Abstract
OBJECTIVE: To determine the association of modifiable factors, such as smoking, body mass index, and alcohol use, with hot flashes, and to ascertain whether the association with hot flashes varies by menopausal stage.
DESIGN: A written survey completed by perimenopausal and postmenopausal women enrolling in a randomized, controlled trial of a menopause risk management program in 1999. Survey items included questions on demographics, health status, and health behaviors.
SETTING: A Massachusetts-based health maintenance organization.
PATIENTS/PARTICIPANTS: Female members, age 40 to 65, excluding women with chronic conditions precluding study participation, were randomly selected from an automated medical record system.
MEASUREMENTS AND MAIN RESULTS: The majority of the 287 postmenopausal and 468 perimenopausal women participating in the study were white, college educated, and nonsmoking. Approximately 30% of both groups reported experiencing hot flashes. Separate multivariable logistic regression models were developed for perimenopausal and postmenopausal women to identify correlates of reporting any versus no hot flashes. After controlling for age, race, oral contraceptive use, hormone replacement therapy use, and depression, correlates of hot flashes in perimenopausal women were body mass index ≥25 kg/m2 (odds ration [OR], 2.00; 95% confidence interval [CI], 1.28 to 3.12) and alcohol use of 1 to 5 drinks per week (OR, 0.52; 95% CI, 0.31 to 0.86). The only significant correlate of hot flashes in the postmenopausal population was high dietary fat intake (OR, 0.35; 95% CI, 0.15 to 0.81).
CONCLUSION: Although study respondents were from similar sociodemographic groups and received their health care in the same health maintenance organization, modifiable factors associated with hot flashes were different for perimenopausal and postmenopausal women.
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References
Kronenberg F. Hot flashes: epidemiology and physiology. Ann NY Acad Sci. 1990;592:52–86, 123–33.
McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Am J Human Biol. 1992;4:37–46.
Avis NE, McKinlay SM. The Massachusetts Women’s Health Study: an epidemiologic investigation of the menopause. J Am Med Womens Assoc. 1995;50:45–9, 63.
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative Randomized Controlled Trial. JAMA. 2002;288:321–33.
Utian WH. Semantics, menopause-related terminology, and the STRAW reproductive aging staging system. Menopause. 2001;8:398–401.
Hunter M. The women’s health questionnaire: a measure of midaged women’s perceptions of their emotional and physical health. Psychol Health. 1992;7:45–54.
den Tonkelaar I, Seidell JC, van Noord PA. Obesity and fat distribution in relation to hot flashes in Dutch women from the DOM-project. Maturitas. 1996;23:301–5.
Freeman EW, Sammel MD, Grisso JA, Battistini M, Garcia-Espagna B, Hollander L. Hot flashes in the late reproductive years: risk factors for African American and Caucasian women. J Womens Health Gend Based Med. 2001;10:67–76.
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;152:463–73.
Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA. Smoking, body mass, and hot flashed in midlife women. Obstet Gynecol. 2003;101:264–72.
Wilbur J, Miller AM, Montgomery A, Chandler P. Sociodemographic characteristics, biological factors, and symptom reporting in midlife women. Menopause. 1998;5:43–51.
Freeman EW, Grisso JA, Berlin J, Sammel M, Garcia-Espagna B, Hollander L. Symptom reports from a cohort of African American and white women in the late reproductive years. Menopause. 2001;8:33–42.
Gannon L, Hansel S, Goodwin J. Correlates of menopausal hot flashes. J Behav Med. 1987;10:277–85.
Schwingl PJ, Hulka BS, Harlow SD. Risk factors for menopausal hot flashes. Obstet Gynecol. 1994;84:29–34.
Obermeyer CM, Ghorayeb F, Reynolds R. Symptom reporting around the menopause in Beirut, Lebanon. Maturitas. 1999;33:249–58.
Avis NE, Crawford SL, McKinlay SM. Psychosocial, behavioral, and health factors related to menopause symptomatology. Womens Health. 1997;3:103–20.
Sternfled B, Quesenberry CP Jr, Husson G. Habitual physical activity and menopausal symptoms: a case-control study. J Womens Health. 1999;8:115–23.
Ivarsson T, Spetz AC, Hammar M. Physical exercise and vasomotor symptoms in postmenopausal women. Maturitas. 1998;29:139–46.
Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000;96:351–8.
Staropoli CA, Flaws JA, Bush TL, Moulton AW. Predictors of menopausal hot flashes. J Womens Health. 1998;7:1149–55.
Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002;77:1207–18.
Anonymous. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;158:1855–67.
Bloch A. Self-awareness during the menopause. Maturitas. 2002;41:61–8.
Tarlov AR, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA. 1989;262:925–30.
McCallum J. The SF36 in an Australian sample: validating a new, generic health status measure. Aust J Public Health. 1995;19:160–6.
Rothman KJ, Greenland S, Walker AM. Concepts of interaction. Am J Epidemiol. 1980;112:467–70.
Campagnoli C, Morra G, Belforte P, Belforte L, Prelato Tousijn L. Climacteric symptoms according to body weight in women of different socio-economic groups. Maturitas. 1981;3:279–87.
Erlik Y, Meldrum DR, Judd HL. Estrogen levels in postmenopausal women with hot flashes. Obstet Gynecol. 1982;59:403–7.
Siiteri PK. Postmenopausal estrogen production. Front Horm Res. 1975;45:625–7.
Freedman RR, Blacker CM. Estrogen raises the sweating threshold in postmenopausal women with hot flashes. Fertil Steril. 2002;77:487–90.
Freedman RR. Physiology of hot flashes. Am J Human Biol. 2001;13:453–64.
