Determinants of hot flashes and night sweats

Impact of comorbidities on COVID-19 mortality in hospitalized women: Insights from the metropolitan area of the Valley of Mexico from 2020 to 2022

Objectives

This research summarizes the impact of the major comorbidities impacting hospitalized women with COVID-19 and their relation to death.

Methods

Public data from national databases (2020-2022) for hospitalized women, including identification data, hospitalization time, comorbidities, and intensive care unit (ICU) admissions, were analyzed. Women were stratified by age (split at 50 years). Binary regression models determined the correlation between comorbidities and COVID-19 with mortality, expressed as odds ratios.

Results

A total of 46,492 women were hospitalized, with 70.1% aged above 50 years. A total of 17,728 fatalities occurred, with 86.5% in the older age group. A total of 5.82% women required intensive care. The common comorbidities were pneumonia, hypertension, diabetes, obesity, and intubation. A total of 56.6% died within the 1st week; in the ICU, 65.7% died by week 2. In the logistic regression, diabetes and chronic kidney disease (CKD) were initially significant, followed by pneumonia and CKD (days 8-14), intubation and, ICU stay (beyond the 15th day). In the ICU, intubation impact worsened over time.

Conclusions

Our study highlights the significant impact of comorbidities on COVID-19 mortality in women in the Valley of Mexico. Pneumonia, diabetes, CKD, and intubation were notably prevalent and correlated strongly with death in older women. Timely intubation improves survival, whereas delayed intubation increases mortality risk, particularly, in the ICU. Urgent targeted interventions are required, especially for older hospitalized women.

Altered sleep architecture following consecutive nights of presleep alcohol

STUDY OBJECTIVES

Alcohol consumption before sleep decreases sleep latency, explaining the common use of alcohol as a sleep aid. The full impact of alcohol on sleep architecture is not well understood, particularly the potential cumulative effects of presleep alcohol consumption across consecutive nights. Here, we describe the effects of presleep alcohol on sleep architecture across three consecutive nights.

METHODS

Thirty adult participants took part in a crossover, within-participants study consisting of two sets of three consecutive nights of in-lab polysomnography. For each series of nights, participants drank one of the two beverages: a mixer only or a mixer plus alcohol (targeting a BrAC of 0.08 mg/L), ending 1 hour before lights out. Polysomnography (PSG) was used to stage sleep, and standard sleep variables were extracted. Linear mixed-effect analysis and generalized additive modeling were used to examine the effect of alcohol on sleep architecture.

RESULTS

Alcohol before sleep increased the rate of slow wave sleep (SWS) accumulation across all three nights and decreased the rate of rapid eye movement (REM) sleep accumulation at the start of each night. Alcohol also decreased the total amount of REM sleep but did not affect the total amount of SWS each night.

CONCLUSIONS

These data indicate that drinking alcohol before sleep substantially affects sleep architecture, including changes to the rate of accumulation of SWS and REM sleep. We show that alcohol disrupts normal sleep architecture, leading to a significant decrease in REM sleep; thus, the use of alcohol as a sleep aid remains a public health concern.

Patterns of smoking and menopause-specific quality of life: smoking duration matters more

Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck's Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women.Supplemental data for this article is available online at.

Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.

Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project

In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.

Dietary patterns and their association with menopausal symptoms: a cross-sectional study

OBJECTIVE

Although menopause is a natural event in a woman's life, some of its symptoms can be severe enough to adversely affect her health. There is some evidence to suggest that diet has an influence on menopausal symptoms, but less attention has been paid to dietary patterns. The purpose of this study is to determine the association of dietary patterns with physical, mental, and genitourinary menopausal symptoms.

METHODS

A cross-sectional study design was applied using a sample of 400 postmenopausal women who attended health centers in the south of Tehran, Iran. The menopausal symptoms were assessed by a Menopause Rating Scale (MRS) questionnaire; a 147-item, semi-quantitative food-frequency questionnaire was used to collect dietary information, and major dietary patterns were identified by principal component analysis. Linear regression was used to evaluate the relationship between menopausal symptoms and dietary patterns.

RESULTS

Three major dietary patterns were identified: vegetables and fruits (VF); mayonnaise, liquid oils, sweets, and desserts (MLSD); and solid fats and snacks (SFS). It has been found that the VF dietary pattern is inversely associated with general (β = -1.37; SE = 1.08; P for trend <0.001), physical (β = -1.54; SE = 1.09; P for trend <0.001), and mental (β = -1.58; SE = 1.11; P for trend <0.001) symptoms. A stronger adherence to the MLSD dietary pattern was directly associated with general (β = 1.15; SE = 1.08; P for trend <0.001) and genitourinary symptoms (β = 1.54; SE = 1.1; P for trend <0.001). Moreover, the SFS dietary pattern was directly related to the general (β = 1.23; SE = 1.09; P for trend = 0.01), physical (β = 1.24; SE = 1.09; P for trend = 0.04), and mental (β = 1.29; SE = 1.12; P for trend < 0.001) symptoms.

