As a new international study draws a surprising conclusion, we ask... What makes British women have the worst menopause?
By Jane Feinmann
Last updated at 11:56 PM on 14th June 2010
Whatever most of us might have thought, menopause symptoms are far from universal. In the U.S., women complain of headaches, aching joints and fatigue. In Japan, the main symptoms are constipation and backache.
But it is women in the UK who do particularly badly, suffering everything from upset stomachs and shortness of breath to irritability and depression. a major new study published last week put British women at the top of the league for unpleasant menopausal symptoms.
Researchers quizzed 1,000 British women aged 45 to 55 and compared the results to similar groups in Japan, China, Canada and the U.S. the British women fared worse in all but one of the 15 symptoms - Chinese women beating Brits with a higher score for irritability.
Symptoms: Many menopausal women complain of night sweats and hot flushes
Two out of three British women suffer from tiredness, while more than 50 per cent complain of hot flushes. This compares with just one in 20 Japanese women suffering from tiredness and one in eight from hot flushes.
So, what could account for these variations in experience? The controversial study, published in Climacteric, the journal of the International Menopause Society, says it is down to being an older woman in different cultures. The researchers say that only two of the 16 symptoms reported by women in the study had anything to do with the menopause - hot flushes and night sweats.
More...
- Childless woman, 66, becomes oldest in the world to give birth to triplets after IVF treatment
- New electroconvulsive therapy for depression
- Eyes down for safer sunglasses: From designer to chainstore, which brands offer the best protection?
'Only these can be classed as common menopausal symptoms internationally and clearly attributable to the menopause,' says the study's lead researcher, Dr volker Scheid of the Department of Integrated Health at Westminster University.
That view is backed by experts in the field. 'This study will trigger a great deal of professional debate at a time when HRT is no longer the panacea for menopausal symptoms that it was until ten years ago,' says David Sturdee, president of the International Menopause Society and a gynaecologist at Solihull Hospital.
'It adds to evidence that many symptoms widely regarded as being menopausal are totally unrelated. This study tells us as much about the quality of life of older women as it does about the clinical signs of menopause.'
There is a growing suspicion that the status of older women in the community is, at least partly, the key to understanding the menopause. And the solution may not be hormones - but talking therapies.
However, the research did appear to confirm one widely-held belief - that a diet high in natural oestrogens provides protection against hot flushes. Certainly, the Japanese and Chinese women scored lowest on physiological symptoms, thanks to their soy-rich diet.
Yet the researchers point out this belief has no scientific foundation - the low rate of hot flushes among women in China and Japan may have a very different cause.
Mr Sturdee says: 'The best way to predict how severely a woman will be affected by the menopause is to look at her mother's experience.
'We will soon have a much better understanding of what genes are involved.
'It seems likely that in countries where menopause is less of a problem there are good genes. But it's also clear that these countries tend to be matriarchal societies where older women are revered for their wisdom.
'Compare that to Britain, where older women often feel lonely and abandoned,' says Mr Sturdee.
His comments came as an ICM survey last week showed that half of older British women feel they 'become invisible' over the age of 50. The stress of growing older in such an environment worsens the impact of hot flushes, says Myra Hunter, Professor of Clinical health Psychology at King's College, London.
'There are negative images of the menopause, largely influenced by cultural views of older women in a society where youthful beauty is prized so highly,' she says.
'It's hardly surprising that women leading a busy inner city life find their self-esteem plummets as they approach the menopause.' Tackling this stress could help minimise hot flushes. Indeed, preliminary research by Professor hunter suggests cognitive behavioural therapy (CBT) can reduce the impact of hot flushes by 50 per cent.
She is directing two trials of CBT as a treatment for hot flushes in women with breast cancer and those living in pressured environments. These initial findings do not surprise Marian van Eyk McCain, a former psychotherapist and founder of The Elderwoman website.
She says the current enthusiasm for older women hanging onto their youthful looks has a downside.
'The whole thing about 60 being the new 40 means that women make greater effort to stay fit and eat well,' she adds. 'That's good, but it can also bring a lot of unhealthy denial.
'And there's subtle ageism in the compliments that older women get - about playing sports when you're 75 or "looking good for your age". I say: "This is what 75 looks like."'
Stress: The sudden drop in oestrogen during menopause can cause psychological as well as physical symptoms (posed by model)
Dr Marilyn Glenville, nutritionist, psychologist and author of the Natural Health Bible For Women, agrees. 'It's not just women in traditional cultures that celebrate older women,' she says.
'In the U.S., women talk about "power surges" rather than hot flushes and there's a new feeling there that as they get older, women gain wisdom and authority.' This, she says, is reflected in the study's better results for American women.
But the study is contentious. 'It's simply not true that hot flushes are the sole menopausal symptom,' says Charles Kingsland, a gynaecologist at the Liverpool Women's Hospital and a spokesman for the Royal College of Obstetricians and Gynaecologists.
He says: 'There is evidence that the sudden drop in oestrogen during menopause can cause psychological as well as physical symptoms. One of the most unpleasant, though fortunately easy to treat, is vaginal dryness.'
However, he agrees that low self-esteem in middle age will aggravate symptoms. He says: 'Whether or not she is stressed, I would recommend that any woman suffering menopausal symptoms try HRT.'
Yet for women who are unconvinced about HRT, the new study offers the promise of another treatment - talking therapies.
'We are optimistic that CBT could soon be offered to help women deal with hot flushes and the stress in their lives,' says Professor Hunter.
'There's no doubt that hot flushes are physiological.
'But there are huge benefits in learning to dismiss the negativity around menopause and allow symptoms to flow over you.'