Kim H, Richardson C, Roberts J, Gren L, Lyon JL. Cold hands, warm heart. Lancet. 1998;351:1492.
Lasley BL, Santoro N, Randolf JF, et al. The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. J Clin Endocrinol Metab. 2002;87:3760–7.
Mantzoros CS, Georgiadis E, Evangelopoulou K, Katsilambros N. Dehydroepiandrosterone sulfate and testosterone are independently associated with body fat distribution in premenopausal women. Epidemiology. 1996;7:513–6.
Simon J, Klaiber E, Wiita B, Bowen A, Yang HM. Differential effects of estrogen-androgen and estrogen-only therapy on vasomotor symptoms, gonadotropin secretion, and endogenous androgen bioavailability in postmenopausal women. Menopause. 1999;6:138–46.
Overlie I, Moen MH, Holte A, Finset A. Androgens and estrogens in relation to hot flushes during the menopausal transition. Maturitas. 2002;41:69–77.
Valimaki M, Ylikahri R. Alcohol and sex hormones. Scan J Clin Lab Invest. 1981;41:99–105.
Dorgan JF, Baer D, Albert P, et al. Serum hormones and the alcohol-breast cancer association in postmenopausal women. J Natl Cancer Inst. 2001;93:710–5.
Mashchak CA, Kletzky QA, Artal R, Mishell DR Jr. The relation of physiologic changes to subjective symptoms in postmenopausal women with and without hot flushes. Maturitas. 1984;6:301–8.
Sarkola T. Acute effect of alcohol on androgens in premenopausal women. Alcohol Alcohol. 2000;35:84–90.
Frias J, Torres JM, Miranda MT, Ruiz E, Ortega E. Effects of acute alcohol intoxication on pituitary-gonadal axis hormones, pituitary-adrenal axis hormones, beta-endorphin and prolactin in human adults of both sexes. Alcohol Alcohol. 2002;37:169–73.
Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998;16:495–500.
Hoggatt KJ, Bernstein L, Reynolds P, et al. Correlates of vitamin supplement use in the United States: data from the California Teachers Study cohort. Cancer Causes Control. 2002;13:735–40.
Patterson RE, Neuhouser ML, White E, Hunt JR, Kristal AR. Cancer-related behavior of vitamin supplement users. Cancer Epidemiol Biomarkers Prev. 1998;7:79–81.
Wilbur J, Holm K, Dan A. The relationship of energy expenditure to physical and psychologic symptoms in women at midlife. Nurs Outlook. 1992;40:269–76.
Hunter MS. Predictors of menopausal symptoms: psychosocial aspects. Baillieres Clin Endocrinol Metab. 1993;7:33–45.
Slaven L, Lee C. Mood and symptom reporting among middle-aged women: the relationship between menopausal status, hormone replacement therapy, and exercise participation. Health Psychol. 1997;16:203–8.
Schifrin E, ed. Jacobs Institute of Women’s Health Expert Panel on Menopause Counseling. Guidelines for counseling women on the management of menopause. Washington, DC: Jacobs Institute of Women’s Health; 2000.
McMahon B, Trichopoulos D, Cole P, Brown J. Cigarette smoking and urinary estrogens. N Engl J Med. 1982;307:1062–5.
Mattison DR, Shiromizu K, Nightingale MS. Oocyte destruction by polycyclic aromatic hydrocarbons. Am J Ind Med. 1983;4:191–202.
McKinlay SM, Bifano NL, McKinlay JB. Smoking and age at menopause in women. Ann Intern Med. 1985;103:350–6.
Cassidenti DL, Vijod AG, Vijod MA, Stanczyk FZ, Lobo RA. Short-term effects of smoking on the pharmacokinetic profiles of micronized estradiol in postmenopausal women. Am J Obstet Gynecol. 1990;163(6 pt 1):1953–60.
Michnovicz JJ, Herschcopf RJ, Naganuma H, Bradlow HL, Fishman J. Increased 2-hydroxylation of estradiol as a possible mechanism for the antiestrogenic effect of cigarette smoking. N Engl J Med. 1986;315:1305–9.
Cassidenti DL, Pike MC, Vijod AG, Stanczyk FZ, Lobo RA. A reevaluation of estrogen status in postmenopausal women who smoke. Am J Obstet Gynecol. 1992;166:1444–8.
Khaw T, Tazuke S, Barrett-Connor E. Cigarette smoking and levels of adrenal androgens in postmenopausal women. N Engl J Med. 1988;318:1705–9.
Friedman AJ, Ravnikar VA, Barbieri RL. Serum steroid hormone profiles in postmenopausal smokers and nonsmokers. Fertil Steril. 1987;47:398–401.
Executive Summary: Stages of Reproductive Aging Workshop (STRAW). Park City, Utah, July 2001. Menopause. 2001;8:402–7.
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Support for Dr. Riley was provided by NRSA grant 2 T32 HP11001-16. Support for the original randomized controlled trial was provided by Informed Health Solutions, LLP.
Dr. Riley was primarily responsible for the design and conduct of the data analysis and writing of the manuscript. Dr. Inui was the founding principal investigator of the randomized, controlled trial in which the baseline survey was conducted; he participated in the design and implementation of the trial, development of the survey instruments, and critical review of the manuscript. Dr. Kleinman provided substantial assistance with statistical analyses and critical review of the manuscript. Dr. Connelly provided assistance with all aspects of the study including conception, design, survey instrument development, data acquisition and analysis, and critical review of the manuscript.
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Riley, E.H., Inui, T.S., Kleinman, K. et al. Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women. J GEN INTERN MED 19, 740–746 (2004). https://doi.org/10.1007/s11606-004-0002-3
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DOI: https://doi.org/10.1007/s11606-004-0002-3