EXECUTIVE SUMMARY

A just-published analysis of Women’s Health Initiative data indicates that hot flashes, especially when they also include night sweats, may increase the risk of developing diabetes.

  • Of the total population analyzed, one-third of participants had experienced hot flashes. Researchers note that the incidence of hot flashes was associated with an 18% increased diabetes risk, and this risk continued to increase on the basis of the severity and duration of the hot flashes.
  • The risk for diabetes was the most pronounced for women who reported any type of night sweats, but only if the onset of hot flashes occurred late in the menopause transition.

Many women experience vasomotor symptoms in menopause; about 35% to 50% of perimenopausal and 30% to 80% of postmenopausal women say they have symptoms such as hot flashes and night sweats.1 A just-published analysis of Womens Health Initiative data indicates that hot flashes, especially when they include night sweats, may increase the risk of developing diabetes.2

To perform the study, researchers analyzed data gathered from the more than 150,000 postmenopausal women ages 50-79 who participated in the Women’s Health Initiative (WHI), a long-term national health study focused on strategies for preventing heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Of the total population analyzed, one-third of participants had experienced hot flashes. Researchers note that the incidence of hot flashes was associated with an 18% increased diabetes risk, and this risk continued to increase based on the severity and duration of the hot flashes. The risk for diabetes was the most pronounced for women who reported any type of night sweats, but only if the onset of hot flashes occurred late in the menopause transition, researchers report.2

Is Age a Factor?

These results follow earlier research released in 2017, which indicates that women who have early or normal onset of menopause are at a higher risk of developing type 2 diabetes than those have late onset of menopause.3 To perform that study, researchers reviewed data obtained via the Rotterdam Study, a population-based, prospective cohort study carried out in the Ommoord district of Rotterdam, the Netherlands. Of its 6,816 participants, 3,969 women were included in the present study.

The analysis indicates that 348 developed incident type 2 diabetes over a median follow-up of 9.2 years. Compared to women with late menopause (defined as 55 years or later), those with the earliest menopause (classified as age younger than 40 years) were almost four times more likely to have developed diabetes.3 Women who experienced menopause at ages 40-44 were 2.4 times more likely to develop type 2 diabetes, whereas those with menopause at ages 45-55 were 60% more likely than those with late menopause to develop the disease. Researchers note the risk of developing type 2 diabetes dropped by 4% per year later the woman experienced menopause. Adjustment for the various confounding factors and genetic risk score did not affect the results, scientists conclude.

Future studies should explore epigenetic marks (changes in gene function that do not involve changes to the DNA sequence) connected to menopause onset and whether these signatures can explain the relationship between age at natural menopause and type 2 diabetes, the researchers note. Future studies are needed to explore the mechanisms of this association, they say.

Impact on Your Practice?

What do these findings mean for your practice? Diabetes currently affects 15% of women age 55 and older, and its incidence is expected to more than double by 2050.3,4 Women who have diabetes are at higher risk of hospitalization or death from diabetes and its complications compared with men who have the disease. Timely identification and management of diabetes with lifestyle modifications or medical management is important to protect post-menopausal health.

The findings from the current study suggest that after adjustment for obesity and race, women with more severe night sweats, with or without hot flashes, still had a higher risk of diabetes, notes JoAnn Pinkerton, MD, executive director of the North American Menopause Society. Menopause is a “perfect time” to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease, she observes. “Suggestions include getting regular exercise and adequate sleep, avoiding excess alcohol, stopping smoking, and eating a heart-healthy diet,” said Pinkerton in a statement. “For symptomatic women, hormone therapy started near menopause improves menopause symptoms and reduces the risk of diabetes.”

Clinicians also should counsel patients on the importance of maintaining a healthy weight by eating a balanced, low-sugar diet, as well as the need to control high blood pressure with medication or lifestyle changes. Both tactics will help reduce the risk for heart disease. Patients also should be advised to increase sources of omega-3 fatty acids in their diet through eating fatty fish, such as mackerel, salmon, and sardines, or plant-based sources, such as soy, canola oil, flax seeds, and walnuts.

REFERENCES

  1. NIH State-of-the-Science Conference Statement on management of menopause-related symptoms. NIH Consens State Sci Statements 2005;22:1-38.
  2. Gray KE, Katon JG, LeBlanc ES, et al. Vasomotor symptom characteristics: Are they risk factors for incident diabetes? Menopause 2017; doi:10.1097/GME.0000000000001033.
  3. Schoenborn C, Heyman KM. Health characteristics of adults aged 55 years and over: United States, 2004-2007. Natl Health Stat Report 2009;16:1-32.
  4. Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the U.S. Diabetes Care 2001;24:1936-1940.