CONCLUSION

The present study demonstrated that there is an inverse association between VF dietary pattern and menopausal symptoms. In contrast, the MLSD and SFS dietary patterns were correlated to an increased risk of these symptoms.

Vasomotor Symptoms Across the Menopause Transition: Differences Among Women

Vasomotor symptoms (VMS) are the primary menopausal symptoms, occurring in up 80% of women and peaking around the final menstrual period. The average duration is 10 years, longer in women with an earlier onset. Compared with non-Hispanic white women, black and Hispanic women are more likely and Asian women are less likely to report VMS. Risk factors include greater body composition (in the early stage of menopausal transition), smoking, anxiety, depression, sensitivity to symptoms, premenstrual syndrome, lower education, and medical treatments, such as hysterectomy, oophorectomy, and breast cancer-related therapies. VMS patterns over time and within higher-risk subgroups are heterogeneous across women.

Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study

OBJECTIVE

The aim of this study was to examine the associations of demographic characteristics, health behaviors, and hormone concentrations with the experience of any, current, more severe, and more frequent midlife hot flashes.

METHODS

Baseline data from 732 women aged 45 to 54 years who were enrolled in the Midlife Women's Health Study were analyzed. A clinic visit was conducted to collect blood samples for hormone assays and to measure ovarian volume using transvaginal ultrasound. A self-administered questionnaire ascertained information on demographic factors, health habits, and hot flash history. Multivariable logistic regression was conducted to examine associations between potential risk factors and hot flash outcomes.

RESULTS

Approximately 45% of participants reported experiencing midlife hot flashes. In covariate-adjusted models, older age, perimenopause status, current and past cigarette smoking, and depressive symptoms were significantly associated with increased odds of all of the hot flash outcomes. In addition, history of oral contraceptive use was associated with increased odds of any hot flashes. In contrast, higher current alcohol intake was significantly associated with decreased odds of any, current, and more severe hot flashes. Higher estradiol and progesterone concentrations were significantly associated with decreased odds of all hot flash outcomes.

CONCLUSIONS

Although the temporality of such associations is not known because of the cross-sectional nature of the data, these observed relationships can help to identify women at risk for hot flashes.

Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study

OBJECTIVES

To examine the associations between consultations with complementary and alternative medicine (CAM) practitioners and menopause-related symptoms.

METHODS

A cross-sectional survey of a nationally representative sample of 10 011 women aged 59-64 years from the Australian Longitudinal Study on Women's Health, conducted in 2010. Women, including those with hysterectomy, oophorectomy and natural menopause, were asked about their consultations with a range of CAM practitioners and menopause-related symptoms experienced.

RESULTS

Acupuncturists were more likely to be consulted by women with hysterectomy experiencing night sweats (odds ratio, OR = 2.21), but were less likely to be consulted by those experiencing hot flushes (OR = 0.53). Acupuncturists were also more likely to be consulted by women with oophorectomy (OR = 3.11) and natural menopausal women (OR = 1.57) experiencing back pain. Massage therapists were more likely to be consulted by women with oophorectomy experiencing back pain (OR = 1.98), women with hysterectomy experiencing anxiety (OR = 1.52), and natural menopausal women experiencing back pain (OR = 1.54) and/or anxiety (OR = 1.29). Naturopaths/herbalists were more likely to be consulted by women with oophorectomy experiencing leaking urine (OR = 2.08). Chiropractors/osteopaths were more likely to be consulted by women across all menopausal status experiencing back pain (OR = 2.52, 2.31 and 2.25 for women with oophorectomy, hysterectomy and natural menopause, respectively).

CONCLUSIONS

There are substantial levels of CAM practitioners' consultations amongst menopausal women, with a range of menopause-related symptoms associated with the use of specific CAM practitioner modalities. It is important that health-care providers are mindful of CAM practitioner use in order to ensure safe, effective and coordinated treatment and support for menopausal women in their care.

Are menopausal hot flashes an evolutionary byproduct of postpartum warming?

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.

Risk factors for night sweats and hot flushes in midlife: results from a prospective cohort study

OBJECTIVE

This study aims to identify social, lifestyle, and reproductive history risk factors for night sweats (NS) only, hot flushes (HF) only, and both NS and HF.

METHODS

Risk factors and symptoms among 10,454 participants of the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years in 1996 were measured at baseline and 3-year intervals (surveys 2-6) for 15 years. Multinomial logistic regression analyses were performed.

