Genes and Menopause: Is the age you start menopause genetic?

Are menopause symptoms hereditary? And are you likely to have a similar menopause to your mum?

Dr Rebeccah Tomlinson, menopause specialist GP, examines the evidence...

As things stand no one can precisely predict when you will go through menopause or how it will affect you. That said, there are studies that have been carried out on mothers and daughters, female twins, sisters and aunts and nieces which show genetics do play a role in predicting the age you are likely to go through this transitional time. Science has yet to get to a point where genetic profiling can forecast menopause age accurately, but mounting research is helping us to slowly understand more about the hereditary aspects and how they can be helpful for understanding your personal menopause journey.

Does menopause age run in families?

Both perimenopause (the lead-up to the menopause which generally happens from the mid 40s onwards but can start as early as your late 30s¹ ) and menopause can occur earlier than the average age (51 in the UK²) as a result of lifestyle factors like smoking. They can also be accelerated by medical treatments like chemotherapy or having a hysterectomy.

So, while the age you will experience menopause is generally accepted to be significantly influenced by your family history – and the age your mother or close female relatives went through it - it is also shaped by both environmental and lifestyle factor and there are a wide range of variables that can affect its timing. Studies have found racial/ethnic differences as to when women start their perimenopause and menopause³ and there is even research showing those living in urban areas have a slightly later natural menopause than those in rural ones⁴. There is some research to suggest being overweight can lead to a later menopause, and that being underweight leads to an earlier one⁵. Women who have never had children also appear to go through menopause earlier and women who have given birth three times have the highest average age at menopause, according to one study⁶. (The same study found that having more than three children did not however lead to an even later age of entering it).

The timing of your menopause

What makes it trickier to predict the timing of your menopause is that using hormonal contraception can mask symptoms of menopause, going through IVF can trigger side effects which are similar to symptoms of perimenopause and menopause and IVF treatments are also linked to having an earlier menopause⁷.

Research also shows having Polycystic Ovary Syndrome (PCOS) can lead to a later menopause (on average two to four years later)⁸. Having certain medical conditions such as autoimmune disorders like rheumatoid arthritis and thyroid problems have also been linked to earlier menopause⁹. If your mother or close female relative had an early or late menopause the likelihood is you will too¹⁰. Having a sister who went through an early menopause (between the ages of 40-45) appears to be the biggest indicator you might also¹¹. This information is significant because of the greater risks to your health posed by an early menopause including an increased risk of cardiovascular disease, osteoporosis, cognitive issues and overall life expectancy. Research also shows that women who go through menopause later than average (after 55) have a higher risk of breast and endometrial cancers¹² but a lower risk of cardiovascular disease¹³.

Are menopause symptoms hereditary?

The ‘when’ of your menopause is, of course, only one part of the story - the ‘how’ remains the other and the severity of your symptoms can also be coloured by your genes. Recent Health and Her research confirms this - with 69% of women who asked their mum finding that their perimenopause symptoms were similar.

Studies also show vasomotor symptoms – hot flushes and night sweats – appear to be influenced by genetic factors and can differ across racial and ethnic groups. The Study of Women’s Health Across the Nation (SWAN)¹⁴ has shown that Black and Latina women enter menopause earlier and have more severe vasomotor symptoms than white women (in the study, white women were shown to experience them for around 6.5 years, Latina women 8.9 years and 10 years for Black women). A study from UCLA published in the journal Menopause¹⁵ has also identified gene variants which affect a receptor in the brain (known as the tachykinin receptor 3 or TACR3) which regulates the release of oestrogen. These variants are found across ethnicities, and it has been found that women who have them are more likely to suffer with hot flushes and night sweats. More research in this area is needed but scientists are hopeful that by identifying these gene variants’ effects on oestrogen it could potentially lead to finding treatments for flushes and night sweats.

Will you have your mother’s menopause?

Whilst the science moves slowly forward into the links between genes and menopause getting your mum’s personal take on her experience can also be insightful, informative, and hopefully reassuring.

Recent Health and Her research suggests this is very much the case with 71% of women saying that asking their mum about it helped them diagnose their own menopause sooner and 80% reporting that having a mother-daughter chat about the issue helped them to not only diagnose their perimenopause earlier but left them feeling better supported, better educated and more confident about how to manage their symptoms.

However, while knowing your mother’s menopause history might provide a more rounded picture for some, accessing this information can be hard for others. Not least because many older women felt (or still feel) embarrassed talking about it. Also, many didn’t recognise that what was happening was the menopause (let alone the perimenopause – a relatively new term) and they didn’t have access to research or knowledge about the subject (including sharing information amongst themselves online) that we have now. Nor does everyone have ready access to that part of their family history – if, say, you were adopted or your mother is no longer around. Ideally if you can glean information from other close female relatives, like an aunt, or older sister, this should help but if you don’t know about your blood relatives this shouldn’t leave you feeling at a disadvantage.

