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Menopause

Snoring, silence, and the menopause taboo: The hidden health crisis affecting millions

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By Professor Ama Johal, clinical lead and dental sleep expert at Aerox Health

During menopause, it’s very common for women to notice significant changes to their sleep patterns and experience things like restless nights, loud snoring, or simply waking up feeling exhausted.

What most don’t realise, however, is that these symptoms can signal something far more serious – obstructive sleep apnoea (OSA), one of the most impactful and consequential sleep-related breathing disorders.

Women across the world are unknowingly fighting an uphill battle. Around 90 per cent of females with moderate to severe sleep apnoea remain undiagnosed.

This collective lack of awareness is due to a plethora of factors including archaic taboos around the subject and lack of education or omission of menopause in sexual education.

Ultimately, this combination leaves women underprepared and vulnerable to the biological, social and medical realities associated with the menopause.

Now more than ever, we must confront this silence head-on and recognise the hidden sleep crisis affecting so many women globally and the opportunity to address it.

The hidden sleep crisis

Snoring that develops or worsens during menopause can progress into OSA due to a decline in estrogen and progesterone which reduces muscle tone in the throat and in turn makes the obstruction or collapse of the airways more likely during sleep.

Yet this link between menopause and sleep disorders remains largely overlooked, leaving millions of women undiagnosed, untreated, and unaware that their sleep struggles are more than just “part of getting older”.

In my practice, I see the consequences of this misunderstanding far too often.

I hear from many female patients who have been suffering in silence, without the knowledge that they could seek help. In fact, I often encounter the common misconception that snoring is a man’s issue.

This preconceived notion perpetuates a persistent gender bias in sleep-related health research.

As ENT consultant and sleep surgeon at University College London hospitals, Ryan Chin Taw Cheong recently highlighted, the development of snoring is reason enough to consult your doctor. It’s time for this pervasive issue to emerge from the dark.

So why don’t women seek help?

When considering why many women do not seek help for their symptoms, there are two overarching reasons.

Firstly, the information and knowledge is not widely available for sufferers to realise that snoring can be a medical issue which can be assessed and subsequently readily treated.

Secondly, there is a potent stigma surrounding both the menopause and snoring which is an inhibiting factor amongst sufferers, discouraging open discussion.

Perhaps unsurprisingly, menopause is not included in traditional sex education in schools. Being unaware of what is ‘normal’ and what could require medical attention is widespread amongst my patients with sleep disorders, yet this information is not freely disseminated outside of clinics.

Unfortunately, cognitive fog and irritability – symptoms of snoring and obstructive sleep apnoea – are too often written off as stress, anxiety or ‘just the menopause’.

Avoiding sharing symptoms with medical providers, combined with online misinformation, often results in individuals suffering in silence or worse, turning to unregulated miracle menopause cures that exacerbate the risks of undiagnosed OSA.

These so-called ‘cures’ reinforce the harmful notion that the menopause is a defect which needs to be fixed rather than a natural life stage.

The health costs of ignoring snoring

A breadth of research links untreated OSA to cardiovascular disease, hypertension and cognitive decline.

However, aside from the medical risks, snoring and sleep apnoea can have profound social and emotional consequences.

For women, the shame in snoring, a symptom often mischaracterised as a ‘male issue’, can significantly affect self esteem and mental health.

Partners may also suffer if the snoring is disruptive to their sleep, in some instances causing rifts in relationships and a phenomena known as ‘sleep divorces’ (sleeping in separate beds or rooms).

In fact, according to a recent study commissioned by 32Co, 47 per cent of recently divorced Brits cite interrupted sleep linked to snoring or sleep disorders as contributing to their relationship breakdowns, with 85 per cent believing ‘sleep divorces’ contributed to ultimate separation.

Sleep specialists seek to manage and monitor the symptoms of sleep disorders and OSA to minimise disruption to an individual’s personal and public life.

Screening menopausal women for OSA is a preventative measure which leads to informed patients. It is not simply about getting better sleep but about the long-term health outcomes.

Breaking the silence: what needs to change

Drawing on the stories of those I meet in my clinic, I would like to outline five steps that we can take to address this silent epidemic.

First, the menopause and associated symptoms should be included in a comprehensive sex and health education.

This could be provided both in schools’ curricula and made readily available at health services catering to adults.

Second, throughout the course of history women’s issues have been chronically underserved.

