Why did we run the survey?
Menopause can be a tricky and uncertain time, and (unfortunately) a difficult subject to seek help for and speak about.
But there are people trying to change this. More and more high profile women are bringing the public's attention to menopause, through documentaries and media interviews – one notable example being Seema Malhotra.
Last month, we began a partnership with Seema (and several content creators on social media) to bring you Let’s Talk Menopause – a campaign to get people sharing their feelings and experiences on the subject.
We asked you to participate in our Let’s Talk Menopause survey – 12 questions, part ‘quiz’, part opinion poll, to help us get a feel for what you know, and how you feel about menopause.
Nearly 1,500 of you (1,485 to be exact) from places across the world including the UK, USA and Europe took the survey, and the results told us so much.
91% of women want menopause to be recognised at work
Probably the most unambiguous result we saw was that when we asked:
Should menopause be recognised as a condition that can affect our attendance at work?
- 91% of respondents answered ‘Yes’
- 9% of respondents answered ‘No’
The ‘Yes’ figure was higher in the UK (93.5%), with fewer respondents in the USA and European countries lowering the average.
This led to some interesting debate on our vidcast. When asked about this, Dr Mukherjee highlighted that it’s a complex subject, and that introducing mandated menopause leave could be counterproductive:
‘It’s really complicated.[...] If you make menopause a protected characteristic and you tell employers: ‘these women are ill, they’re going to have mental health issues, they’re not capable of working’, the big employers are going to [feel like they] have to wrap women in cotton wool and that’s going to put the big employers off employing women – whether we like it or not.’
‘I want to keep mid-life women in the workplace – we need equality and leadership in our world and women in the boardroom making decisions, because women have a lot of different things to bring to the table than men.’
‘Most women need modest, if any, reasonable adjustments in the workplace – provision for working from home, extension for deadlines if they’ve got a particular problem – and it’s different for everyone.’
To give a bit more context to this, a Fawcett Society report from May 2022 revealed that eight out of 10 women said their workplace offered no support networks (79%), absence policies (81%), or information sharing with staff (79%). Despite 81% of women saying their workplace had no absence policies in place for menopause, 44% of women claimed their ability to work had been affected by menopause symptoms. 41% of women also said that they had seen menopause or associated symptoms treated as a joke by people at work.
‘I think the culture in larger organisations needs to change.’ said Dr Mukherjee. ‘I think if a woman does have a block in a presentation or in [...] the boardroom, or wherever it may be, and she has to leave, that she’s not being laughed at afterwards, and that [she’s asked] ‘are you okay?’ [and she’s encouraged to] take some time out and come back in again.’
‘Having a day off here and there – some people will need that. But I think the culture needs to change. There’s no point giving people two days off a month but then them being laughed at for [for example] having a fan on the desk or brain fog in the middle of a presentation or having to leave because they’re having a flush. Women who feel supported do better in the workplace.’
35% of women don’t feel like they have enough menopause support
Do you feel like you have enough support around you to understand and manage menopause?
- 65% of women answered ‘Yes’
- 35% of women answered ‘No’
In the UK, the percentage of women selecting ‘Yes’ was slightly higher (69% vs 31% ‘No’).
But this was lower in the USA (59% ‘Yes’ vs 41% ‘No’) and even lower in the European countries we surveyed (39% ‘Yes’ vs 61% ‘No’).
These results echo an Ipsos survey published in 2022, that asked women how knowledgeable they felt about menopause. In this, 70% of British women said they felt knowledgeable, compared to 66% of USA women, 61% of Swedish women, 59% of German women and 56% of Dutch women.
‘Most of my friends and the women I know going through it have the right support,’ Seema commented, ‘but maybe for the women that don’t, it’s because it’s a taboo subject, or culturally it’s not something they’re open to talking about. But because there is more awareness and we are talking more about it, it is getting better.’
‘But looking at this result, we’ve still got to push women to think that they can speak about it.’
Dr Mukherjee added: ‘I get people contacting me every day on my social media saying my GP won’t help me, I just don’t feel like I’ve got the support. I think there are many many women who aren’t getting the support [with menopause].’
35% of women don’t feel like they can speak to their partner about menopause
Do you feel like you can talk to your partner about menopause?
- 65% of women answered ‘Yes’
- 35% of women answered ‘No’
So why do 35% of voters feel like they can’t discuss the menopause with their partner?
A 2019 online study in the US, known as the MATE survey, may give some additional context, and may also alleviate some anxiety women have around talking to their partners about symptoms.
