Somatic and affective anxiety symptoms and menopausal hot flashes

Stress predicts depression symptoms for women living with bipolar disorder during the menopause transition

OBJECTIVE

Although sleep disturbance is an important feature in bipolar disorder, the relationship between mood symptoms, sleep disturbances, and hot flash symptom severity during menopause for women with bipolar disorder is largely unknown.

METHODS

Women with bipolar disorder (n = 100) who were categorized as perimenopausal using the STRAW and Monash criteria took part in an international online survey. The survey contained questions on history of reproductive health; the clinical course of bipolar disorder; menopausal symptoms (Menopause Rating Scale [MRS]); depression, anxiety, and stress (Depression Anxiety and Stress Scale-21) and the Altman Mania Rating Scale.

RESULTS

MRS sleep problems and hot flash severity were positively correlated with each other and with depression, anxiety, and stress symptoms. Mania scores were not significantly correlated with sleep or hot flash severity scores. A stepwise regression analysis on depression symptoms, using MRS sleep disturbance and MRS hot flash severity scores as predictors with anxiety and stress symptoms in the model, found that stress alone predicted 40% of the variance in total depression scores.

CONCLUSION

Stress plays an important role in the experience of depression for women living with bipolar disorder during the perimenopausal phase. More research is needed to determine if stress management programs may be helpful for women living with bipolar disorder during this time of life and if these in turn, may improve depressive symptoms.

Effect of Hypnosis on Anxiety: Results from a Randomized Controlled Trial with Women in Postmenopause

Anxiety is common, yet often under-treated, among women in postmenopause. This study examined the effect of a hypnotic intervention designed to reduce hot flashes, on anxiety levels of postmenopausal women. Anxiety was assessed using the State-Trait Anxiety Inventory, the Hospital Anxiety and Depression Scale-Anxiety subscale, and a visual analog scale. Additionally, hypnotizability was tested as a moderator of anxiety reductions. Significant reductions in anxiety were found from baseline to endpoint and follow-up and hypnosis was superior to the control condition. Additionally, ratings of Current Anxiety decreased from pre-session to post-session at each weekly visit and the pre-session scores reduced continuously. Hypnotizability was found to moderate anxiety reductions, but regardless of hypnotizability level participants, on average, experienced significant symptom improvement from baseline scores. These data provide initial support for the use of hypnosis to reduce symptoms of anxiety among postmenopausal women.Trial registration: This study was registered at ClinicalTrials.gov on February 11, 2011 under Identifier number NCT01293695 ( https://clinicaltrials.gov/ct2/show/NCT01293695?term=Elkins&cond=hot+flashes&draw=2&rank=2 ).

Relationships between depression and anxiety symptoms and adipocyte-derived proteins in postmenopausal women

INTRODUCTION

Studies on the association between adiponectin and leptin and anxiety and depression among postmenopausal women are limited. Therefore, the present study specifically evaluates the mutual relationships between adiponectin and leptin and anxiety and depression in postmenopausal women.

PARTICIPANTS AND DESIGN

In this cross-sectional study, a total of 190 women aged 40-65 years were enrolled. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and anxiety symptoms were evaluated using the Hamilton Anxiety Rating Scale (HAM-A). Fasting specimens were collected to measure sex hormone, glucose, insulin, and adipokine levels. Multiple linear regression analysis was performed to evaluate the associations between depression and anxiety and adipocyte-derived hormones.

SETTINGS

The study was performed in a hospital medical center.

RESULTS

Among 190 enrolled postmenopausal women, Spearman's rank correlation analysis revealed significant correlations between CES-D and HAM-A (r = 0.715, P < 0.0001), between CES-D and adiponectin (p = 0.009) and leptin (p = 0.015), and between HAM-A and adiponectin (p = 0.01) and leptin (p = 0.001). The subjects with CES-D ≥ 16 and with HAM-A ≥ 18 had higher adiponectin levels than those with CES-D < 16 and HAM-A < 18, respectively. After adjusting for age, body mass index, exercise, alanine amino transferase and parameters of lipid profiles, Log adiponectin levels were found to be significantly associated with both CES-D and HAM-A, and Log leptin levels were only significantly associated with HAM-A.

CONCLUSIONS

The data show that adiponectin and leptin levels are significantly associated with depression and anxiety symptoms. These results suggest that higher adiponectin and lower leptin levels may serve as potential markers related to anxiety and mood in postmenopausal women. More future research that is designed to deal with the important confounders (e.g., population heterogeneity) is needed to investigate comprehensively on these associations.

