Do you remember your mom’s, aunt’s, or even your grandma’s menopause transition? Sometimes it seems like they had it a lot easier because we didn’t hear them talk about it.

Spoiler Alert: They. Did. Not.

But now that you find yourself on the cusp of “The Change” you might be wondering how much of your experience will be like theirs.

Are you doomed to experience severe hot flashes 20 years after menopause like your mom?

Or is menopause hormone therapy off the table because of a family history of breast cancer?

The short answer is that genetics plays a part, but it isn’t the whole story. Yes, they matter, but you can’t do anything about them so unless you have oodles of cash laying around just asking to be spent on genetic testing, it’s something to consider, not dwell on.

That said, knowing what the generations before you went through can, in some cases, give you an idea of what to be prepared for. And speaking from my own experience, if I had been prepared for what could be coming, I would’ve had a much easier time adjusting when symptoms hit like a ton of bricks.

As it was, I was entirely blindsided.

What We Know About Menopause & Genetics

Here's what the research actually tells us:

• Your genes write up to about 85% of the menopause script but they don’t control your experience
• Four key areas are most influenced by genetics: timing, symptoms, duration, and treatment response
• Your lifestyle can override your genetics for both better or worse

Twin studies have shown that genetics account for up to 85% of when menopause happens but there is a whole lot of wiggle room when it comes to how you experience menopause.

I’ll give you a personal example here. My mom had terrible hot flashes throughout the menopause transition and now, 20 years postmenopause, she still has terrible hot flashes. I have hot flashes, and if you were to measure them somehow, they would likely be similar in severity to my mom’s. However, I don’t experience them as severe because they aren’t nearly as bad as being an undiagnosed hyperthyroid, which is something I experienced in my mid-30s, but my mom’s thyroid is still chugging along just fine in her 70s.  

Bottom line: Genetics may determine what and when, but they do not dictate how.

Four Key Areas Likely Influenced by Genetics

Your family history can give you clues about:

• Age at menopause onset: some research suggest daughters will reach menopause within one year of their mother's age
• Symptom types and severity: if mom had hot flashes, you might too
• How long symptoms last: some get the express train, others get the scenic route
• Response to treatments: the same genetic factors that control hormone processing affect how well hormone therapy works

The operative word here is influenced.

If your mom had an easy menopause but you're stressed to the max, smoking, and running on three hours of sleep, don't expect to coast on her good genes. Conversely, if your family history looks like a menopause horror story but you're managing stress, staying active, and taking care of yourself, you might just get through this with minimal disruption to daily life.

Symptoms Most Likely to Run in Families

• Hot Flashes & Night Sweats occur in as many as 80% of menopause experiences
• Mood Changes & Anxiety, specifically depression, have a genetic overlap with hot flashes/night sweats
• Weight Changes & Bone Density: general body type and metabolism are at least partially inherited but can be overridden with lifestyle

Recent research found specific genes associated with hot flashes, which explains why some women need to bring two extra sets of clothes whenever they leave the house while others are just thankful they aren’t freezing in the office AC anymore.

And some of the same genes involved with hot flashes ruining your wardrobe also overlap with the genetic influences of depression. This explains why some people have a double whammy of physical and emotional symptoms while others have just one or the other.

When it comes to weight changes and bone density, yes, there is a genetic component to it. In the case of bone density, the genetic contribution can be as high as 70%. But this is one area where lifestyle can really make a difference.

Diet, exercise, stress management, and good sleep habits can all impact weight fluctuations during and after the menopause transition. It was once thought impossible, but new research is showing that we can actually build muscle and bone in postmenopause.

Bottom Line: if you're genetically prone to hot flashes and you smoke like a chimney, you're basically handing your genes a megaphone. On the flip side, if you’re active, eat well, manage your stress levels, and prioritize quality sleep, at least most of the time, you might just turn down the volume on those genetic tendencies.

What You Can Actually Control

• Talk to family if you can and/or it’s safe to do so
• Track your symptoms as your doctor will ask and brain fog just might yeet all that info right out of your head
• Get baseline lab work: knowing cholesterol, kidney & liver function, iron levels, etc. before there is a problem can help you and your doctor identify what is and isn’t normal for you
• Prioritize a Supportive Lifestyle: we are all out of forks to give folks

At this point, you know that genetics aren’t the whole story and that you have the power to influence your experience through lifestyle, self-care, and proactive planning.

Remember, everyone’s menopause experience is unique to them so what worked for your mom or aunties might not work for you, and vice versa. There are a lot of tools to help with symptoms, but the trick is finding the best ones for your experience.

Talk to Your Family (If You Can)

This may seem like an obvious place to start, but getting accurate information from family might not be trickier than you’d think.

