Q: My parents’ generation didn’t seem to think menopause was that important. But my friends and I agree that hot flashes and night sweats are incredibly uncomfortable. Does menopause get worse?
A: The way we frame menopause has certainly changed culturally, but something seems to be changing biologically too, especially in terms of hot flashes and night sweats.
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The strongest data examining this question comes from Sweden. Researchers examined groups of women born in 1918 and 1930 and compared them to women born in 1954 and 1966. Over decades, they interviewed these women about their experiences with hot flashes as they turned 50.
They found that women of more recent generations were significantly more likely to experience hot flashes than those born earlier. Thirty-five percent of later-born women suffered daily hot flashes, compared to 24 percent of women from earlier generations.
The question became: why?
Other studies have shown links between certain aspects of health and hot flashes. For example, smoking and increased BMI are associated with higher rates, and both factors have changed over the past hundred years. Stress levels and medications such as birth control 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 between generations, the change would disappear, or at least decrease.
But that didn’t happen. Even after taking into account things like BMI and medication use, women born later were almost twice as likely of experiencing daily hot flashes 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 are likely to experience more hot flashes than in previous generations. She believes this is caused by environmental, genetic and social factors that are difficult to distinguish from each other.
“Menopause is like a big woven tapestry that brings together many threads. It is not a straight line connecting two things,” she said.
Why are hot flashes becoming more common?
One possibility is that women are increasingly reporting hot flashes because the way we view menopause has changed. We’ve come a long way since the term ‘la menopause’ was coined by a 19th century French male physician. (He wrote a whole section in his textbook on how menopause causes hysteria.)
Women are now encouraged to talk about their symptoms more openly than in the past.
But if we accept that the women in the Swedish study accurately reported their symptoms for the purposes of medical research, we must look for another explanation.
Much of what we know about menopause today comes from the Study of Women’s Health Across the Nation. SWAN began in 1994 and sought to understand the menopausal transition in an ethnically and racially diverse sample of women in the United States. It enrolled 3,302 women aged 42 to 52, whose menstruation had not yet stopped and continues to follow them today.
This study is monumental in the world of women’s health – there are few similar studies (the aforementioned Swedish study involved mostly white, relatively thin women). From SWAN we learned that compared to white women, people from Chinese and Japanese backgrounds experience longer menstrual cycles, and black women experience a longer transition to menopause – with symptoms of hot flashes and night sweats lasting 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 revealed that a range of factors – such as lower levels of education and higher levels of stress and anxiety – were linked to women experiencing hot flashes and night sweats for a longer period of time.
According to Reed, it is useful to know these associations. For example, treatments known to reduce stress, such as cognitive behavioral therapy, can improve hot flashes and night sweats. Some scientists also claim that environmental changes, such as pollution and rising global temperatures, worsen the perception of hot flashes.
But these factors are not the end of the story, especially when it comes to differences between generations. Rather, they are likely markers of something else that science has yet to discover.
One of these possibilities is epigenetic changes – or changes in our DNA that occur during our lifespan.
“Our DNA is more complex than just what is passed on through our eggs and sperm,” Reed said. “There is no doubt that the complexity of our environment today is changing our DNA when we look at behavior over time and how organisms adapt.”
For example, she explained that babies born to obese mothers experience changes in their DNA that can increase their own risk for obesity and cardiovascular disease later in life. Scientists have observed unique epigenetic changes in patients who enter menopause early and in patients with worse hot flashes. But it remains to be seen what exactly triggers these 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 never something we should normalize. If you experience hot flashes and they reduce your ability to enjoy your daily life, contact your doctor and seek help. Talking about your symptoms can help your doctor identify other potential risk factors. For example, women with severe hot flashes are more likely to have a heart attack or stroke. Find a doctor who takes your symptoms seriously, and don’t sweep your experiences under the rug.
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