Relationships Between Vasomotor Symptoms and Mood in Midlife Urban Chinese Women: Observations in a Prospective Study

CONTEXT

During the menopausal transition, there is a greater likelihood of the prevalence of various bothersome symptoms, including vasomotor symptoms (VMS) and mood symptoms.

OBJECTIVE

To investigate the association among bothersome VMS and symptoms of anxiety and depression in Chinese women during perimenopause and early in menopause.

DESIGN, PATIENTS, SETTING, AND INTERVENTIONS

This study included 430 midlife Chinese women who had experienced natural menopause and were followed up for 10 years. A structured questionnaire was provided annually, comprising the VMS Bother Score (range 1-8) from the Menopause-Specific Quality of Life questionnaire, the Hospital Anxiety and Depression Scale, and other physical and behavioral factors.

RESULTS

Among the 430 women evaluated, 78.8% had experienced VMS during long-term follow-up. The overall level of VMS bother score was relatively low (1.92 ± 1.32). Both anxiety and depressive symptoms were significantly associated with VMS bother. After adjusting for potential covariates, the association between anxiety or depression symptoms and VMS bother remained highly significant. Menopausal stage, body mass index, general health, follicle-stimulating hormone, and estradiol were independent contributors to VMS. In time-lagged (1-year) models, VMS bother scores significantly predicted the risk of symptoms of both anxiety and depression the following year. In contrast, anxiety symptoms, rather than depressive symptoms, could predict VMS bother the following year.

CONCLUSION

The prevalence of VMS in our cohort was higher than has been previously reported; however, the overall level of bother was relatively low. This study demonstrated a strong relationship between VMS bother and mood symptoms in Chinese women progressing from perimenopause through natural menopause.

Symptoms at midlife among women in Nagaland, India

OBJECTIVES

This article highlights the prevalence of symptom frequencies in Nagaland, India, with a focus on depressed mood and hot flashes. We also examine how symptoms cluster together among Naga women and identify factors associated with symptom experience. We hypothesized an elevated frequency of depressed mood because of the stresses associated with social responsibilities within a patriarchal culture, and a low frequency of hot flashes because of the thinness of the population.

METHODS

Standardized questionnaires with close-ended questions were used to determine the frequency of symptoms and sociodemographic and health parameters among women aged 35 to 65 years (n = 352). Factor analysis was used to examine the relations among symptoms. Bivariate analyses and linear regressions were also employed to identify sociodemographic and health factors associated with symptoms.

RESULTS

Menopausal symptoms, such as feeling dizzy or faint, anxiety or panic, and excitable, were significantly higher in premenopausal women; hot flashes in perimenopausal women; and feeling tired or lack in energy, headaches, difficulty in sleeping, and muscle or joint pain in postmenopausal women. Four symptom factors were identified: symptoms related to the loss of estradiol, psychosomatic symptoms, uneasiness, and depressed mood. After adjusting for menopausal status, socioeconomic status, education, and self-reported health status, body mass index was observed to be inversely associated with the depressed mood factor but not other factors.

CONCLUSION

In the context of Nagaland, India, having extra weight may contribute to emotional well-being; however, further research is warranted.

Onset of the Menopause Transition: The Earliest Signs and Symptoms

Although more than 80% of women experience some degree of psychological or physical symptoms around menopause, both women and clinicians have misconceptions about how hormonal changes relate to menopausal symptoms and psychological conditions. Recently, several large-scale, longitudinal studies have been conducted to better characterize symptoms and changes that occur around menopause. This article offers current evidence for symptoms that occur in the early menopause transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.

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.

Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort

OBJECTIVE

The aim of this study was to identify temporal associations of anxiety dimensions with menopausal hot flashes in women progressing through the menopausal transition. We hypothesized that associations of both somatic and affective dimensions of anxiety with hot flashes increased in the menopausal transition, and that somatic anxiety was an independent risk factor for menopausal hot flashes.

METHODS

Hot flashes, anxiety symptoms, hormone levels, and other psychosocial variables were assessed annually for 14 years of follow-up. The 233 women were premenopausal at baseline and continued through 1 year or more after the final menstrual period. Anxiety dimensions were assessed with the Zung Anxiety Scale, a validated measure of affective anxiety and somatic anxiety. Summed item scores were divided by the number of items rated, so that ranges of the two dimensions were comparable.