RESULTS

Compared with neither symptom, both symptoms together were reported less often by highly educated women (odds ratio, 0.61; 99.9% CI, 0.50-0.74), but more often by women who were heavier (odds ratio, 1.23; 99.9% CI, 1.08-1.40), were current smokers (odds ratio, 1.31; 99.9% CI, 1.09-1.56), were high-risk drinkers (odds ratio, 1.44; 99.9% CI, 1.10-1.89), were perimenopausal (odds ratio, 6.57; 99.9% CI, 5.52-7.82) or postmenopausal (odds ratio, 4.74; 99.9% CI, 4.00-5.63), had gained weight (odds ratio, 1.15; 99.9% CI, 1.01-1.31), or had premenstrual tension (odds ratio, 1.86; 99.9% CI, 1.48-2.34), than by women without these characteristics. HF only was reported less often by highly educated women (odds ratio, 0.73; 99.9% CI, 0.59-0.90), but more often by perimenopausal (odds ratio, 3.58; 99.9% CI, 2.95-4.35) or postmenopausal (odds ratio, 2.97; 99.9% CI, 2.47-3.57) women and by those with premenstrual tension (odds ratio, 1.60; 99.9% CI, 1.25-2.04). Finally, NS only was reported more often among current smokers (odds ratio, 1.55; 99.9% CI, 1.11-2.19), high-risk drinkers (odds ratio, 1.76; 99.9% CI, 1.04-2.97), perimenopausal women (odds ratio, 1.53; 99.9% CI, 1.14-2.06), those with diabetes (odds ratio, 1.91; 99.9% CI, 1.08-3.35), those with premenstrual tension (odds ratio, 1.67; 99.9% CI, 1.09-2.56), or those of early age at first pregnancy (odds ratio, 1.45; 99.9% CI, 1.05-1.99).

CONCLUSIONS

The presence of both symptoms is associated with social, behavioral, and menstrual factors. Some differences in risk factors among women who report only one symptom or both symptoms are observed, suggesting a slightly different etiology for each.

Cross-cultural analysis of determinants of hot flashes and night sweats: Latin-American immigrants to Madrid and their Spanish neighbors

OBJECTIVE

This study applies a biocultural perspective to better understand the determinants of hot flashes and night sweats within immigrant and local populations in Madrid, Spain.

METHODS

A combined sample of 575 women from Madrid, aged 45 to 55 years, was drawn from two studies. The Spanish sample (n = 274) participated in The Decisions At Menopause Study in 2000-2002. The Latin-American sample (n = 301) was drawn from immigrants to Madrid in 2010-2011. χ(2) analyses and logistic regression models were carried out on the combined sample, controlling for origin of provenance.

RESULTS

Forty-four percent of women reported hot flashes, 36% reported night sweats, and 26% reported both symptoms. Compared with Spanish women, Latin-American women were less likely to report hot flashes (odds ratio, 0.7; 95% CI, 0.4-0.9), after demographic variables and menopause status were controlled for. The same was not found for night sweats and for both symptoms combined. Determinants of hot flashes differed from determinants of night sweats.

CONCLUSIONS

Because their determinants differ, hot flashes and night sweats should be queried and analyzed separately. Latin-American women are less likely to report hot flashes, but not night sweats or both symptoms combined. More research is needed to clarify the differences in reported hot flashes, as the lesser reporting among immigrants could have been a cultural phenomenon rather than a biological phenomenon.

'You know I've joined your club… I'm the hot flush boy': a qualitative exploration of hot flushes and night sweats in men undergoing androgen deprivation therapy for prostate cancer

OBJECTIVE

Hot flushes and night sweats are common amongst menopausal women, and psychological interventions for managing these symptoms have recently been developed for women. However, flushes in men with prostate cancer, which commonly occur following androgen deprivation therapy (ADT), remain under-researched. This study is a qualitative exploration of flush-related cognitive appraisals and behavioural reactions reported by a sample of these men.

METHODS

Semi-structured, in-depth interviews were conducted with 19 men who were experiencing flushes after receiving ADT for prostate cancer. Framework analysis was used to generate and categorise emergent themes and explore associations between themes.

RESULTS

Five main cognitive appraisals included the following: changes in oneself, impact on masculinity, embarrassment/social-evaluative concerns, perceived control and acceptance/adjustment. There were men who held beliefs about the impact of flushes on their perceptions of traditional gender roles, who experienced shame and embarrassment due to concerns about the salience of flushes and perceptions by others and who experienced feelings of powerlessness over flushes. Powerlessness was associated with beliefs about the potentially fatal consequences of discontinuing treatment. Two other dominant themes included awareness/knowledge about flushes and management strategies. Experiences of flushes appeared to be influenced by upbringing and general experiences of prostate cancer and ADT.

CONCLUSIONS

The range of men's appraisals of, and reactions to, flushes generated from this qualitative exploration were broadly similar to those of menopausal women but differed in terms of the influence of masculinity beliefs. These findings could be used to inform future research and psychological interventions in this under-researched field.

Duration of menopausal hot flushes and associated risk factors

OBJECTIVE

To estimate the duration of moderate-to-severe menopausal hot flushes and identify potential risk factors for hot flush duration.

METHODS

The Penn Ovarian Aging Study cohort was monitored for 13 years. Hot flushes were evaluated at 9-month to 12-month intervals through in-person interviews. The primary outcome was the duration of moderate-to-severe hot flushes estimated by survival analysis (n=259). Potential risk factors included menopausal stage, age, race, reproductive hormone levels, body mass index (BMI), and current smoking. A secondary analysis included women who reported any hot flushes (n=349).

