From genetics and hormone sensitivity to stress, weight and gut health, discover why menopause symptoms vary so widely between women and what may help
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Whilst I was lucky (or unlucky!) enough just to get bad anxiety, other women I know have had every menopause symptom going; from achy bones and hot flushes to brain fog and sleep problems – for some all at the same time. Discover the science behind why women experience menopause differently.
Why do women have different experiences of menopause?
Menopause isn’t sadly a one-size-fits-all transition; for some lucky women it is a breeze and for others it can be a struggle. Neither means that one woman is healthier than another, but there are certain factors that can play a part. It’s all down to things like our genetics, brain chemistry, hormones, sleep, stress, background, medical history and lifestyle.
Is age a main factor?
It seems not. According to nurse consultant Hazel Hayden, founder of the Bristol Menopause & Wellwoman Clinic:
“Many people assume symptoms are directly linked to age, but age alone tells us very little. A 45-year-old woman in perimenopause can experience significant symptoms, while a 50-year-old woman who has reached menopause may report almost none.”
Below, we look at what factors do effect our menopause experience.
Our hormones
“The main reason is not always the hormone levels themselves, but how sensitive each individual’s body and brain react to hormonal change,” explained Hazel. “Some women can tolerate fluctuations in oestrogen with ease, whilst other women are far more sensitive and this can be to even small hormonal shifts, particularly within areas of the brain that regulate temperature, sleep, mood, memory, and cognition.
“Often for most women, the troublesome symptoms occur during perimenopause, the years leading up to menopause, rather than after menopause itself. During this stage, oestrogen levels can fluctuate dramatically from day to day and month to month. These fluctuations can trigger hot flushes, night sweats, anxiety, mood changes, sleep disturbance, and brain fog. In contrast, a woman who has already reached menopause may have lower but more stable hormone levels and therefore feel significantly better.
“The is not simply about how much oestrogen a woman has. The way her brain and body respond to hormonal change also matters, and researchers are still working out why.”
There are also differences in how each individual’s brain responds to declining oestrogen, Hazel pointed out.
“Oestrogen has important effects on neurotransmitters such as serotonin, dopamine, and noradrenaline, which influence mood, concentration, motivation, and wellbeing. This can help to explain why some women notice significant changes in cognition and mental health, whereas others report very few symptoms.
“It is also important to remember that symptom severity does not reflect hormone levels or indicate whether someone is having a “better” or “worse” menopause. Two women can have very similar hormone profiles but completely different experiences.”
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Our genetics
“Genetics also plays a major role,” added Hazel. “We often see similarities within families. Women whose mothers or sisters experienced significant menopausal symptoms may be more likely to experience them themselves.”
Stress levels
It’s no surprise that stress plays a huge part in menopause.
Dr Reamika West, a specialist in integrative women’s health and bioidentical hormone balancing for the Marion Gluck Clinic, says high stress levels are known to worsen many menopause typical symptoms.
“High cortisol levels (common in chronically stressed states) can further reduce the calming hormone progesterone (which starts to drop during perimenopause), resulting in worsened anxiety and mood swings.
“Stress worsens hot flushes by narrowing the “thermoneutral zone” already narrowed by oestrogen, which means the brain reacts by triggering a hot flush during very minor changes in temperature,” she explained. “Chronically elevated cortisol levels can impact brain fog which can be further worsened with oestrogen fluctuations.”
Our weight
“Obesity and being sedentary can also affect symptoms, as inflammation levels tend to be higher, which can result in worse joint pains, hot flushes, and blood sugar dysregulation (also impacted by fluctuating oestrogen levels),” added Dr West.
Gut health
Gut health can play a role in our symptoms and is often an overlooked part of the menopause. This is because the gut and our hormones are closely connected and changes in the gut microbiome have an influence on how our oestrogen is processed in the body.
“Gut health can play a role, also due to inflammation, and via enzymes made by microbes that affect the excretion of hormones like oestrogen,” said Dr West.
Smoking
Although there is no firm evidence that smoking-related changes in gut bacteria make menopause symptoms worse, research does point to people who smoke may experience more hot flushes.
“Smoking also impacts oestrogen metabolism, and is associated with earlier menopause,” said Dr West.
Health conditions
Various health conditions can impact menopause, such as thyroid disorders, people with diabetes and those with heart conditions – although symptoms may compound each other.
Dr West adds: “Prior mood disorders and conditions such as ADHD can mean worse mood symptoms with the hormonal shifts of perimenopause, due to differences in brain receptors to what we call “neurosteroids” (this may be one reason why many women are first diagnosed with ADHD during perimenopause).”
How to help yourself during menopause
“To try and help manage your symptoms, I suggest regular physical activity, healthy nutrition, good sleep habits, and effective stress management as these may help some women experience a smoother transition,” said Hazel.
And Dr West adds: “Women who eat a varied and healthy diet, who exercise regularly, maintain strong social connections, and who don’t have chronic stress tend to be able to cope with the hormonal fluctuations without experiencing debilitating symptoms. This can explain why a woman age 45 can feel overwhelmed and like she isn’t the same person anymore, whereas a woman age 50 can have very minor symptoms or even none at all.”
Final note
All the information above reflects the fact there is no “normal” menopause experience. A woman who feels well at 50 is not unusual, nor is a woman who develops symptoms at 45. Both experiences are to be expected.