RESULTS

Seventy-two percent of the sample reported moderate/severe hot flashes during the 14-year interval. There was no significant interaction between anxiety dimensions and menopausal stages. When adjusted for menopausal stage, the magnitude of association between somatic anxiety and hot flashes, however, dramatically increased (odds ratio [OR], 3.03; 95% CI, 2.12-4.32; P < 0.001), whereas the association between affective anxiety and hot flashes increased to a lesser extent (OR, 1.27; 95% CI, 1.03-1.57; P = 0.024). Women with high levels of somatic anxiety (top third of the sample) had the greatest risk of hot flashes (P < 0.001). When the anxiety dimensions were considered in combination, the additive effect of high affective anxiety symptoms was minimal, with no significant difference between the group with high affective/low somatic symptoms and the low symptom group in incident hot flashes at each menopausal stage (P = 0.54). In multivariable analysis, somatic anxiety increased the risk of hot flashes more than three times (OR, 3.13; 95% CI, 2.16-4.53; P < 0.001), but affective anxiety was not significantly associated with hot flashes after adjustment for other study variables (OR, 1.19; 95% CI, 0.96-1.48; P = 0.117). Time-lagged somatic anxiety scores significantly predicted hot flashes, with a 71% increase in risk (OR, 1.71; 95% CI, 1.21-2.41; P = 0.002). Time-lagged affective anxiety scores did not predict hot flashes (OR, 1.06; 95% CI, 0.87-1.31; P = 0.58).

CONCLUSIONS

This study showed a strong predictive association of somatic anxiety with the risk of menopausal hot flashes. The temporal associations suggest that somatic anxiety is not simply a redundant measure of hot flashes but predicts the risk of menopausal hot flashes and may be a potential target in clinical management of perimenopausal women.

Measuring hot flash phenomenonology using ambulatory prospective digital diaries

OBJECTIVE

This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary.

METHODS

This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of three consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred.

RESULTS

Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the face (78.9%), neck (74.7%), and chest (61.3%). Of all reported hot flashes, 32% occurred concurrently with prickly skin, 7% with anxiety, and 5% with nausea. A novel finding from the study was that 38% of hot flashes were accompanied by a premonitory aura.

CONCLUSIONS

A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly used retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci, and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience.

Is anxiety associated with hot flashes in women with breast cancer?

OBJECTIVE

Women with breast cancer are at higher risk for experiencing hot flashes (HFs), which is attributable, in large part, to systemic cancer treatments and their effects on estrogen levels. However, other factors, such as anxiety, could also play a role. This study aimed to assess the cross-sectional and temporal relationships between anxiety and HFs among women treated for breast cancer and to clarify the direction of these relationships.

METHODS

Fifty-six women recently treated for breast cancer were assessed prospectively using a 14-day Hot Flashes and Anxiety Diary (HFAD). Anxiety and HFs were also assessed using the Hospital Anxiety and Depression Scale-anxiety subscale and the Menopause-Specific Quality of Life Questionnaire-vasomotor subscale. In addition, HFs were objectively recorded for a continuous 24-hour period using home-based sternal skin conductance.

RESULTS

No cross-sectional relationship was found between anxiety and subjectively assessed HFs, or between anxiety and the frequency and intensity of objectively assessed HFs. However, a greater anxiety level on the HFAD was significantly associated with a shorter time to reach the HF peak, as assessed with sternal skin conductance (partial Spearman correlation coefficient rsp = -0.44). Moreover, greater anxiety predicted more severe self-reported HFs on the following night, both assessed with the HFAD (rsp = 0.13). Conversely, self-reported diurnal and nocturnal HFs on the HFAD did not predict next-day anxiety level.

CONCLUSIONS

This study reveals a significant relationship between anxiety and faster-developing objectively measured HFs. Furthermore, anxiety has been found to significantly predict subsequent increases in self-reported HFs, suggesting that strategies that target anxiety could potentially have a beneficial effect on HFs in women with breast cancer.

Diagnosis and Treatment of Anxiety in the Aging Woman

The peri- and postmenopausal periods represent a window of vulnerability for emergence of anxiety symptoms and disorders in the life cycle of adult women. Compared to depression, anxiety symptoms and disorders remain largely unexplored during this phase of a woman's life, despite the significant impact on quality of life if not diagnosed and treated. Here, we review the literature to present our current understanding of the epidemiology, causal factors, diagnosis, and treatment of anxiety in the aging woman.

Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort

OBJECTIVE

This study aims to estimate the risk of hot flashes relative to natural menopause and to evaluate the associations of hormone levels, behavioral variables, and demographic variables with the risk of hot flashes after menopause.

METHODS

We performed annual assessment of 255 women who were premenopausal at baseline and reached natural menopause within 16 years of follow-up.

RESULTS

The prevalence of moderate/severe hot flashes increased in each premenopausal year, reaching a peak of 46% in the first 2 years after the final menstrual period (FMP). Hot flashes decreased slowly after menopause and did not return to premenopausal levels until 9 years after the FMP. The mean (SD) duration of moderate/severe hot flashes after the FMP was 4.6 (2.9) years (for any hot flashes, 4.9 [3.1] y). One third of women at 10 years or more after menopause continued to experience moderate/severe hot flashes. African-American women (obese and nonobese) and obese white women had significantly greater risks of hot flashes compared with nonobese white women (interaction, P = 0.01). In multivariable analysis, increasing follicle-stimulating hormone levels before the FMP (P < 0.001), decreasing estradiol (odds ratio, 0.87; 95% CI, 0.78-0.96; P = 0.008), and increasing anxiety (odds ratio, 1.05; 95% CI, 1.03-1.06; P < 0.001) were significant risk factors for hot flashes, whereas higher education levels were protective (odds ratio, 0.66; 95% CI, 0.47-0.91; P = 0.011).

CONCLUSIONS

Moderate/severe hot flashes continue, on average, for nearly 5 years after menopause; more than one third of women observed for 10 years or more after menopause have moderate/severe hot flashes. Continuation of hot flashes for more than 5 years after menopause underscores the importance of determining individual risks/benefits when selecting hormone or nonhormone therapy for menopausal symptoms.

Duration of menopausal vasomotor symptoms over the menopause transition

IMPORTANCE

The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments.

OBJECTIVES

To determine total duration of frequent VMS (≥ 6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence.

DESIGN, SETTING, AND PARTICIPANTS

The Study of Women's Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS.

MAIN OUTCOMES AND MEASURES

Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause.

RESULTS

The median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS.

CONCLUSIONS AND RELEVANCE

Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing VMS) were related to longer-lasting VMS. Health care professionals should counsel women to expect that frequent VMS could last more than 7 years, and they may last longer for African American women.

Hypnotic relaxation therapy for reduction of hot flashes in postmenopausal women: examination of cortisol as a potential mediator

Hypnotic relaxation therapy (HRT) has been shown to reduce hot flashes in postmenopausal women and breast cancer survivors. While the biological mechanism by which HRT reduces hot flashes is unknown, it has been speculated that reduction of stress mediates the intervention's effectiveness. The purpose of the present study was to examine the effect of HRT on a known biomarker of stress (cortisol) and changes in cortisol as a mediator. Sixty-two postmenopausal women received hypnotic relaxation therapy for hot flashes and completed measures of hot flashes in addition to providing cortisol samples at baseline and endpoint. HRT resulted in significantly decreased early evening salivary cortisol concentrations. However, changes in salivary cortisol concentrations did not mediate the effects of HRT.

Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation

OBJECTIVE

Little is known about the risk of anxiety in women during midlife and the menopausal transition. We examined anxiety as a cluster of four symptoms and determined the association between menopausal stage and high anxiety during 10 years of follow-up of 2,956 women of multiple race/ethnicities.

METHODS

This study was a longitudinal analysis of data from the multisite Study of Women's Health Across the Nation, a study of menopause and aging. Women were aged 42 to 52 at study entry. The outcome was high anxiety, with a score of 4 or greater on the sum of four anxiety symptoms rated according to frequency in the previous 2 weeks from 0 (none) to 4 (daily; upper 20%). Covariates included sociodemographics, health factors, stressors, and vasomotor symptoms.

RESULTS

Women with low anxiety at baseline were more likely to report high-anxiety symptoms at early or late perimenopause or postmenopause than at premenopause (odds ratio, 1.56-1.61), independent of multiple risk factors, including upsetting life events, financial strain, fair/poor perceived health, and vasomotor symptoms. Women with high anxiety at baseline continued to have high rates of high anxiety throughout follow-up, but odds ratios did not differ by menopausal stage.

