Journal of General Internal Medicine

, Volume 23, Issue 9, pp 1507–1513 | Cite as

Revisiting the Duration of Vasomotor Symptoms of Menopause: A Meta-Analysis

  • Mary C. PolitiEmail author
  • Mark D. Schleinitz
  • Nananda F. Col



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


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.


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.


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.


Hormone Therapy Menopausal Symptom Symptom Duration Menopausal Hormone Therapy Vasomotor Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Agency for Healthcare, Research, and Quality (AHRQ) 2R01 HS013329-04A1. An earlier version was presented at the Society for Medical Decision Making Annual Meeting, October 2007. We would like to thank Nancy Avis, Ph.D. (Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC), Janet Guthrie, M.Sc., Dip. Ed, Ph.D. (Center for Women’s Health, University of Melbourne, Australia), and Martha Hickey, M.D. (School of Women’s and Infants’ Health, University of Western Australia, Australia) for their thoughtful reviews of this manuscript.

Conflict of Interest

None disclosed.


  1. 1.
    McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14(2):103–15.PubMedCrossRefGoogle Scholar
  2. 2.
    Guthrie J, Dennerstein L, Taffe J, Donnelly V. Health care-seeking for menopausal problems. Climacteric. 2003;6(2):112–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Lobo R (ed). Treatment of the postmenopausal woman: Basic and clinical aspects.: Academic Press; 2007.Google Scholar
  4. 4.
    Medical Knowledge Self Assessment Program 14. 2007.Google Scholar
  5. 5.
    North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: Position statement of The North American Menopause Society. Menopause. 2004;11:11–33.CrossRefGoogle Scholar
  6. 6.
    Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52–86. discussion 123–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Col NF. The impact of risk status, preexisting morbidity, and polypharmacy on treatment decisions concerning menopausal symptoms. Am J Med. 2005;118(12 Suppl 2):155–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007;297(13):1465–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Women’s Health Initiative. Scientific Resources Website. Vol. 2006.Google Scholar
  10. 10.
    Grodstein F, Clarkson TB, Manson JE. Understanding the divergent data on postmenopausal hormone therapy. The New England Journal of Medicine. 2003;348(7):645–50.PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Obstetricians and Gynecologists. Executive Summary. Hormone Therapy. Obstetrics & Gynecology. 2004;104:1S.CrossRefGoogle Scholar
  12. 12.
    Mosca L, Collins P, Herrington DM, et al. Hormone Replacement Therapy and cardiovascular disease: A statement for healthcare professionals from the American Heart Association. Circulation. 2001;104:499–503.PubMedCrossRefGoogle Scholar
  13. 13.
    Grady D. Management of menopausal symptoms. The New England Journal of Medicine. 2006;355(22):2338–47.PubMedCrossRefGoogle Scholar
  14. 14.
    National Institute of Health. NIH State-of-the-Science conference on management of menopause-related symptoms. Vol. 2005; 2005.Google Scholar
  15. 15.
    Woods NF, Mitchell ES. Symptoms during the perimenopause: Prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005;118(12B):14S–24S.CrossRefGoogle Scholar
  16. 16.
    Medical Women’s Federation. An investigation of the menopause in one thousand women. The Lancet. 1933:106–108.Google Scholar
  17. 17.
    Feldman BM, Voda A, Gronseth E. The prevalence of hot flash and associated variables among perimenopausal women. Res Nurs Health. 1985;8(3):261–8.PubMedGoogle Scholar
  18. 18.
    Kronenberg F. Hot Flashes. New York: Raven Press, Ltd.; 1994:97.Google Scholar
  19. 19.
    Association for Healthcare Research and Quality. Evidence report/Technology assessment: Management of menopause-related symptoms. Vol. 2005; 2005.Google Scholar
  20. 20.
    Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000.Google Scholar
  21. 21.
    McKinlay SM, Jefferys M. The menopausal syndrome. Br J Prev Soc Med. 1974;28(2):108–15.PubMedGoogle Scholar
  22. 22.
    Oldenhave A, Jaszmann LJ, Haspels AA, Everaerd WT. Impact of climacteric on well-being. A survey based on 5213 women 39 to 60 years old. Am J Obstet Gynecol. 1993;168(3 Pt 1):772–80.PubMedGoogle Scholar
  23. 23.
    Thompson B, Hart SA, Durno D. Menopausal age and symptomatology in a general practice. J Biosoc Sci. 1973;5(1):71–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Berg G, Gottwall T, Hammar M, Lindgren R. Climacteric symptoms among women aged 60–62 in Linkoping, Sweden, in 1986. Maturitas. 1988;10(3):193–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Nedstrand E, Pertl J, Hammar M. Climacteric symptoms in a postmenopausal Czech population. Maturitas. 1996;23(1):85–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Avis NE, Brockwell S, Colvin A. A universal menopausal syndrome? Am J Med. 2005;118(12 Suppl 2):37–46.PubMedCrossRefGoogle Scholar
  27. 27.
    Brown WJ, Mishra GD, Dobson A. Changes in physical symptoms during the menopause transition. Int J Behav Med. 2002;9(1):53–67.PubMedCrossRefGoogle Scholar