The study was designed to explore men’s awareness of the menopause and how they understood their partner’s experiences of it. It was sent to 1356 eligible men, most of whom were aged 50-69. Only around a third (450) of those who received the survey completed it. 56% of those who did complete it felt the menopause had a negative effect on their relationships. But 72% of men who completed the survey said they had engaged in discussions with their partners about symptoms, and 75% believed they were influential in some way in their partner’s decision to ‘seek treatment or make lifestyle adjustments’.
So while only a third of men interacted with the survey, of those who did respond, there was a receptiveness to talking about menopause symptoms.
‘There is this stereotypical assumption that men may [say] ‘Well you just need to pull yourself together’. But that’s the one thing you can’t do when you’re menopausal – ‘just to pull yourself together’ – because it’s not that simple. And maybe women feel like they can’t talk to their partners because they feel like they’re going to get that sort of response.’
‘There’s certainly some education to be done amongst partners, so that we’re approachable, educated, aware, and know what to expect, and what to look out for.’
36% of women don’t feel like it’s socially acceptable to talk about menopause
When we asked:
Do you feel like it's socially acceptable to openly discuss menopause?
- 64% said ‘Yes’
- 36% said ‘No’
And there was an interesting difference between different countries on this question:
- In the UK, 67% said ‘Yes’ and 33% said ‘No’
- In the USA, it was 61% ‘Yes’ and 39% ‘No’
- In the European countries we surveyed, it was 43% ‘Yes’ and 57% ‘No’
- And in Germany specifically, it was just 29% ‘Yes’ and 71% ‘No’
‘That saddens me,’ said Seema of the results. ‘I think it goes back to years ago – [menopause] was a very hushed conversation and you weren’t supposed to speak about it. But really, I think times have changed. We have to talk about these things.’
‘I think probably the ones saying they don’t want to openly discuss or it’s not socially acceptable may be the older women, because I think younger women now are much happier talking about it.’ said Dr Mukherjee.
‘When I look at my Mum’s generation,’ said Seema, ‘this was a subject they never spoke about. And since I’ve been speaking about it and others have been, my Mum thinks it great. She says ‘I wish I could speak about it like that, because we just weren’t allowed, we just had to deal with it’.’
On the difference between UK and other countries, Dr Mukherjee commented:
‘We’ve done a lot of breaking that taboo in the UK. Lots of amazing women have been talking about menopause. Younger women can see: ‘Look, they’re not all old and shriveled up, they’re absolutely amazing’, and it’s not bad to talk about it, and that talking about it improves the whole experience.'
'I don’t think we have that in Europe and it’s not there in America. America is probably closer to the UK because people like Oprah have started talking about it – but in Europe, it’s minimal. And I don’t think [people in] Europe look at what’s going on on UK social media.’
Responding to the notion that menopause is still seen as a sign of aging in European countries, Dr Mukherjee said:
'We might have historic stereotypes in Europe saying that it’s associated with being old, but it isn’t – that’s just an incorrect perception and taboo. We’ve broken it down better in the UK and we still need to do more work, but [it looks like] the rest of Europe needs to do even more work.’
42% of women think menopause mostly starts before the age of 45
At what age does menopause most often start?
- 2% of people said between 26 and 35
- 42% of people said between 36 and 45
- 54% of people said between 46 and 55
- 2% of people said between 56 and 65
The median age in the UK is 51, and the most common age range that women go through menopause is actually between 45 and 55.
But the average for different ethnic backgrounds varies, as Dr Mukherjee explains:
’South Asian women tend to have the youngest average age of menopause, around the age of 45, South East Asian women between 45 and 50, black women around the age of 48, and caucasian women around the age of 51.’
When someone goes through menopause before the age of 40 – which is rare – the name given to this is premature ovarian insufficiency (POI).
According to POI charity the Daisy Network, around 5% of women under 45 and 1% of women under 40 will have an early spontaneous menopause that occurs naturally . But there are other factors that can cause menopause to happen earlier, such as medical or surgical inducement.
Seema, who was induced in her 40s, felt like going through menopause at an earlier stage had a big impact on her.
‘I was one of the people who thought it happens when you’re over 50. And it impacted me because I had a lack of knowledge. I didn’t know what the symptoms were and what I should be concerned about, and I didn’t know how to deal with it. Because I was induced as well when I had a hysterectomy, all the symptoms hit me like a ton of bricks. I felt like everything came at once.’