RESULTS

The median duration of moderate-to-severe hot flushes was 10.2 years and was strongly associated with menopausal stage at onset. Hot flushes that started near entry into the menopause transition had a median duration greater than 11.57 years; onset in the early transition stage had a median duration of 7.35 years (95% confidence interval [CI] 4.94-8.89; P<.001); and onset in the late transition to postmenopausal stages had a median duration of 3.84 years (95% CI 1.77-5.52; P<.001). The most common ages at onset of moderate-to-severe hot flushes were 45-49 years (median duration, 8.1 years; 95% CI 5.12-9.28). African American women had a longer duration of hot flushes than white women in adjusted analysis.

CONCLUSION

The median duration of hot flushes considerably exceeded the timeframe that is generally accepted in clinical practice. The identified risk factors, particularly menopausal stage, race, and BMI, are important to consider in individualizing treatment and evaluating the risk-to-benefit ratio of hormones and other therapies.

Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study

BACKGROUND

Diet has been suggested to be a potential risk factor for vasomotor menopausal symptoms (VMSs), ie, hot flushes and night sweats.

OBJECTIVE

We investigated the associations between dietary patterns and risk of VMSs by using data from middle-aged women born between 1946 and 1951 in the Australian Longitudinal Study on Women's Health.

DESIGN

A prospective cohort study of 6040 women with a natural menopause were followed up at 3-y intervals over 9 y. Dietary intake was assessed at baseline in 2001, and the presence of VMSs was assessed at baseline and follow-up. Factor analysis and generalized estimating equation models for binary repeated measures were performed.

RESULTS

Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the fruit or Mediterranean-style diet was inversely associated with VMSs in a comparison of the top with the bottom quintile, with adjusted ORs of 0.81 (95% CI: 0.71, 0.93; P-trend = 0.0009) and 0.80 (95% CI: 0.69, 0.92; P-trend = 0.0004), respectively. The high-fat and -sugar pattern increased the risk of VMSs in a comparison of the top with the bottom quintile, with an adjusted OR of 1.23 (95% CI: 1.05, 1.44; P-trend = 0.02).

CONCLUSIONS

Consumption of a fruit or Mediterranean-style diet decreased the risk of reporting VMSs, whereas consumption of a high-fat and -sugar diet increased the risk of VMSs. These results may eventually lead to a basis for the development of dietary preventive measures for VMSs.

Testing a cognitive model of menopausal hot flushes and night sweats

OBJECTIVE

Hot flushes and night sweats (HFNS) are commonly experienced by women during the menopause transition and are particularly problematic for approximately 25% having negative impact on their quality of life. We previously developed a cognitive model of HFNS, which outlines potential predictors of HFNS. This study aims to test the model by investigating the relationships between personality characteristics, perceived stress, mood, HFNS beliefs and subjective and physiological measures of menopausal HFNS.

METHODS

140 women (menopause transition or postmenopausal) who were experiencing at least 10 HFNS per week for at least a month, completed assessment interviews, including questionnaires assessing optimism, somatic amplification, perceived stress, depressed mood, anxiety, HFNS beliefs and HFNS frequency, problem-rating and 24-hour sternal skin conductance monitoring. Structural equation models (SEM) were used to investigate the optimum predictive model for HFNS Frequency and HFNS Problem-Rating.

RESULTS

On average 63 HFNS per week and moderately problematic HFNS were reported. The physiological measure of HFNS frequency was not associated with socio-demographic variables, personality or mood. The final SEM explained 53.2% of the variance in problem rating. Stress, anxiety and somatic amplification predicted HFNS problem rating but only via their impact on HFNS beliefs; HFNS frequency, smoking and alcohol intake also predicted HFNS problem rating.

CONCLUSIONS

Findings support the influence of psychological factors on experience of HFNS at the level of symptom perception and cognitive appraisal of HFNS.

Factors associated with reporting classic menopausal symptoms differ

OBJECTIVES

To investigate how symptoms experienced in midlife cluster and to identify factors independently associated with hot flushes, night sweats, and vaginal dryness.

METHODS

A questionnaire was sent to 8206 women aged 45-54 years, recruited from family practices in north-east Scotland, UK. Using data collected about 23 symptoms, we conducted factor analysis for premenopausal, perimenopausal, postmenopausal and surgically menopausal women. Forward stepwise logistic regression was used to identify sociodemographic, lifestyle and psychological variables independently associated with the classic menopausal symptoms.

