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What was Menopause like for our Mothers and Grandmothers?
A new study pulls back the curtain just a little
I’m fascinated with the history of menopause, and unfortunately we have precious little of it as most of what was written on the subject, such as it is, comes from men. Menopause was either a death sentence, or not significant enough to mention. Nice dichotomy.
I often wonder how our ancestors coped with hot flashes? Were they worse or better? What did they think caused them? Although, the answer to the last one would almost certainly be a build up of “toxins”, as menstrual blood was believed to contain “toxins”, so when periods stopped, the toxins backed up into the blood.
One of the first accounts of hot flashes in the medical literature was in 1582, by Dr. Jean Liébault, a French physician. He described them as petite rougers. He recorded that they typically occurred in the face and ended in profuse sweating or moiteurs. Sounds pretty similar! And in the 1700s women in England referred to hot flashes as hot blooms. I personally prefer that term, as it really does feel like the heat is coming out of your head.
So women were having them, but were they as common as we seem to experience today?
It’s a hard question to answer, but researchers in Sweden have uncovered a piece of the puzzle. They were able to obtain data on hot flashes from the Prospective Population Study of Women in Gothenburg. In this study, women were asked a variety of questions about their health, which included questions about stress, smoking, and yes, hot flashes. Women completed the questionnaire at age 50 and the researchers were able to collect data from women born in 1918, 1930, 1954, and 1966.
What did they find?
Women born in 1918 and 1930 were less likely to report hot flashes at age 50 than their counterparts those born in 1954 and 1966. The results are a little broad, these are yes/no answers at a specific point in time, so we don’t know how long these hot flashes lasted for these women or the severity. However, 33% of 50-year-old women born in 1966 and 38% born in 1954 had daily hot flashes versus 22% born in 1930 and 25% born in 1918.
So what does this mean?
We have to be careful about reading too much into this, because this is a small snapshot of four periods in time. Basically, we’re getting a quick peek through a window. We don’t know the age of the women at menopause or the duration of the menopause transition.
Interestingly, the only factor that was related to hot flashes was taking hormone therapy. The likely explanation is women with a worse hot flash experience were more likely to take hormones. Otherwise, no single contributing factor for hot flashes emerged, such as smoking or BMI or stress.
Assuming the data is correct, this means the current generation of women in Sweden who are in menopause report more daily hot flushes at age 50 than than women born almost 50 years before. Why?
One hypothesis raised by the research is the presence of endocrine disrupting chemicals which are more prevalent today. The researchers point out that some phthalates may also be linked with menopause.
But I think we need to consider other options as well. Might diet play a role? Lifestyle? Working conditions? Community support?
There is also the possibility that there are cultural differences in willingness to discuss menopause symptoms, even in the context of a medical study. Thinking back to my own mother, born in 1934, I doubt she would have told any researcher she had hot flashes if just asked one or two questions, especially if a man were asking. And she was plagued with hot flashes for years. I think it would have been a mix of shame and stoicism. So, I wonder if women born in 1918 and 1930 might have been less forthcoming about what may have been seen as “private” symptoms.
Interestingly, when the anthropologist Margaret Lock studied women with hot flashes in Japan in the 1980s, only 20% or so of women reported hot flashes. Fast forward just 20 years and many more women were reporting hot flashes. One theory is that once a word for hot flashes entered the lexicon, there was now permission to discuss the symptoms.
There was also a study that looked at women of Japanese and European descent living in Hawaii. Both groups recorded their hot flashes, but they were also hooked up to equipment that measured hot flashes so the researchers could match the experience with what was actually happening in the body. Physically as recorded by the equipment, the two groups had roughly the same number of hot flashes, but the Japanese American women were about half as likely as their American European counterparts to report they were feeling the hot flashes while they were having them.
In addition, some women report hot flashes when physically there is no sign of them. Does this mean the hot flash is occurring in the brain, but the body isn’t responding or is something else being interpreted by the brain as a hot flash?
Basically, studying hot flashes is complicated both from a biological and a cultural perspective.
This new study can’t tell us much beyond the fact that when asked a few questions, women living in Sweden who were 50 years old in 1966 and 1954 were significantly more likely to report daily hot flashes than 50 year old women born in 1930 and 1918. Regardless, I think it’s interesting and it tells us that we need to be tracking the menopause experience over time, because it’s possible that this information may in turn help us understand why some women suffer much more from hot flashes than others. Are hot flashes really changing or are women now feeling they can speak more about them? It’s an important question.
I’m not writing about this study because it offers any solutions, but because it’s interesting. It also tells us the importance of having detailed data and of following women over time, and they are doing both with SWAN (the Study of Women’s Health Across the Nation). I just heard at the annual meeting of the North American Medical Society that SWAN participants are coming in for their 17th year of evaluation and blood work!
So kudos to the researchers for giving us a little glimpse of the past. In many ways it’s like finding a photograph with just a date written on the back. It raises more questions than it answers. But that’s okay, because great questions are the first step in great research.
Kerstin Rödström, MD, PhD, Lilian Weman, BA, Valter Sundh, MS, and Cecilia Björkelund, MD, PhD. Perception of higher frequency of daily hot flashes in 50-year-old women today: a study of trends over time during 48 years in the Population Study of Women in Gothenburg, Sweden. Menopause. 2022;29,1124-1129.