‘If you’re a younger woman who has to have a surgically induced menopause for gynaecological issues or health issues,’ said Dr Mukherjee, ‘then if you’re going from normal hormone cycling to nothing, it’s a tough gig. Especially if you’re not given warning, information, support or treatment. That’s considered one of the most severe and difficult forms of menopause.’
British women were more likely to turn to HRT
What can help with menopause symptoms?
and gave a range of multiple choice answers, and respondents could tick as many as they liked.
The top three most selected answers were:
- Taking HRT (selected 77% of the time)
- Talking to a doctor (73%)
- Exercising more (73%)
But there was a difference between the UK and other countries.
Taking HRT was selected by:
- 82% of UK respondents
- 53% of European respondents
- 44% of USA respondents
So why might UK women be much more likely to turn to HRT than women elsewhere?
Some high profile media stories from around 20 years ago may have some bearing on this. There was some research that initially linked HRT use with an increased risk of cancer – which gained press attention and may have caused a lower take-up of the treatment amongst menopausal women.
But Dr Mukherjee explains that while the risks are there, the findings of the study have been more closely looked at since, and opinion on HRT has changed.
‘Those studies were deconstructed [...] and they both produced this association between HRT and breast cancer – but those studies were conducted on postmenopausal women who started on HRT after the age of 50, many of them after 60 and even in their 70s. So it wasn’t really looking at women who need HRT going into menopause who are younger cohorts.'
'Essentially, we understood the flaws in those studies over the subsequent 10 years and by 2015, the UK NICE guidelines said that HRT should be being given to women who need it.'
'In a way, I think the UK has led the world on further information about the benefits and risks – and this sort of over-exaggeration of risk – with HRT.'
'Since the pandemic, there’s been a lot of influencers on social media talking about menopause and HRT and that has come predominantly from the UK. So with the rise in the use of HRT, we [the UK] are leading. It’s not happening as much in the United States or Europe, so [the survey results] don’t surprise me.’
Dr Atkinson added: ‘Those studies have definitely influenced the way women think about HRT. Things are changing. There’s more research to show that the women that need HRT can really benefit from it, and benefit safely.'
'There are safer forms of HRT than others. We should, as doctors, be steering people towards the safer forms and encouraging them to be used more. But again, even with the ones that perhaps are less safe – if they’re the most convenient and are going to make you feel better and exercise more and eat better and sleep better, then you’re piling up the benefits of HRT, which you compare against these risks which are there, but they’re small.’
Other interesting findings from this question were that:
- Only 55% of respondents chose ‘talking to someone close to you about them’
- Only 46% of respondents chose ‘taking a mineral’ or ‘vitamin supplement’
as ways of helping with symptoms.
‘46% is quite low – I would’ve expected it to be higher. But maybe that’s down to people not associating that you can take vitamins alongside HRT.’ said pharmacist Sanjeda Chowdhury.
‘During the menopause, oestrogen levels drop, and oestrogen is a big factor in bone health. Taking vitamin D and calcium can help prevent bigger problems down the line like osteoporosis. You’ve got magnesium that can help with sleep that studies have shown. You’ve got vitamin B6 and B12 to help with energy levels and fatigue.’
HRT use is much less common than we think
What % of women going through menopause do you think use HRT?
and we received answers across the spectrum. The most selected were:
- 12% said 21-30% of people use HRT
- 16% said 31-40% of people use HRT
- 21% said 41-50% of people use HRT
- 16% said 51-60% of people use HRT
- 12% said 61-70% of people use HRT
In fact, HRT use is lower in the UK than most people thought.
In the UK, for example, 87.3% of our participants thought that anywhere between 21% and 80% of women used HRT.
The most recent data we have suggests that 15% of women going through menopause in the UK use HRT, but this is increasing. In 2021/22, there were 7.8 million HRT items prescribed in the UK, which was an increase by 30.5% on the year before.
HRT use isn’t increasing everywhere, though. And France is an interesting example of this. In 2003/2004, it was estimated that around 36-41% of women used HRT, however by 2020 this number had fallen to only around 6%. Fear of hormones and side effects were the main reasons given for not using HRT in 2020.
So while it seems as though public opinion towards HRT in the UK has become more positive, this isn’t the case everywhere else.
People knew about the most common symptoms
What symptoms do you associate with menopause?