RESULTS

Overall, 4407 women responded. Hot flushes were experienced by 46.7% (95% confidence interval (CI) 45.2-48.2) of women, night sweats by 46.4% (95% CI 44.9-47.9) and vaginal dryness by 28.2% (95% CI 26.9-29.6). Seven factors including 20 symptoms emerged from factor analysis. Hot flushes were associated with: being perimenopausal or postmenopausal; low education; obesity; low social support; reporting night sweats, musculoskeletal, bloating, menstrual and sexual symptoms; using complementary alternative medicines, lifestyle (e.g. exercising) or psychological management strategies (e.g. talking to family or friends) for menopausal symptoms. Night sweats were associated with: lower body weight; smoking; possible depression; reporting sleep difficulties, hot flushes and sexual symptoms; using lifestyle strategies for menopausal symptoms. Vaginal dryness was associated with: being postmenopausal; high education; high social support; below average physical health, reporting hot flushes, somatic symptoms and decreased sexual interest; using psychological or lifestyle strategies for menopausal symptoms.

CONCLUSION

It is important to investigate each classic menopausal symptom separately. Combining menopausal symptoms into categories such as vasomotor symptoms may lead to inaccurate conclusions about variables associated with these symptoms.

Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up

BACKGROUND

We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. Following an initial pilot study, which focused on the acceptability and safety of SGB for this important problem, we evaluated its short- and long-term efficacy.

MATERIALS AND METHODS

Postmenopausal breast cancer survivors with severe vasomotor symptoms resistant to standard nonhormonal pharmacological intervention were eligible. Diaries were used to measure daily hot flash scores (frequency and intensity) and sleep quality (Pittsburgh Sleep Quality Index) during scheduled visits at baseline, 1, 4, 12 and 24 weeks following the SGB. Efficacy data were analyzed using longitudinal regression models.

RESULTS

Thirty-four patients participated and none refused the SGB procedure. Most patients received more than one SGB. The pilot study found SGB to be safe. In the main study, hot flash scores were reduced from baseline by 64% [95% confidence interval (CI) -74% to -49%] and 47% (95% CI -62% to -27%) at weeks 1 and 24, respectively. The odds ratio of better sleep quality relative to baseline was 3.4 at week 1 (95% CI 1.6-7.2) and 4.3 at week 24 (95% CI 1.9-9.8).

CONCLUSION

In the short term, SGB appears to be an effective treatment with acceptable morbidity for some breast cancer survivors with therapy-resistant vasomotor symptoms and/or sleep disturbances. Although sleep quality was maintained out to 24 weeks the efficacy of SGB for hot flashes was reduced over time. A randomized controlled trial is needed to confirm these findings.

Menopause Symptoms' Severity Inventory (MSSI-38): assessing the frequency and intensity of symptoms

OBJECTIVES

Menopausal instruments usually assess the frequency or intensity of symptoms. The present study develops and validates an inventory to assess the severity of menopausal symptoms through the measurement of their frequency and intensity, and explores the differences between women with different menopausal status.

METHODS

A community sample of 992 Portuguese women in pre-, peri- and postmenopause completed the proposed inventory with 47 items. Factor exploratory and confirmatory analyses, and comparative statistics for paired and independent samples, were applied using PASW Statistics v.19 and AMOS v.18 software.

RESULTS

The final structure with 38 items organized in 12 factors showed overall good psychometric properties (in terms of factor analysis, convergent, discriminant and criterion validity, as well as regarding reliability, sensitivity, and measure invariance in two different and independent samples). The Wilcoxon test confirmed significant differences between frequency and intensity of symptoms. Moreover, peri- and postmenopausal women in this community sample presented low symptom severity (ranging from 0.4 to 1.4 in a scale from 0 to 4). Although postmenopausal participants presented higher levels (when compared with their perimenopausal counterparts), the two groups only diverged significantly in some physical symptoms (namely, aches and pain, vasomotor symptoms, numbness, skin and facial hair changes, urinary and sexual symptoms).

CONCLUSION

This research emphasizes that severity measurement of symptoms should account for both frequency and intensity. Moreover, it contributes a fully validated 12-dimension inventory for menopausal symptoms, the Menopause Symptoms' Severity Inventory-38. Regarding differences between peri- and postmenopausal women, the increment in symptoms only happens in physical symptoms, although the severity levels are not exacerbated.

Menopausal hot flushes and night sweats: where are we now?

OBJECTIVE

An overview of the current knowledge on the etiology and treatment of vasomotor symptoms in postmenopausal women.

MATERIALS AND METHODS

Acknowledged experts in the field contributed a brief assessment of their areas of interest which were combined and edited into the final manuscript.

RESULTS

Women around the world experience vasomotor symptoms as they enter and complete the menopause transition. Vasomotor symptoms, specifically hot flushes, are caused by a narrowing of the thermoneutral zone in the brain. This effect, although related to estrogen withdrawal, is most likely related to changes in central nervous system neurotransmitters. Peripheral vascular reactivity is also altered in symptomatic women. Estrogen replacement therapy is the most effective treatment for hot flushes. Of the other interventions investigated, selective serotonin and selective norepinephrine reuptake inhibitors and gabapentin show efficacy greater than placebo. Objective monitoring of hot flushes indicates a robust improvement with hormone replacement therapy but little to no change with placebo. These data suggest that the subjective assessment of responses to therapy for vasomotor symptom results in inaccurate data. Hot flushes have recently been associated with increased cardiovascular risks and a lower incidence of breast cancer, but these data require confirmation.

