Is menopause getting worse? How obesity, birth control and 'forever chemicals' in water are making hot flashes more intense

Women are experiencing more severe menopause than previous generations of women, research suggests.

Doctors and data researchers are now coming to the conclusion that a multitude of factors – obesity, medication use, chemicals in food and pollution - are making women genetically prone to worse symptoms.

For example, nearly four in 10 middle-aged women are obese, which leaves them with chronic inflammation that already causes a host of issues the menopause makes worse - trouble sleeping, aching muscles and hot flashes. 

And there is some evidence people today living in cities with high rates of air pollution have genetic mutations that make them vulnerable to inflammation.

Additionally, women today are also more likely to speak up about their symptoms, discuss them with other women, and seek treatment from doctors, which researchers add could be responsible for the inflated numbers and help explain why women today seem to experience worse transitions.

Hot flashes are the most commonly reported symptom of menopause, with 75 percent of women having these sudden, brief increases in body temperature

Women born in 1954 and 1966 were nearly twice as likely to experience daily hot flashes at age 50 than women born in 1918 and 1930, regardless of obesity, smoking status and stress

Menopause occurs when the ovaries stop making estrogen, the female sex hormone. 

Women are considered menopausal when they haven’t had a menstrual period for 12 consecutive months, at which point their normal periods stop completely and they can no longer have babies. 

Most women experience it between the ages of 45 and 55, but the average age in the US is 51.

Night sweats and hot flashes are the most commonly reported symptoms, but a sweeping study across generations has shown women born earlier had fewer of them.

The data comes from Sweden, where researchers investigated groups of 50-year-old women born in 1918 and 1930 – the ‘earlier-born cohorts’ – and those born in 1954 and 1966, the ‘later-born cohorts.’ Those born in the later generation had more frequent hot flashes than those preceding them.

Even after taking into account smoking history, perceived high stress levels, body mass index, waist-to-hip ratio, hormone therapy, and hormonal contraceptives, recent birth cohorts still showed higher odds of experiencing daily hot flashes compared to earlier cohorts. 

It could be a function of women being more open about menopause overall. The condition has traditionally been viewed as a time in a woman's life when she is no longer vital or attractive. 

The menopausal transition usually lasts about 7 years, during which time women can experience a long roster of symptoms that go beyond just hot flashes and night sweats

But now, there is a growing number of women willing to share their menopause experiences to raise awareness and benefit others in the same transitional life stage. With that has come support groups and an increased willingness in the medical community to learn how to treat the symptoms.

Menopause is also increasingly becoming a viable market for pharmaceutical companies, too. 

The global menopause treatment market is expected to reach a value of more than $22 billion in 2032, up from $13.3 billion in 2022, according to Future Market Insights' most recent industry analysis.  

Still, almost a quarter of women do not feel comfortable talking about menopause, which is discussed in hushed tones. 

But social acceptance of the topic has grown since the latter half of the 20th century with the women’s reproductive health and feminist movements.

The world has changed drastically since the older cohorts in the Swedish study were born. Before the 1980s, for instance, obesity was a rare condition.

Women who live in areas with high pollution face risk of infertility 

The findings by Italian researchers are believed to be the first to show exposure to pollutants, such as nitrogen dioxide from car fumes, 'severely reduce ovarian reserves'. 

In the US today, roughly four in 10 women have obesity, a marker for poorer all-around health and a higher risk of chronic diseases.

Obese women are more likely to report hot flashes than women with a normal BMI. 

Body fat is like insulation. When there's more of it, it's harder for heat to escape, leading the body to get overheated more easily, causing hot flashes.

Just as obesity rates have changed over time, so have concentrations of people living in areas with unhealthy levels of pollution.

An estimated 119 million Americans live among air pollution that could harm their health, and humans live with the threat of microplastics and forever chemicals contaminating food and drinking water.

Dr Susan Reed, an obstetrician/gynecologist and professor at the University of Washington, told the Washington Post: ‘Our DNA is more complex than just what gets passed down through our eggs and sperm.

‘There’s no question that the complexity of our environment today is modifying our DNA if we look at behavior through time and how organisms adapt.’

Pollution, particularly certain chemicals found in the air and water, such as PFAS, are known to disrupt the endocrine system, which governs the balance of hormones in the body, potentially affecting estrogen, progesterone, and other hormone levels - all of which factor into menopause.

Prolonged exposure to endocrine disruptors may contribute to irregular menstrual cycles, fertility issues, and alterations in menopause onset. 

The intensity of menopause isn't the only thing that's changed over time. 

A separate 2020 study of 312,600 women born in Norway between 1936 and 1964 found the age of menopause onset increased by more than two years between women in the earlier cohort (born between 1936 and 1939) and women in the later cohort (born between 1960 and 1964), rising from 50.3 years old to 52.7 years old. 

Late menopause has been associated with an increased risk of breast cancer, but also with an increased life expectancy.