• Some people were adopted and don’t know any of their family’s medical history
• For some, family dynamics make it unsafe to talk to them about anything, even medical history
• Previous generations were expected to suffer in silence and may still refuse to talk about it or may not even realize their symptoms were menopause related

But, and this is a big but, if you can have these conversations, do it. One study showed 71% of women recognized their own symptoms sooner after talking with their mothers and 80% felt more supported after those conversations.

Questions to get the conversation started:

• When did you start perimenopause?
• How long did it last?
• What symptoms did you have, and how severe were they?
• Did any treatments help?

Track Your Symptoms

I know, I know, tracking takes time nobody has. But here's the thing: when you go to your doctor, they'll ask what symptoms you're experiencing, how often, and how severe. Going prepared with a few months of data will help you remember everything and give your doctor a clearer picture.

Time with doctors gets shorter every year, so being prepared maximizes your limited face time. Plus, meno-brain is real, and having notes helps you remember what the doctor said after you’ve forgotten everything they just said by the time you reach the car (ask me how I know).

Get Baseline Health Metrics

This is huge. Knowing what your cholesterol, blood pressure, and blood glucose look like before things get chaotic helps you and your healthcare team make better decisions.

Knowing what's normal for you is invaluable information. We usually only go to the doctor when something's wrong but being able to compare current bloodwork to when you felt good speeds up treatment decisions significantly.

Prioritize a Supportive Lifestyle

For many of us, this is the first time we simply can't ignore our own needs to attend to everyone else's. Our bodies are forcing us to pay attention and put our needs first.

This is really hard when there's laundry to do, kids to shuttle around, and aging parents to care for. But the reality is, we've been pouring from empty cups for far too long, and trying to continue business as usual just isn't gonna fly anymore.

Final Thoughts

Every menopause experience is unique, but knowing your family history can help you prepare for what you might face. There are tons of tools available to help with symptoms, but the trick is finding the best ones for your specific situation.

At the end of the day, control what you can, don't stress about what you can't, and remember that you're not destined to repeat your mother's experience.

References

Some of the below references were used to write this blog post but I’ve also included some additional sources if you’re a science nerd like me and will gladly jump down the rabbit hole.

Bywinona. (n.d.). Genetics and menopause. Bywinona Journal. https://bywinona.com/journal/genetics-and-menopause

Clue. (n.d.). Menopause is hereditary: Here's the latest research. Helloclue. https://helloclue.com/articles/menopause/menopause-is-hereditary-here-s-the-latest-research

Elektra Health. (n.d.). Genetics and menopause. https://www.elektrahealth.com/genetics-and-menopause/

Health and Her. (n.d.). Genes and menopause: Is the age you start menopause genetic? Expert Advice Blog. https://healthandher.com/en-us/blogs/expert-advice/genes-and-menopause-is-the-age-you-start-menopause-genetic-1

Hernandez Cordero, S., Yang, Q., Lindström, S., Kraft, P., Zawistowski, M., Dudbridge, F., Carey, D. J., Wesselius, A., Buring, J. E., Lee, I.-M., Ridker, P. M., Chasman, D. I., Rose, L. M., Gapstur, S. M., Diver, W. R., Stevens, V. L., Haiman, C. A., Stram, D. O., Wilkens, L. R., ... Murabito, J. M. (2021). Genome-wide association study reveals novel loci associated with circulating IGF-1, IGFBP-3, and IGF-1/IGFBP-3 molar ratio in women. Frontiers in Genetics, 12, 676546. https://www.frontiersin.org/journals/genetics/articles/10.3389/fgene.2021.676546/full

Kulkarni, B., Mahanty, S., Reddy, B. M., & Kumar, N. (2022). Genetic influences on depression during menopause transition. Psychological Medicine, 52(8), 1543-1552. https://pmc.ncbi.nlm.nih.gov/articles/PMC9167895/

Menopause Society. (n.d.). Hot flashes. https://menopause.org/patient-education/menopause-topics/hot-flashes

Stewart, T. L., & Ralston, S. H. (2000). Role of genetic factors in the pathogenesis of osteoporosis. Journal of Endocrinology, 166(2), 235-245. https://www.sciencedirect.com/science/article/abs/pii/S0378512201002833

The Better Menopause. (n.d.). How genetics influence your menopause experience. The Better Gut Community Blog. https://thebettermenopause.com/blogs/the-better-gut-community/how-genetics-influence-your-menopause-experience#:~:text=Nutrigenomics%20is%20the%20study%20of,%22off%22%20to%20our%20advantage

UCLA Health. (n.d.). Are hot flashes genetic? UCLA Health News. https://www.uclahealth.org/news/release/are-hot-flashes-genetic

University of Michigan School of Public Health. (2021, May 19). Genetic influences on menopause symptoms. News. https://sph.umich.edu/news/2021posts/genetic-influences-on-menopause-symptoms.html