The use and abuse of screening tests around menopause

Association of Various Dimensions of Hot Flashes with Systemic Levels of Gonadal Steroids

Hot flashes, the cardinal sign of menopausal vasomotor symptoms, are experienced by millions of women. The experience of hot flashes is characterized by significant inter- and intra-individual variability among women. The goals of this study were to compare concentrations of gonadal hormones between menopausal women with hot flashes (HF) and those with no HF, and to characterize the association between steroid levels and multiple dimensions of hot flashes. Menopausal women, with HF and with no HF, participated in four study sessions, one every 2 months. The Menopausal Vasomotor Symptom (MVS) survey was used to collect subjective data on various dimensions of hot flashes. Concentrations of gonadal hormones were measure at each bi-monthly session. Steroid levels were correlated to duration, frequency, length of each episode, timing, intensity, and bothersomeness of hot flashes. Data from twenty ( n = 20) women with HF and fifteen ( n = 15) with no HF with similar demographic profiles were analyzed. The results from the present study showed that systemic levels of estrone and progesterone were significantly lower in women experiencing HF than in asymptomatic women. There was a significant association between levels of estradiol, estrone, progesterone, and androstenedione, but not testosterone, with duration, frequency, timing, intensity, and bothersomeness of HF. The findings from this preliminary study suggest that management of symptoms associated with vasomotor HF should be individualized and guided by two factors: (i) thorough assessment of subjectively reported multiple dimensions of hot flashes, and (ii) levels of circulating gonadal steroids representing an average from 2–4 measures. This approach may lead to more targeted, effective, and safe management of vasomotor symptoms in the rapidly growing population of menopausal women.