Climate Change and Its Potential Impact on Menopausal Hot Flashes

A Commentary

James N. Smith, MPhil; Kim R. van Daalen, MPhil; Rashmi Venkatraman, MPH

Disclosures

Menopause. 2020;27(7):816-817. 

In This Article

Abstract and Introduction

Abstract

Climate change is known to impact men and women differently and yet how it will change the health impact of menopause, specifically hot flashes, has not been well researched or understood. Given the duration of symptoms, the high number of women suffering from them, and the associated consequences, any marginal change in incidence due to climate change could result in a very large number of women being affected. Global health systems need to be prepared for this and ensure that gendered issues like menopause do not fall through the cracks as we prepare for our future climate.

Introduction

Climate change will impact the health of women and men differently. Access to reproductive health services and pregnancy-related outcomes may be influenced by changes in the infectious disease burden or extreme temperatures and weather. Women are also more exposed to risk factors such as indoor air pollution.[1] Simultaneously, as the world warms with climate change there is potential for the global burden of menopausal symptoms to increase significantly.

Yet, the potential impact of climate change on women during menopause has not been well researched or understood. This could represent a substantial undescribed health burden for women across the world. Therefore, this commentary aims to highlight how vasomotor symptoms associated with menopause might be impacted by climate change.

The number of women older than 50 years is estimated to reach 1 billion worldwide in the next 25 years, and approximately 73% of postmenopausal women, typically older than 50 years, experience menopausal vasomotor symptoms.[2] However, these projections do not take into account environmental changes that may impact women disproportionately. Menopausal vasomotor symptoms, specifically hot flashes and night sweats, are not assessed in major global reviews of climate change health impacts and research on this topic is limited to cross-sectional analyses.[3] Yet, there exists a plausible mechanism by which climate change could increase the burden of menopausal symptoms. Elevated ambient temperature is thought to increase the frequency and severity of hot flashes. Environmental cooling is commonly included in guidelines as a rational intervention, although there is no trial evidence to support this.[4] Anthropogenic climate change will increase both temperature extremes and the global average temperature, dependent on the region. This will increase the probability of an individual being exposed to extremes of temperature for a prolonged period.[5]

The scale of the impact on quality of life is difficult to assess but the impacts as a result of menopause could be substantial.[6] Up to 80% of menopausal women may suffer from moderate to severe hot flashes at some time in their lives.[7] The known additional associated impacts of hot flashes such as sleep disturbances, fatigue, and an increased dependence on medical resources can all be reasonably expected to change in turn.[7] Symptoms commonly persist for 5 to 10 years.[8] Given the duration, high number of women suffering from them, and associated consequences, any marginal change in incidence could result in a large number of women being affected. The burden of menopause-associated vasomotor symptoms impacts women financially.[6,9,10] Studies looking at direct and indirect costs and work productivity loss days have shown that women who experience vasomotor symptoms are significantly associated with increased healthcare resource utilization and decreased work productivity.[6,10,11]

Menopause and specifically fluctuating estrogen levels are also associated with changes in cardiovascular disease risk and mood disorders.[6] These conditions are already predicted to worsen due to the climate crisis with evidence suggesting communities globally will be severely impacted with increased numbers suffering from noncommunicable diseases and mental health issues.[3]

It should be noted that there is considerable variation between different ethnic backgrounds in regards to menopausal symptoms.[8] Therefore intersectional research is needed to anticipate for the multilayered facets that influence the impacts of climate change on human health. Furthermore, whether variability of temperatures or increased average temperature will be most important and whether physiological adaptation may occur is unknown. Certain cultural perceptions that might be held, such as menopause being nothing more than a biological transition or hot flashes being nothing more than a part of life, further contribute to a cultural stigma leading to less women seeking help.[9] It is acknowledged that the financial impacts of climate change-driven changes in incidence will be hard to model as the global healthcare expenditures attributable to the management of menopausal symptoms, or lack thereof, are not well understood.[12] This information would, however, be pivotal in understanding the true cost of the impacts of menopause on women's livelihoods and overall quality of life.

Overall gendered health impacts of climate change and the potential substantial increased burden of menopause for women identified in this commentary seems to be mostly absent from the environmental and medical literature. This is particularly concerning as climate change is predicted to worsen existing social and economic inequalities among and within countries. Health professionals working in women's health need to be aware of the potentially large changes to the burden from menopausal hot flashes, and other climate-related health impacts, which could occur in the coming decades. Health experts can play a major role in advocating for changing the language used when discussing the emotional, physical, and financial burdens of menopause with their patients. The medical community has a responsibility not just to ensure there is adequate treatment available for women who have these problems but also to advocate for greater action on climate change to avoid these possible future harms. Experts in women's health are well placed to lead efforts to address this gap and ensure that an intersectional approach is taken. Ensuring that future health services meet the related needs is pivotal and through being effective advocates for action on climate change and its consequences health professionals could help millions of women worldwide benefit from better management of menopausal symptoms and an overall increased quality of life.

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