Menopausal Hot Flashes Can Start Younger and Last For Years Interview with:

Rebecca Thurston, Ph.D. Professor in the University of Pittsburgh Department of Psychiatry and Epidemiologist at the University of Pittsburgh Graduate School of Public Health.

Dr. Rebecca Clark-Thurston

Rebecca Thurston, Ph.D.
Professor, University of Pittsburgh Department of Psychiatry and
Epidemiologist, University of Pittsburgh
Graduate School of Public Health What is the background for this study?

Response: Vasomotor symptoms – or hot flashes and night sweats – are the “classic” symptom of the menopause transition. Most women will get vasomotor symptoms, yet there have been striking gaps in our knowledge about them, including what their natural history is. The traditional thinking has been that vasomotor symptoms last a few years around the final menstrual period for most women. However, in this and several other papers we have debunked this myth. What are the main findings?

Response: We studied over 1400 women participating in the Study of Women’s Health Across the Nation (SWAN) who were followed for on average 15 years over midlife – from when they were premenopausal or early in the menopause transition to when they were postmenopausal and beyond. We assessed women every year, which is important, as we are not asking women to rely upon memory of their symptoms. None of the women were taking hormones at the time we assessed them for this work. We have learned several important things. In prior SWAN findings, we found that upwards of 70% of women get vasomotor symptoms, and they last on average much longer than previously thought. In this new work we show that the experience of vasomotor symptoms – both with respect to when they have them and how long they last – vary dramatically across women, and show four distinct patterns. Some women experience vasomotor symptoms early, when they are still menstruating. Other women start them later – when their periods have stopped – and the symptoms persist for years. A lucky minority of women – about 27% – will have no or low levels of vasomotor symptoms. Then we have our super flashers – about a quarter of the women – who will have vasomotor symptoms for decades starting when they are still menstruating and persisting well over a decade and beyond.

There were certain characteristics of the women that predicted which pattern of vasomotor symptoms they would follow. The obese women tended to have vasomotor symptoms early. Chinese women tended to be relatively protected. And our super flashers – these women who had them persistently for over the entire menopause transition – African American women were the lucky winners here. The super flashers were also regular alcohol drinkers and tended to be in poorer mental and/or physical health. It is also important to note that hormones did not tell the whole story. There was some relation between a woman’s estrogen level and her vasomotor symptom group, but not a strong one. What should readers take away from your report?

Response: The take away message is that our old thinking about vasomotor symptoms – that they last for just a few years for most women – is incorrect. Vasomotor symptoms often start earlier and/or last much longer than previously thought. In fact, there are four distinct patterns women tend to follow. Our health care providers should be aware that our old thinking about vasomotor symptoms needs to be updated. Based upon a woman’s characteristics, including her race/ethnicity, weight, and overall mental and physical health, we can help her anticipate what pattern she may follow. What recommendations do you have for future research as a result of this study?

Response: Next steps are several fold:

1) The understanding biology of vasomotor symptoms is not well understood. We need to better understand this underlying biology and consider that there may be more than one type of hot flash – is the biology is different for these different groups?

2) We also need to understand what if anything vasomotor symptoms mean for women’s health. Are they just annoying symptoms to get through, or are they signals of underlying health changes (beyond simply hormonal changes)? Some research would suggest that frequent or severe vasomotor symptoms may be signals for underlying changes in a woman’s vasculature. Other work has linked them to bone loss. We need more research here.

3) Finally, and most importantly, we need more treatments. Right now we can offer women hormones or antidepressants. These are important treatments, and in some cases highly effective. However, we need more options for women, including options that do not require women to take a drug. Are there behaviors a woman can adopt to help her prevent, reduce, or better cope with her vasomotor symptoms? There is some work here, but we urgently need more. Stay tuned. Thank you for your contribution to the community.

Progression and timing of menopause symptoms over the menopause transition may be related to demographic and psychosocial factors

Menopause, July 13 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on July 20, 2016 by Marie Benz MD FAAD