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Reeves AN, Lewis TT, Hood MM, Thurston RC, Avis NE, Burnett-Bowie SAM, Cortés YI, Neal-Perry G, Harlow SD. Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN). Menopause 2024; 31:484-493. [PMID: 38595299 PMCID: PMC11126360 DOI: 10.1097/gme.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women. METHODS Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS. RESULTS Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women. CONCLUSIONS Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
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Affiliation(s)
- Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan
- Epidemiology and Population Health, School of Medicine, Stanford University
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Michelle M Hood
- Department of Epidemiology, School of Public Health, University of Michigan
| | - Rebecca C. Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
- Department of Psychology, University of Pittsburgh
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | | | | | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina – Chapel Hill
| | - Siobán D. Harlow
- Department of Epidemiology, School of Public Health, University of Michigan
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Vermeulen RFM, van Beurden M, Gaarenstroom KN, Teunis T, Kieffer JM, Aaronson NK, Kenter GG, Korse CM. Does anti-Müllerian hormone predict change in menopausal symptoms following risk-reducing salpingo-oophorectomy? A prospective observational study. Climacteric 2018; 21:574-580. [PMID: 30295077 DOI: 10.1080/13697137.2018.1512965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether serum anti-Müllerian hormone (AMH) predicts symptom burden after risk-reducing salpingo-oophorectomy (RRSO) in order to individualize counseling. METHODS Patient-reported menopausal symptoms, sexual functioning, and psychological distress (depression and anxiety) were assessed 1 day before (T0) and 6 weeks (T1) and 7 months (T2) after RRSO. AMH was assessed before RRSO. Multivariable regression analysis was used to investigate the association between AMH and short-term and long-term change in symptom burden following RRSO. RESULTS Ninety-one premenopausal women at high risk of ovarian cancer were included. Presurgical AMH was not related significantly to change in symptoms post RRSO. As a secondary outcome we found that regular menses before RRSO was associated specifically with long-term increase in hot flushes (sr = 0.40, p = 0.001; total R2 = 0.171) and depression (sr = 0.29, p = 0.012; total R2 = 0.132). Earlier receipt of chemotherapy was associated with long-term improvement in sexual functioning (sr = 0.24, p = 0.041; total R2 = 0.348). CONCLUSION In this cohort, AMH was not a significant predictor of change in symptoms following RRSO. Regular menses prior to RRSO and earlier receipt of chemotherapy were significantly, but relatively weakly, associated with changes in outcomes 6 weeks and/or 7 months after RRSO.
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Affiliation(s)
- R F M Vermeulen
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , the Netherlands
| | - M van Beurden
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , the Netherlands
| | - K N Gaarenstroom
- b Department of Gynecology , Leiden University Medical Center , Leiden , the Netherlands
| | - T Teunis
- c Plastic, Reconstructive and Hand Surgery , University Medical Center Utrecht , Utrecht , the Netherlands
| | - J M Kieffer
- d Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , the Netherlands
| | - N K Aaronson
- d Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , the Netherlands
| | - G G Kenter
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , the Netherlands
| | - C M Korse
- e Department of Laboratory Medicine , The Netherlands Cancer Institute , Amsterdam , the Netherlands
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Ee CC, Thuraisingam S, Pirotta MV, French SD, Xue CC, Teede HJ. Expectancy after the first treatment and response to acupuncture for menopausal hot flashes. PLoS One 2017; 12:e0186966. [PMID: 29077767 PMCID: PMC5659680 DOI: 10.1371/journal.pone.0186966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background Evidence on the impact of expectancy on acupuncture treatment response is conflicting. Objectives This secondary analysis of a randomized sham-controlled trial on acupuncture for menopausal hot flashes investigated whether treatment expectancy score was associated with hot flash score at end-of-treatment. Secondary analyses investigated whether there were associations between other pre-specified factors and hot flash score. Study design Women experiencing moderately-severe hot flashes were randomized to receive 10 sessions of real or sham acupuncture over eight weeks. Hot flash score was collected using a seven-day hot flash diary, and expectancy using the modified Credibility and Expectancy Questionnaire immediately after the first treatment. Linear mixed-effects models with random intercepts were used to identify associations between expectancy score and hot flash score at end-of-treatment. Regression was also used to identify associations between pre-specified factors of interest and hot flash score. Because there was no difference between real and sham acupuncture for the primary outcome of hot flash score, both arms were combined in the analysis. Results 285 women returned the Credibility and Expectancy Questionnaire, and 283 women completed both expectancy measures. We found no evidence for an association between expectancy and hot flash score at end-of-treatment for individual cases in either acupuncture or sham group. Hot flash scores at end-of-treatment were 8.1 (95%CI, 3.0 to 13.2; P = 0.002) points lower in regular smokers compared to those who had never smoked, equivalent to four fewer moderate hot flashes a day. Conclusion In our study of acupuncture for menopausal hot flashes, higher expectancy after the first treatment did not predict better treatment outcomes. Future research may focus on other determinants of outcomes in acupuncture such as therapist attention. The relationship between smoking and hot flashes is poorly understood and needs further exploration.