More resources can be funnelled into conducting research to help us better understand the impact of the menopause on women’s physical and mental health.

Future research would also help to neutralise the gender bias of previous studies.

Third, launching public health campaigns and workplace initiatives to encourage employers to recognise sleep disorders as a significant element of menopause will help build awareness and reduce the impact of stigmas.

Fourth, myth-busting, shattering taboos, and normalising discussion about the menopause will be key.

We must view snoring as a gender neutral issue rather than a male stereotype and denounce harmful rhetoric and jokes that perpetuate stigma.

Fifth, we must better equip more localised healthcare providers up and down the country to both diagnose and treat OSA effectively.

Sleep disorders are not niche issues but a major public health concern with potentially severe consequences.

Quality of life amongst my patients is inextricably linked with sleep quality.

Recognising the relationship between snoring and OSA and the menopause is not simply about pathologising a natural stage of life, but providing women with the information, respect and medical care they deserve.

Only through more transparency and collaboration amongst researchers, educators and clinicians can we hope to close the gender gap in sleep medicine and bring this hidden crisis to light.

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Menopause

Enter the menopause innovation award before it’s too late

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If you are working in menopause care and have not yet entered the Femtech World Awards, you have until this Friday, 17 April, to put your work forward.

The award celebrates those leading the way in reshaping how menopause is understood and supported across healthcare and society.

The winner will have demonstrated exceptional innovation in addressing the health, wellbeing and quality of life needs of people going through this transition.

Judges will assess impact, inclusivity, accessibility and the ability to challenge stigma while delivering meaningful, real-world solutions.

The scope is intentionally broad.

Whether you have developed a digital platform, a diagnostic tool, a pharmaceutical or non-pharmaceutical treatment, a workplace support programme or something that does not sit neatly within a single category, if your work is improving the menopause experience, this award is for you.

Who is behind the award

The category is sponsored by Cross-Border Impact Ventures (CBIV), an impact venture capital firm investing in early growth stage health technology companies across medical devices, diagnostics, therapeutics and digital health.

Every company CBIV supports must show relevance to women’s, children’s and adolescents’ health, with the ambition to scale into emerging markets.

Annie Thériault, managing partner at Cross-Border Impact Ventures, said: “Being part of the FemTech World Awards gives us a front-row seat to the most exciting breakthroughs in women’s health.

“It’s a powerful way to stay connected to the pulse of innovation and the future of care.”

What you stand to gain

Entry is free.

Every shortlisted organisation receives extensive coverage across all Femtech World platforms, placing your innovation in front of a global audience of investors, clinicians, industry leaders and potential partners.

The winner also receives a trophy and a dedicated interview.

The deadline is this Friday

Nominations and entries close on 17 April.

After that, the Femtech World team will shortlist the strongest submissions, with the final decision made by a representative from CBIV.

Find out more about the awards and enter for free here.

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Menopause

Premature menopause raises long-term heart risk by 40%, study finds

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Women who enter natural menopause before age 40 face about a 40 per cent higher lifetime risk of developing coronary heart disease than women who experience menopause later, according to a large study that is the first to calculate lifetime heart risk associated with premature menopause.

The findings suggest that doctors should routinely ask women about age at menopause, using the menopausal transition as an opportunity to identify higher-risk women and intervene earlier.

Dr Priya Freaney is assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.

She said: “When menopause happens before age 40, women still have more than half of their life expectancy ahead of them.

“Understanding their cumulative lifetime risk of blockage-related heart disease is critical.”

Coronary heart disease is a condition where the heart’s arteries become blocked or narrowed by a buildup of fatty deposits called plaque.

By restricting blood flow to the heart, these plaques can lead to sudden events (heart attacks) or gradual damage (weakened heart muscle).

The study of more than 10,000 U.S. women followed for decades also found that premature menopause was three times more common among Black women than white women (15.5 per cent vs. 4.8 per cent).

According to Freaney, the disparity likely reflects a complex mix of life-course exposures, health conditions and structural inequities rather than solely inherent biological differences.

Freaney and colleagues analysed data from 10,036 postmenopausal Black and white women who participated in six long-running U.S. studies, including the Framingham Heart Study, Atherosclerosis Risk in Communities Study and the Women’s Health Initiative.

The women were followed between 1964 and 2018.