CONCLUSIONS

Vasomotor symptoms are experienced by women of all ethnic groups. They are caused by changes in the central nervous system associated with estrogen withdrawal and are best treated with estrogen replacement therapy. Objective monitoring of hot flushes indicates that placebo has little to no effect on their improvement. Subjective assessments of hot flushes in clinical trials may be inaccurate based on objective measurement of the frequency of hot flushes. Based on preliminary reports, women experiencing hot flushes have an increased risk of cardiovascular disease and a reduced incidence of breast cancer.

Perceived control, lifestyle, health, socio-demographic factors and menopause: impact on hot flashes and night sweats

OBJECTIVE

To develop a model to predict the perceived severity of hot flashes (HF) and night sweats (NS) in symptomatic middle-aged women.

METHODS

This was a cross-sectional study of a community-based sample of 243 women with vasomotor symptoms. Menopausal status was ascertained using the 'Stages of Reproductive Aging Workshop' criteria. Women's 'perceived control' over their symptoms was measured by a validated Portuguese version of the Perceived Control over Hot Flushes Index. Structural equation modelling was employed to construct a causal model of self-reported severity of both HF and NS, using a set of 20 variables: age, marital status, parity, professional status, educational level, family annual income, recent diseases and psychological problems, medical help-seeking behaviour to manage menopausal symptoms, use of hormone therapy and herbal/soy products, menopause status, intake of alcohol, coffee and hot beverages, smoking, physical exercise, body mass index and perceived control.

RESULTS

Significant predictors of perceived severity were the use of hormone therapy for both HF (β=-.245; p=.022) and NS (β=-.298; p=.008), coffee intake for both HF (β=-.234; p=.039) and NS (β=-.258; p=.029) and perceived control for both HF (β=-1.0; p<.001) and NS (β=-1.0; p<.001). The variables explained respectively 67% and 72% of the variability in the perceived severity of HF and NS. Women with high perceived control had a significantly lower frequency (t(235)=2.022; p=.044) and intensity of HF (t(217)=3.582; p<.001); similarly, participants with high perceived control presented a lower frequency (t(235)=3.267; p<.001) and intensity (t(210)=3.376; p<.001) of NS.

CONCLUSION

Perceived control was the strongest predictor of the self-reported severity of both HF and NS. Other causal predictors were hormone therapy and caffeine intake. All three were associated with less severe vasomotor symptoms.

Patterns of occurrence and concordance between subjective and objective hot flashes among Muslim and Hindu women in Sylhet, Bangladesh

This study examined the pattern of occurrence and the rate of concordance between objective hot flashes measured by sternal skin conductance and the subjective experience of "gorom vap laga" (feeling steaming hot) among Muslim and Hindu women living in Sylhet, Bangladesh. Participants were aged 40-55, not pregnant or lactating, not using hormone therapy, and with no history of hysterectomy. Thirty women wore an ambulatory hot flash monitor for 8 h on average, from mid-morning to early evening. True positive, false negative, and false positive measures of hot flashes were examined in relation to demographic, reproductive, and lifestyle variables. On body diagrams, women were most likely to indicate hot flashes on the top of their head (64%) and upper chest (68%). The greatest number of objective hot flashes occurred during the hour of 17:00, perhaps due to the heat of the day, and the clothing and activity associated with prayer. Muslim participants demonstrated more objective hot flashes per woman than Hindu participants (1.5 vs. 0.1, P < 0.05), and Muslims had more false positive measures (86%) compared with Hindu participants (0%, P = 0.06). Among all women who reported subjective hot flashes (n = 19), the proportion of true positive scores was 19%. Overall, the frequency of objective hot flashes was low compared with reports from studies in the United States. The pattern of sweating assessed by body diagrams was not associated with variation in hot flash experience.

Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis

BACKGROUND

Treatment decisions about menopause are predicated on a transient duration of vasomotor symptoms. However, evidence supporting a specific duration is weak.

OBJECTIVE

To estimate the natural progression of vasomotor symptoms during the menopause transition by systematically compiling available evidence using meta-analytic techniques.

DATA SOURCES

We searched MEDLINE, hand searched secondary references in relevant studies, book chapters, and review papers, and contacted investigators about relevant published research.

REVIEW METHODS

English language, population-based studies reporting vasomotor symptom prevalence among women in menopausal transition in time intervals based on years to or from final menstrual period were included. Two reviewers independently assessed eligibility and quality of studies and extracted data for vasomotor symptom prevalence.

RESULTS

The analyses included 10 studies (2 longitudinal, 8 cross sectional) with 35,445 participants. The percentage of women experiencing symptoms increased sharply in the 2 years before final menstrual period, peaked 1 year after final menstrual period, and did not return to premenopausal levels until about 8 years after final menstrual period. Nearly 50% of all women reported vasomotor symptoms 4 years after final menstrual period, and 10% of all women reported symptoms as far as 12 years after final menstrual period. When data were examined according to symptom severity ('any' vs. 'bothersome'), bothersome symptoms peaked about 1 year earlier and declined more rapidly than symptoms of any severity level.