The bottom line is that whilst asking about your mother’s menopause can offer a potential snapshot of what your experience might be it is not genetically set in stone and there is so much you can do to shape how your own plays out.

Take control of your own menopause

Using the latest research, information and online tools available all women can help to take control of their own symptoms from perimenopause onwards by:

Preparing for it. Track your symptoms using the Health & Her app to pinpoint how they manifest themselves and if, and when, they get better or worse. Build up a picture that is specific to you, including what triggers your symptoms, what exacerbates them and what helps.

Give up, or don’t start, smoking. Regardless of your family history this is by far the most relevant factor for predicting a menopause earlier than the average – going through it around one or two years earlier than on average¹⁶. It is theorised that smoking reduces oestrogen and impacts on ovarian ageing.

Adjusting your diet. A Mediterranean diet has been shown to minimise many typical menopause symptoms according to a study from 2022¹⁷. The high intake of fruit and vegetables and legumes (like kidney beans, lentils, chickpeas) and extra virgin olive oil in the diet led to less severe, or fewer, menopause symptoms including vasomotor ones, like hot flushes and night sweats, plus psychological ones, including depression. Women on a Mediterranean diet also report sleeping better (sleep problems remain one of the most frequent side effects of perimenopause and menopause).

Exercising regularly. Exercise has been shown to ease many menopause symptoms including alleviating stress, anxiety, feelings of depression, sleep problems, lack of energy, loss of muscle mass and bone density. It can also help improve your heart health which is at increased risk post menopause.

Try supplements. According to the British Menopause Society, 95% of women in perimenopause want to try supplements first to help them with their menopause symptoms¹⁸. Ingredients to look out for which appear to help support them include the phyto-oestrogens Red Clover and Wild Yam plus vitamins and minerals such as B vitamins and magnesium (find them all and more in Perimenopause Multi-nutrient Support).

HRT. This is first line treatment for menopausal symptoms recommended by the National Institute for Health and Care Excellence (NICE) that replaces declining levels of hormones such as oestrogen. Talk to your GP or menopause specialist about an HRT regimen that would be suitable for you if you feel you need it.

Stress reduction. Stressing about how the menopause is likely to affect you is not going to help when declining levels of oestrogen are already making you less likely to cope with stress and anxiety because falling oestrogen levels make it harder for you to regulate levels of the primary stress hormone cortisol.

A positive mind set – even if your mum, your auntie and/or your gran have all said their menopause was difficult don’t let this become a self-fulfilling prophecy for you. The lifestyle habits above can all positively affect how yours will play out plus menopause can be a hugely positive and liberating experience for many women, for a variety of reasons. These include no longer having to worry about PMS, periods and contraception. It also marks a transitional time for many in terms of re-evaluating life and carving out well-deserved time for themselves.

References

1. https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause#:~:text=Perimenopause%20and%20menopause%20are%20a,although%20it%20can%20start%20earlier).
2. https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause#:~:text=Perimenopause%20and%20menopause%20are%20a,to%20reach%20menopause%20is%2051.
3. https://pubmed.ncbi.nlm.nih.gov/11323317/
4. https://pubmed.ncbi.nlm.nih.gov/5298639/
5. https://www.healio.com/news/endocrinology/20171026/bmi-may-affect-timing-of-menopause#:~:text=Ten%20percent%20of%20women%20are,%25%20to%2030%25%20lower%20odds.
6. https://academic.oup.com/humrep/article/37/2/333/6427299
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473711/
8. https://www.medicalnewstoday.com/articles/319363#:~:text=In%20a%20person%20with%20PCOS,of%20both%20PCOS%20and%20menopause.
9. https://my.clevelandclinic.org/health/diseases/21138-premature-and-early-menopause#:~:text=Family%20history%20of%20menopause%20at,Crohn's%20disease%20or%20thyroid%20disease.
10. https://pubmed.ncbi.nlm.nih.gov/9243205/#:~:text=The%20odds%20of%20a%20woman,mothers%20and%20daughters%20menopausal%20age.
11. https://pubmed.ncbi.nlm.nih.gov/7672145/
12. https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/menopause-and-cancer-risk
13. https://pubmed.ncbi.nlm.nih.gov/8602000/#:~:text=The%20risk%20of%20cardiovascular%20mortality,mortality%20risk%20decreased%20by%202%25.
14. https://www.swanstudy.org/
15. https://journals.lww.com/menopausejournal/abstract/2017/03000/association_of_genetic_variation_in_the_tachykinin.5.aspx
16. https://www.lancastergeneralhealth.org/health-hub-home/2021/october/one-more-reason-not-to-smoke-early-menopause#:~:text=The%20effect%20of%20smoking%20on,years%20earlier%20for%20heavy%20smokers.
17. https://www.frontiersin.org/articles/10.3389/fendo.2022.886824/full
18.  03-WHC-FACTSHEET-Complementary-And-Alternative-Therapies-NOV2022-B.pdf (womens-health-concern.org)