  28. 28.
    Groenveld FPMJ, Bareman FP, Barentsen , Dokter HJ, Drogendijk AC, Hoes AW. Vasomotor symptoms and the well–being in the climacteric years. Maturitas. 1996;23:293–9.CrossRefGoogle Scholar
  29. 29.
    Melby MK. Vasomotor symptom prevalence and language of menopause in Japan. Menopause: The Journal of the North American Menopause Society. 2005;12(3):250–7.Google Scholar
  30. 30.
    Soules M, Sherman S, Parrott E, et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Climacteric. 2001;4(4):267–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Genazzani A, Nicolucci A, Campagnoli C, et al. Validation of Italian version of the Women’s Health Questionnaire: Assessment of quality of life of women from the general population and those attending menopause centers. Climacteric. 2002;5:70–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Binfa L, Castelo-Branco C, Blumel JE, et al. Influence of psychosocial factors on climacteric symptoms. Maturitas. 2004;48:425–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Travers C, O’Neill SM, King , Battistutta D, Khoo SK. Greene Climacteric Scale: Norms in an Australian population in relation to age and menopausal status. Climacteric. 2005;8:56–62.PubMedCrossRefGoogle Scholar
  34. 34.
    Ford K, Sowers MF, Crutchfield M, Wilson A, Jannausch M. A longitudinal study of the predictors of prevalence and severity of symptoms commonly associated with menopause. Menopause: The Journal of the North American Menopause Society. 2005;12(3):308–17.Google Scholar
  35. 35.
    Stroup DF, Berlin JA, Morton SC, et al. Meta analysis of observational studies in epidemiology: A proposal for reporting. JAMA. 2000;283(15):2008–20012.PubMedCrossRefGoogle Scholar
  36. 36.
    Lau J. Metaanalyst. Boston, MA, US.Google Scholar
  37. 37.
    DerSimonian , Laird N. Meta-analysis in Clinical Trials. Control Clin Trials. 1986;7:177–88.PubMedCrossRefGoogle Scholar
  38. 38.
    Kaufert P, Syrotuik J. Symptom reporting at the menopause. Soc Sci Med. 1981;15(3):173–84.Google Scholar
  39. 39.
    Hunter M. The south-east England longitudinal study of the climacteric and postmenopause. Maturitas. 1992;14(2):117–26.PubMedCrossRefGoogle Scholar
  40. 40.
    Bardel A, Wallander M-A, Svardsudd K. Hormone replacement therapy and symptom reporting in menopausal women. A population-based study of 35–65 year old women in mid-Sweden. Maturitas. 2002;41:7–15.PubMedCrossRefGoogle Scholar
  41. 41.
    Overlie I, Finset A, Holte A. Gendered personality dispositions, hormone values, and hot flushes during and after menopause. J Psychosom Obstet Gynaecol. 2002;23:219–27.PubMedCrossRefGoogle Scholar
  42. 42.
    Keenan NL, Mark S, Fugh-Berman A, Browne D, Kaczmarczyk J, Hunter C. Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies. Menopause: The Journal of the North American Menopause Society. 2003;10(6):507–15.Google Scholar
  43. 43.
    Juang KD, Wang SJ, Lu S, Lee SJ, Fuh JL. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas. 2005;52(2):119–26.PubMedCrossRefGoogle Scholar
  44. 44.
    Kumari M, Stafford M, Marmot M. The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms. J Clin Epidemiol. 2005;58(7):719–27.PubMedCrossRefGoogle Scholar
  45. 45.
    Miller S, Gallicchio LM, Lewis LM, et al. Association between race and hot flashes in midlife women. Maturitas. 2006;54:260–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Sievert LL, Obermeyer CM, Price K. Determinants of hot flashes and night sweats. Ann Hum Biol. 2006;33(1):4–16.PubMedCrossRefGoogle Scholar
  47. 47.
    Huang AJ, Grady DG, Blackwell TL, Bauer DC, Sawaya GF. Persistent hot flashes in older postmenopausal women (abstract). J Gen Intern Med. 2007;22(suppl 1):168.Google Scholar
  48. 48.
    Guthrie J, Dennerstein L, Taffe J, Lehert P, Burger HG. Hot flushes during the menopause transition: a longitudinal study in Australian-born women. Menopause. 2005;12(4):460–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Warren MP. Historical perspectives in postmenopausal hormone therapy: Defining the right dose and duration. Mayo Clinic Proceedings. 2007;82(2):219–26.PubMedCrossRefGoogle Scholar
  50. 50.
    Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age. Am J Epidemiol. 2000;152(5):463–73.PubMedCrossRefGoogle Scholar
  51. 51.
    Avis NE, Crawford SL, McKinlay SM. Psychosocial, behavioral, and health factors related to menopause symptomatology. Womens Health. 1997;3(2):103–20.PubMedGoogle Scholar
  52. 52.
    Avis NE, Stellato , Crawford S, et al. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Soc Sci Med. 2001;52(3):345–56.PubMedCrossRefGoogle Scholar
  53. 53.
    Avis NE, Zhao X, Johannes CB, Ory M, Brockwell S, Greendale GA. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2005;12(4):385–98.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Mary C. Politi
    • 1
    Email author
  • Mark D. Schleinitz
    • 2
  • Nananda F. Col
    • 3
  1. 1.Department of Behavioral and Preventive MedicineBrown Medical SchoolProvidenceUSA
  2. 2.Department of General Internal MedicineBrown Medical SchoolProvidenceUSA
  3. 3.Center for Outcomes Research and EvaluationMaine Medical CenterPortlandUSA

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