CONCLUSIONS

Our findings suggest a median symptom duration of about 4 years among symptomatic women. A longer symptom duration may affect treatment decisions and clinical guidelines. Further prospective, longitudinal studies of menopausal symptoms should be conducted to confirm these results.

Gabapentin for the treatment of menopausal hot flashes: a randomized controlled trial

OBJECTIVE

To compare the effectiveness and tolerability of gabapentin with placebo for the treatment of hot flashes in women who enter menopause naturally.

DESIGN

A randomized, double-blind, placebo-controlled trial was conducted across the greater Toronto area between March 2004 and April 2006 in the community and primary care settings. Eligible participants were 200 women in natural menopause, aged 45 to 65 years, having at least 14 hot flashes per week. Study participants were randomized to receive gabapentin 300 mg oral capsules or placebo three times daily for 4 weeks. The primary outcome measure was the mean percentage change from baseline to week 4 in daily hot flash score, determined from participant diaries. Secondary outcome measures included changes in weekly mean hot flash scores and frequencies, quality of life, and adverse events.

RESULTS

Of the 197 participants, 193 (98%) completed the study. Analysis was by intention to treat. Hot flash scores decreased by 51% (95% CI: 43%-58%) in the gabapentin group, compared with 26% (95% CI: 18%-35%) on placebo, from baseline to week 4. This twofold improvement was statistically significant (P < 0.001). The Menopause-Specific Quality-of-Life vasomotor score decreased by 1.7 (95% CI: 1.3-2.1; P < 0.001) in the gabapentin group. These women reported greater dizziness (18%), unsteadiness (14%), and drowsiness (12%) at week 1 compared with those taking placebo; however, these symptoms improved by week 2 and returned to baseline levels by week 4.

CONCLUSIONS

Gabapentin at 900 mg/day is an effective and well-tolerated treatment for hot flashes.

"It's my hormones, doctor"--does physical activity help with menopausal symptoms?

OBJECTIVE

Many women experience health problems when going through menopause, and these health problems may result in a substantial reduction in quality of life. There are some indications that physical activity may play a role in ameliorating menopausal symptoms, but there is conflicting evidence about this. To assess the relationship between changes in physical activity and self-reported vasomotor, somatic, and psychological symptoms.

DESIGN

Data from the third (2001) and fourth (2004) surveys of the Australian Longitudinal Study on Women's Health were used. Data from 3,330 middle-aged women were included in the analyses. In linear regression models, the relationships between changes in physical activity of at least moderate intensity and total menopausal, vasomotor, somatic, and psychological symptoms were determined.

RESULTS

Physical activity was not associated with total menopausal symptoms, vasomotor or psychological symptoms. A weak association with somatic symptoms (B = -0.003; 95% CI: -0.005 to -0.001) was found. Weight gain was associated with increased total, vasomotor, and somatic symptoms. Weight loss was associated with a reduction in total and vasomotor symptoms.

CONCLUSION

Changes in physical activity were not related to vasomotor or psychological symptoms and only marginally to somatic symptoms. Changes in weight showed a stronger relationship with menopausal symptoms. The relationship between weight change and menopausal symptoms merits further exploration.

Variation in sweating patterns: implications for studies of hot flashes through skin conductance

OBJECTIVE

The literature of sweat physiology and population variation in response to heat stress suggests that variation in sweating patterns may affect the measurement of hot flashes. This study examined variation in sweating patterns in Puebla, Mexico, and Amherst, MA, and compared the levels of concordance between subjective and objective measures of hot flashes.

DESIGN

Thirteen women in Puebla, Mexico, and 15 women in Amherst, MA, aged 45 to 61, completed surveys, body diagrams of heat flow during a hot flash, anthropometric measures, and the measurement of hot flashes through skin conductance monitoring. Hot flashes were measured through sternal (Mexico and Massachusetts) and nuchal (Mexico only) skin conductance.

RESULTS

Mexican women were significantly more likely to describe the heat of hot flashes on the back of their neck (100% vs 40%) and on their arms and/or hands (85% vs 40%) compared with women in Massachusetts. Hot flashes in the midback were associated with concordance between nuchal, but not sternal, measures of skin conductance and subjective report in Mexico. In comparing average scores for concordance between subjective and sternal measures of hot flashes, there was a higher mean score for true positives in Mexico (61% vs 29%, P=0.06) and a significantly higher mean score for false-negative measures in Massachusetts (57% vs 21%, P=0.04).

CONCLUSIONS

Variation in rates of concordance between subjective and objective measures were not adequately explained by sweating patterns. Future studies should consider population variation in acclimatization and assess variation in the amount of sweat produced during a hot flash.

Symptom groupings at midlife

OBJECTIVE

To examine how symptoms at midlife grouped together by factor analyses in four different countries and to examine whether life changes were associated with symptom frequencies.