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Affiliation(s)
- Carolyn C. Ee
- National Institute of Complementary Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Sharmala Thuraisingam
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie V. Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon D. French
- School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, New South Wales, Australia
| | - Charlie C. Xue
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation: a partnership between Monash Health and the School of Public Health, Monash University, Melbourne, Victoria, Australia
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Coping with menopausal symptoms: An internet survey of Belgian postmenopausal women. Maturitas 2016; 90:24-30. [DOI: 10.1016/j.maturitas.2016.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
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Hunter MS, Stefanopoulou E. Vasomotor symptoms in prostate cancer survivors undergoing androgen deprivation therapy. Climacteric 2015; 19:91-7. [PMID: 26673756 DOI: 10.3109/13697137.2015.1125460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hot flushes and night sweats (HFNS) are common but under-researched in prostate cancer survivors undergoing androgen-deprivation therapy (ADT). We aimed to examine subjective reports and physiological measures of HFNS, and the influence of sociodemographic, clinical and psychological factors on HFNS in men undergoing ADT. METHODS Sixty-eight men undergoing ADT for prostate cancer attended an assessment interview, completed questionnaires (assessing HFNS frequency and problem-rating, mood, stress, optimism, somatosensory amplification, HFNS beliefs/behaviors) and wore an ambulatory sternal skin conductance (SSC) monitor for 48 h. RESULTS The sample had a mean age of 69.76 (standard deviation, SD = 8.04) years, were on average 27.24 (SD = 28.53) months since cancer diagnosis and had been on their current ADT regime for 16 months (range 2-74 months). The men reported frequent (weekly mean 51.04, SD = 33.21) and moderately problematic HFNS. Overall, 294 (20%) of the SSC-defined HFNS were concordant with prospective frequency (event marker), while 63% were under-reported and 17% were over-reported, under-reporting being more common than over-reporting. There were no significant predictors of HFNS frequency (subjective or physiological measures), but psychological variables (HFNS beliefs and behaviors (β = 0.56, p < 0.03), anxiety (β = 0.24, p < 0.01) and somatic amplification (β = 0.76, p < 0.04) were the main predictors of problematic HFNS, i.e. troublesome symptoms. CONCLUSIONS These results are consistent with those of studies of women during menopause and breast cancer survivors, i.e. subjective and physiological measures appear to identify different HFNS dimensions. Psychological variables (HFNS beliefs and behaviors, anxiety and somatic amplification) can be targeted, using cognitive behavior therapy, for symptom relief.
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Affiliation(s)
- M S Hunter
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - E Stefanopoulou
- a Department of Psychology , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
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Jayasena CN, Comninos AN, Stefanopoulou E, Buckley A, Narayanaswamy S, Izzi-Engbeaya C, Abbara A, Ratnasabapathy R, Mogford J, Ng N, Sarang Z, Ghatei MA, Bloom SR, Hunter MS, Dhillo WS. Neurokinin B administration induces hot flushes in women. Sci Rep 2015; 5:8466. [PMID: 25683060 PMCID: PMC4329553 DOI: 10.1038/srep08466] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/21/2015] [Indexed: 12/04/2022] Open
Abstract
Neurokinin B (NKB) is a hypothalamic neuropeptide binding preferentially to the neurokinin 3 receptor. Expression of the gene encoding NKB is elevated in postmenopausal women. Furthermore, rodent studies suggest that NKB signalling may mediate menopausal hot flushes. However, the effects of NKB administration on hot flushes have not been investigated in humans. To address this, we performed a randomised, double-blinded, placebo-controlled, 2-way cross-over study. Ten healthy women were admitted to a temperature and humidity-controlled research unit. Participants received 30 minute intravenous infusions of NKB and vehicle in random order. Symptoms, heart rate, blood pressure, sweating and skin temperature were compared between NKB and vehicle in a double-blinded manner. Eight of ten participants experienced flushing during NKB infusion with none experiencing flushing during vehicle infusion (P = 0.0007). Significant elevations in heart rate (P = 0.0106 vs. pre-symptoms), and skin temperature measured using skin probe (P = 0.0258 vs. pre-symptoms) and thermal imaging (P = 0.0491 vs. pre-symptoms) characteristic of menopausal flushing were observed during hot flush episodes. Our findings provide evidence that NKB administration can cause hot flushes in women. Further studies are required to determine if pharmacological blockade of NKB signalling could inhibit hot flushes during the menopause and during treatment for sex-steroid dependent cancers.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Alexander N Comninos
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Evgenia Stefanopoulou
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital, London, UK
| | - Adam Buckley
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Chioma Izzi-Engbeaya
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Ali Abbara
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Risheka Ratnasabapathy
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Julianne Mogford
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Noel Ng
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Zubair Sarang
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Mohammad A Ghatei
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Stephen R Bloom
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Myra S Hunter
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital, London, UK
| | - Waljit S Dhillo
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Abstract
OBJECTIVE Hot flashes are commonly associated with menopause, and some researchers have questioned whether the widespread phenomenon may somehow be adaptive. It has been hypothesized that hot flashes were selected to occur during the hypoestrogenic postpartum period as a mechanism to warm infants. The purpose of this study was to test whether postpartum hot flashes are similar to hot flashes associated with menopause and whether postpartum hot flashes are concordant with breast-feeding episodes. METHODS Women who gave birth within the past year (n = 20) and a comparison group of women who had not given birth in the past 2 years (n = 14) participated in interviews and anthropometric measures. All wore ambulatory skin conductance monitors for a mean of 6.5 hours during afternoons and early evenings. New mothers also recorded breast-feeding episodes. Objectively measured and subjectively reported hot flashes were compared between groups and in relation to breast-feeding and other variables. RESULTS Age of infants ranged from 4 days to 11 months. New mothers were more likely to report feeling warmer than the comparison group (100% vs 7%) but were not significantly more likely to demonstrate hot flashes (35% vs 50%) or to report hot flashes (30% vs 21%) during the study period. Of 75 breast-feeding episodes, only 4% were concurrent with an objective hot flash, and only 9% were concurrent with a subjective hot flash. CONCLUSIONS This study does not support the hypothesis that menopausal-like hot flashes evolved to warm infants during the postpartum period.
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