changes in patients who undergo early menopause and among those who have worse hot flashes. But it remains to be seen exactly what causes such changes – and what role they may play in shaping women’s symptoms.
What I want my patients to know
Experiencing menopause is a normal process, but suffering is not something we should ever normalize. If your hot eyes are bothering you and your ability to enjoy your daily life is diminishing, talk to your doctor and get help. Talking about your symptoms can tell your doctor about other potential risk factors – for example, women with hot flashes are more likely to have a heart attack or stroke. Find a doctor who takes your symptoms seriously, and don’t brush your experience under the rug.
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