The three most commonly selected were:
- Hot flushes (85%)
- Sleeping problems (84%)
- Mood swings (77%)
Around 75% to 85% of women will experience vasomotor symptoms like hot flushes during menopause – and with 85% of people who responded to our survey associating hot flushes with menopause, it’s clear that people know to expect this symptom.
Sleeping problems scored highly too, at 84%. But while according to research, around 50% of women experience sleep disturbances by postmenopause, up to 60% of women experience symptoms like urinary incontinence and vaginal atrophy, irritation and dryness. This means urogenital symptoms (another word for symptoms that affect the genitals and urinary system) are a little more common than sleep problems, but only 57% of our survey respondents said they associated vaginal dryness with menopause.
Some other symptoms that weren’t selected as often were:
- Irregular periods (45%)
- Skin problems (46%)
Less than half of respondents selecting ‘Irregular periods’ is significant because, as Daniel explains, changes in your menstrual cycle can be when ‘the jigsaw slots into place’ for many women – meaning the point at which they realise, having experienced other symptoms already, that they’re going through the menopause.
More UK women associated mental health problems with menopause
‘Depression or other mental health problems’ was also an option respondents could choose on the symptoms question.
It was selected by:
- 66% of respondents in the UK
- 45% of respondents in European countries
- 43% of respondents in the USA
‘When it comes to low mood, and more severe mental health issues, we know that it’s not necessarily the majority of women but it can happen and is usually associated with loss of physical health – if a woman is getting worse and worse in terms of symptoms, and she doesn’t know what the solutions are [...] then menopause can be a trigger for that.’ explains Dr Mukherjee.
‘I don’t think we should be saying that menopause is a type of depression – I think that’s going too far. But I think there are some women who will be more vulnerable to [mental health issues] because of their experience, the severity of their symptoms, what support they have and other health issues.'
'Many women do get symptoms of anxiety, overwhelm, irritability, mood being up and down, and palpitations. I think it’s all about getting the right help at the right time and being empowered by understanding what is going on in your life. Because it’s less scary if you know what’s going on.'
'If you don’t know what’s going on, those symptoms can be terrifying.’
UK women may be more knowledgeable about symptoms
We also found that on average, UK respondents selected more symptoms when answering this question than respondents from Europe or the USA.
When we looked at how many symptoms people selected on average, we found that:
- UK respondents clicked 9.3 symptoms
- USA respondents clicked 6.8 symptoms
- European respondents clicked 6.3 symptoms
This supports the Ipsos findings quoted earlier that UK women feel more knowledgeable about symptoms than women from the USA and European countries.
Most women thought that sex still happens during menopause
True or false: Women don’t tend to have sex during menopause.
- 36% said this was true
- 64% said this was false
Interestingly, the percentage of women who chose ‘True’ was lower in the UK (34%) than it was in the USA (39%) and in European countries (52%).
Anecdotally, women not having sex during the menopause is a myth. But each individual experience can be different. Changes in sexual activity are common in both men and women as they age. But it’s difficult to determine whether or not the menopause plays a part. A small research poll did find that menopausal women were worried about their relationship due to stopping having sex during that period of time.
Most women were aware that sex drive can fall after menopause
True or false: Your sex drive is much lower after menopause.
- 73% said this was true
- 27% said this was false
When taken together with the question on sexual activity during menopause, this might suggest that most people recognise that sex can and does still take place during the menopause, yet there may be a drop in libido over time.
Studies suggest that, while a decrease in libido won’t affect everyone going through menopause in the same way, sexual desire tends to drop during late menopause and more so early postmenopause. As oestrogen and T levels decrease and FSH levels increase, libido tends to decrease too.
Incidentally, a study of postmenopausal women (approximately 4418 eligible participants) found only 22.5% were sexually active. But there were many reasons cited for this including lack of a partner, partner’s health and sexual function and the use of medication, among others. An active sex life in postmenopausal life was most commonly found where the participants had an intimate partner and good physical health.
This survey was carried out between 1st and 19th September 2023.
Participants were invited to take the survey via social media links, and were not pre-screened.
A total of 1,485 respondents completed the survey. 1,453 described their biological sex as female; 23 as male; 4 as trans woman; 3 self-described; and 2 selected ‘rather not say’.
We received responses from the UK, USA, Canada, Germany, Sweden, The Netherlands, Denmark and India. In the survey analysis, responses from Canada and India were not counted because we received fewer than 50 in each country, which we considered too few to be statistically significant.
Declaration of interest: Treated provides a medical consultation and online pharmacy service, prescribing and dispensing HRT and vitamin D, amongst other treatments.