During that time, the Northwestern scientists found more than 1,000 cases of coronary heart disease events in the data, including fatal and non-fatal heart attacks.

Even after accounting for cardiovascular risk factors such as smoking, obesity, hypertension and diabetes, premature menopause was associated with 41 per cent higher risk of coronary heart disease for Black women and 39 per cent increased risk for white women.

The scientists note in the study that the causes of premature menopause are not fully understood and are likely multifactorial.

Potential contributors include genetic, biological and environmental factors, as well as earlier age of the first menstrual period, health behaviors (such as smoking), obesity and the cumulative effects of chronic stress.

It is also unclear whether the menopausal transition itself creates a vascular environment that promotes disease, or whether women who experience premature menopause already have an underlying risk profile that predisposes them to both premature menopause and cardiovascular disease.

Even at the average age, menopause’s hormonal changes can affect cardiovascular health.

During menopause, declining estrogen levels trigger changes that increase coronary heart disease risk.

“As the natural estrogen declines, no matter what age it happens in, cholesterol and blood pressure go up, body fat distribution shifts to the abdomen, muscle mass gets lower, blood sugars can become dysregulated and arteries stiffen,” said Freaney, who also is director of the Women’s Heart Care Program at Northwestern Medicine Bluhm Cardiovascular Institute.

“Together, these changes over a short period increase the risk of heart disease.”

Freaney said women who experience premature menopause should think of it as an early signal to take their heart health seriously.

“Tell yourself: I have to be far more proactive than my neighbor about my own heart health,” Freaney said.

“The vast majority of heart disease is preventable, but people need to know that they’re at risk early in life because effective prevention takes decades.

“Tell your doctor, ‘I experienced premature menopause. What can we do to protect my heart?’” she suggests.

The findings also highlight a gap in how menopause is discussed in medical care, according to Freaney.

“All clinicians need to get comfortable asking about menopause because we have estrogen receptors from our head to our toes.”

For years, menopause has largely been treated as a gynecologic issue, she said. But the hormonal transition affects nearly every system in the body, including the cardiovascular system.

That means cardiovascular clinicians should routinely ask about menopause history when assessing long-term cardiovascular risk.

“Historically, women have been vastly understudied in cardiovascular science, and we still have much to learn about how menopause influences heart health,” Freaney said.

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Menopause

Cardiff opens its first women’s health hub as nationwide rollout begins

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Cardiff’s first women’s health hub has opened, offering specialist perimenopause and menopause support for women aged 40 to 65.

Minister for mental health and wellbeing Sarah Murphy visited the East Cardiff Menopause Hub this week to learn about the new service, which brings together patient-centred advice, treatment and community support under one roof.

The hub forms part of a Wales-wide network of pathfinder women’s health hubs established during the first phase of delivering the Women’s Health Plan.

Women registered with one of the East Cardiff GP Cluster practices will be able to access extended 20-minute consultations, available face-to-face, by telephone or online, with GPs who have specialist experience in menopause care.

Practice nurses will also provide broader healthcare support, including blood pressure checks, lifestyle advice and guidance on hormone replacement therapy.

A Menopause Café, open to women of all ages, will offer a welcoming community space to share experiences and ask questions.

Sarah Murphy said: “It was fantastic to visit the Maelfa hub and see first-hand how Cardiff and Vale University Health Board is bringing high-quality, compassionate care closer to home for women in East Cardiff.

“Women’s health hubs will make it easier for women in Wales to get care when they need it.

“As the pathfinder hubs are rolled out, we’ll be listening to women’s feedback and adapting to make sure we are building a health service which meets the needs of women and girls, now and for generations to come.”

By March, every health board in Wales will have a pathfinder women’s health hub. Each health board has received an additional £300,000 this financial year to support their development.

The hubs form part of the Women’s Health Plan, which includes more than 60 actions to close the gender health gap and is based on feedback from around 4,000 women across Wales.

Dr Claire Beynon, executive director of public health at Cardiff and Vale University Health Board, said: “Too many women feel unsupported or unheard when seeking help for the symptoms of menopause.

“The East Cardiff Menopause Hub is a really positive step in bringing high-quality, compassionate care closer to home, with longer appointments and specialist expertise focused on women’s health needs.

“By combining clinical care with community support, this service helps women feel informed, confident and in control of their health. It also reflects our wider commitment to reducing health inequalities.”

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