DESIGN

The Decisions at Menopause Study was a multisite study of women aged 45 to 55 drawn from the general population in the United States, Spain, Lebanon, and Morocco. Semistructured questionnaires collected demographic, reproductive, and lifestyle information, along with 4-week recalls of 25 symptoms. Factor analyses were performed using symptom frequency data from each country. Symptoms frequencies were examined by chi analysis in relation to job, home, and life changes. Regression scores for individual factors were examined as dependent variables in relation to menopause status and life change while controlling for demographic and reproductive variables.

RESULTS

The intercorrelation among symptoms differed in country-specific ways, eg, hot flashes grouped with vaginal dryness and sexual symptoms in Spain, with general somatic symptoms in Morocco, and did not cluster with other symptoms in the United States or Lebanon. In chi2 analyses, household change, not job change, was associated with increased symptomatology in Spain. Job change was a significant predictor of the first symptom cluster in the United States (mental symptoms) and Spain (emotional symptoms). Home change was a significant predictor of the third (mental) symptom cluster in Spain. Life change was a significant predictor of symptom clusters in Spain and Morocco.

CONCLUSIONS

Cross-population comparisons demonstrate variation in symptom clusters. Regression analyses showed how the variables that predict symptom groupings (eg, job change, marital status, menopause status, or level of education) also differed in country-specific ways.

The roles of biologic and nonbiologic factors in cultural differences in vasomotor symptoms measured by surveys

OBJECTIVE

To review evidence of cultural differences in both biologic and nonbiologic factors as possible explanations for variation across cultures in self-reported vasomotor symptoms from surveys.

DESIGN

Literature review and cross-sectional and longitudinal comparisons of ethnic groups with respect to patterns of symptom reporting from the Study of Women's Health Across the Nation (SWAN).

RESULTS

The evidence to date indicates that cultural differences in vasomotor symptom reporting on surveys reflect both differences in the underlying biology, which ar likely to influence vasomotor symptom occurrence, and differences in nonbiologic sociocultural factors such as attitudes toward menopause, which are likely to be related to vasomotor symptom perception and reporting,

CONCLUSIONS

It is important to consider interactions of culture and biology in studies of vasomotor symptoms. Recommendations for future studies include using both open- and closed-ended questions, including measurements of objective indicators such as reproductive hormone concentrations, measuring both culturally related biologic and nonbiologic factors related to vasomotor symptom occurrence or reporting, and using the same general study protocol for multiple cultural groups being compared.

Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii

OBJECTIVE

The Hilo Women's Health Survey was designed and administered to gather baseline data on women's health in Hilo, HI. This randomized, cross-sectional study allowed for a focus on ethnic differences in symptom reporting. The results presented here focus on hot flash and night sweat experience among Japanese-American and European-American women.

DESIGN

Survey packets were mailed to street addresses associated with parcel numbers pulled randomly from Hilo tax maps. Of the 6,401 survey packets delivered to households, 1,824 questionnaires were completed and returned. The results reported here are based on 869 women aged 40 to 60, of whom 249 described themselves to be 100% Japanese and 203 described themselves to be 100% European-American. Logistic regression analyses were used to examine whether the relationship between ethnicity and vasomotor symptoms persisted after controlling for other variables.

RESULTS

European-American participants were more likely to have ever experienced a hot flash as compared with Japanese-American participants (72% vs 53%, P<0.01). During the 2 weeks before the survey, European-American participants were more likely to have experienced hot flashes (P<0.05) and night sweats (P<0.01). In logistic regression analyses, after controlling for age, body mass index, menopause status, level of education, financial comfort, smoking habits, alcohol intake, exercise, use of hormone therapy, and soy intake, European-American women were still significantly more likely to have experienced hot flashes (odds ratio=1.858) and night sweats (odds ratio=2.672).

CONCLUSIONS

The results, based on self-reporting of menopausal symptoms, indicate that Japanese-American women report fewer hot flashes and night sweats than European-American women. Japanese-American women reported a higher intake of soy, but soy intake was not associated with fewer vasomotor symptoms.

Bio-psycho-socio-cultural perspectives on menopause

The menopause transition is a bio-psycho-socio-cultural process. Recent prospective studies highlight the complex ways in which lifestyle and cultural factors influence women's experience of the menopause. For the majority of well women, the menopause is a relatively neutral event, although women living in Western countries in general report more symptoms than those from non-Western cultures. Hot flushes and night sweats are the main symptoms of the menopause, and while the exact physiological causes are unknown, the role of norepinephrine is implicated in lowering the threshold for flushing. Psychological factors - including anxiety, stress, thoughts and beliefs and self-esteem - influence the experience of hot flushes, and a cognitive behavioural model is described which is compatible with a bio-psycho-socio-cultural perspective. Relaxation and cognitive behavioural approaches appear to be acceptable to women, and there is some evidence for their efficacy, but larger controlled trials are needed.