EXECUTIVE SUMMARY
Just-published findings show that women fit into four distinct groups when it comes to having hot flashes and night sweats, which offers potential ramifications for therapy and prevention of future health conditions.
- Most women will get hot flashes or night sweats at some point during menopause. Research indicates 42% to 79% of women experience vasomotor symptoms during the menopausal transition.
- Depending on which category a woman falls into as determined by the research, there may be important implications regarding her health, scientists note. More investigation is needed to examine causal relationships.
Most women will get hot flashes or night sweats at some point during menopause. Research indicates 42% to 79% of women experience vasomotor symptoms (VMSs) during the menopausal transition.1-4 Just-published findings show that women fit into four distinct groups when it comes to having hot flashes and night sweats, which offers potential ramifications for therapy and prevention of future health conditions, according to research led by the Graduate School of Public Health at the University of Pittsburgh.5
“Most women get vasomotor symptoms, and we used to think these symptoms lasted from three to five years, right around the time of the final menstrual period,” said senior author Rebecca Thurston, PhD, a professor in the department of psychiatry at the University of Pittsburgh and an epidemiologist at the University of Pittsburgh Graduate School of Public Health. “We now know that these symptoms persist for far longer, typically 7-10 years, and occur at different times for different women.”
Researchers looked at 1,455 women enrolled in the Study of Women’s Health Across the Nation (SWAN), a longitudinal, multicenter study of about 3,000 women in midlife from five racial/ethnic groups. The women, who had not yet gone through menopause when they enrolled, were not on hormone therapy, and they did not have a hysterectomy. The women reported their VMSs on an annual basis, along with receiving a clinical examination and, sometimes, a blood test.
In their analysis, the researchers found that women could be relatively equally divided into four distinct trajectories for VMSs as they went through menopause transition:
- onset early (11 years before the final menstrual period), with a decline after menopause (early onset group);
- onset near the final menstrual period, with later decline (late onset group);
- onset early, with persistently high frequency (high group);
- persistently low frequency (low group).
Certain characteristics were more common in different categories, researchers note. Their analysis findings include the following:
- A consistently low chance of having symptoms throughout the menopause transition was more common in Chinese women than other women.
- A consistently high chance of having symptoms throughout the transition was more common in black women, those with less education, those who reported drinking alcohol moderately or heavily, and those who reported symptoms of depression or anxiety.
- An early onset of symptoms in the decade before the final period, with cessation thereafter, was more common among women who were obese, had symptoms of depression or anxiety, were in poorer health than their peers, and were older at menopause.
- A late onset of symptoms after the final period that gradually declined in the following decade was more common in women with a lower body mass index, those who smoked, and black women than other women.5
Co-author Maria Brooks, PhD, professor of epidemiology and associate professor of biostatistics at Pitt Public Health, says, “It’s fascinating that we can distinguish these unique patterns and, then, pinpoint specific characteristics associated with each of these trajectories. When we see patterns like this, it indicates that there’s something going on beyond hot flashes and night sweats being a passing nuisance.”
Depending on which category a woman falls into, as determined by the researchers, there may be important implications regarding her health, says Brooks, who served as principal investigator of the SWAN coordinating center.
JoAnn Pinkerton, MD, NCMP, executive director of the Cleveland-based North American Menopause Society, notes, “This information provides insight into the different patterns of highly prevalent and often bothersome menopause symptoms. Interventions to treat vasomotor symptoms may be tailored to address specific factors, including ethnicity and patterns of hot flashes that contribute to VMS, allowing us to target women who are most affected and helping clinicians to counsel women and women’s ability to make informed decisions about treatment options.”
Research currently published by Thurston indicates that some of these trajectories are associated with risk factors for cardiovascular disease.6
“At this point, we can’t completely untangle any causal relationship between vasomotor symptoms and health outcomes or suggest preventative measures for vasomotor symptoms without further study,” states Thurston. “But women and their doctors can use these findings now to help them get a better idea what they’re likely to experience as they go through menopause and to plan the best ways to manage their symptoms.”
REFERENCES
- Gold E, Sternfeld B, Kelsey J, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000; 152:463-473.
- Maartens L, Knottnerus J, Pop V. Menopausal transition and increased depressive symptomatology: A community based prospective study. Maturitas 2002; 42:195-200.
- Overlie I, Moen M, Holte A, et al. Androgens and estrogens in relation to hot flushes during the menopausal transition. Maturitas 2002; 41:69-77.
- Dennerstein L, Dudley EC, Hopper JL, et al. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000; 96:351-358.
- Tepper PG, Brooks MM, Randolph JF Jr, et al. Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause 2016; doi:10.1097/GME.0000000000000676.
- Jackson EA, El Khoudary SR, Crawford SL, et al. Hot flash frequency and blood pressure: Data from the Study of Women’s Health Across the Nation. J Womens Health (Larchmt) 2016; doi: 10.1089/jwh.2015.5670.