CONCLUSIONS

Women with high anxiety at premenopause may be more often anxious and are not at increased risk for high anxiety at specific stages of the menopausal transition. In contrast, women with low anxiety at premenopause may be more susceptible to high anxiety during and after the menopausal transition than before the menopausal transition.

Evaluation and management of depressive and anxiety symptoms in midlife

OBJECTIVES

Evaluation and management of anxiety and depression during the menopausal transition are complicated by the overlap between some symptoms of affective disorder with those of menopausal symptoms, and also by inconsistencies in the literature regarding the relationship between the menopausal transition and affective disorders.

METHODS

We have reviewed key studies over the past three decades addressing depression and anxiety during the menopause transition, in order to present a practical, clinical approach to the evaluation and management of anxiety and depressive symptoms at midlife.

RESULTS

Symptoms of anxiety and depression are common at midlife and may coincide with menopausal symptoms. Some menopausal symptoms are also symptoms of anxiety and/or depression. Management should include treatment of troublesome menopausal symptoms, providing strategies to deal with psychosocial stressors, and exclusion of clinically significant anxiety and depressive disorders. Interventions such as exercise and cognitive behavior therapy may improve mood and general health at menopause, and a multifocal approach is recommended. Depression of greater than moderate severity requires treatment with an antidepressant. Some selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may also improve vasomotor symptoms and these should be considered in women with both affective disorder and vasomotor symptoms.

CONCLUSIONS

There is no clear evidence that the menopause transition alone increases the risk of clinically significant affective disorders, except in women with risk factors such as psychosocial stressors, severe and prolonged vasomotor symptoms and a previous history of affective disorders. Nevertheless, anxiety and depression are common in women and clinicians should be alert to the symptoms of these conditions at all encounters.

The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder

PURPOSE

To explore whether the symptoms of climacteric syndrome associated with its physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder.

METHODS

We recruited 78 climacteric patients with anxiety-depression disorder and 72 control participants in perimenopausal/postmenopausal without anxiety-depression disorder for this study. We measured symptoms using the Greene Climacteric Symptom Scale in all cases. We also collected demographic data and tested sexual hormone, blood pressure, bone density, cognitive, estrogen receptor-alpha (ERα) gene polymorphism as physiological factors, using HARS-14 and CHDS assessed psychological disorder degree.

RESULTS

C-MMSE scores as well as Estradiol and progesterone levels in the anxiety-depression disorder group were significantly lower compared to the control group (P < 0.01). In addition, the anxiety-depression disorder group had significantly higher Greene Climacteric Scale scores, as well as somatic symptoms compared to controls (P < 0.01). Moreover, the anxiety, depression and somatic symptoms of the Greene Climacteric Scale were positively correlated with HARS-14 and CHDS scores (P < 0.001) and negatively with estrogen level and C-MMSE scores (P < 0.05) in the anxiety-depression disorder group. Greene Climacteric Scale Symptoms were not significantly correlated with blood pressure, bone density or other factors (P > 0.05). There was no significant change in the allele frequency or the estrogen receptor-alpha gene polymorphisms, between the two groups (P > 0.05); however, the Pp genotype was negatively associated with C-MMSE scores (r = appraises, P = 0.033).

LIMITATIONS

The sample size was relatively small.

CONCLUSIONS

The symptoms of somatic symptoms in patients with climacteric syndrome and anxiety-depression disorder are associated with the emotional disorder but not with a physical disease. The Pp ERα polymorphism Pvu II is associated with a cognitive decrease.

Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65

OBJECTIVE

Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women.

DESIGN

Cross-sectional cohort study.

SETTING

UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort.

POPULATION

A cohort of 202,638 postmenopausal women, aged 50-74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005.

METHODS

Women completed a follow-up questionnaire, and those aged 54-65 years were mailed a survey in July 2008.

MAIN OUTCOME MEASURES

  Hot flush prevalence and hot flush rating scale.

RESULTS

Of the 15,000 women mailed, 10,418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19-1.86), ever having smoked (OR 1.27, 95% CI 1.11-1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01-1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57-3.72), hysterectomy (OR 2.74, 95% CI 2.32-3.25), depressed mood (OR 1.57, 95% CI 1.24-1.99), years since last menstrual period (OR 0.95, 95% CI 0.94-0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97-0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic.

CONCLUSIONS

To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.