Obesity and fat distribution in relation to hot flashes in Dutch women from the DOM-project

The authors studied obesity and fat distribution in relation to the occurrence of hot flashes in a population-based study comprising 2904 women aged 40–44 and 569 women aged 54–69 presenting for mammographic screening (the DOM-project). Women aged 40–44 in the upper tertiles of Quetelet's index and waist/hip ratio reported hot flashes significantly more often than women in the respective lower tertiles. These associations were independent of each other and independent of age. After adjustment for age, waist/hip ratio and menopausal status, the odds ratio comparing the upper tertile of Quetelet's index to the lower tertile was 1.70 (95% confidence interval, 1.30 – 2.21). After adjustment for age, Quetelet's index and menopausal status, the odds ratio comparing the upper tertile of waist/hip ratio to the lower tertile was 1.37 (95% CI, 1.05 – 1.78). In women aged 54–69 no significant associations between Quetelet's index and complaints of hot flashes were observed. Women in the upper tertile of waist/hip ratio reported hot flashes more often than women in the lower tertile, but this result was not significant (OR 1.38; 95% CI, 0.87 – 2.22).     

Acupuncture for postmenopausal hot flashes

OBJECTIVE: To determine whether individually tailored acupuncture is an effective treatment option for reducing postmenopausal hot flashes and improving quality of life. METHODS: In a randomized, placebo-controlled pilot study, 29 postmenopausal participants averaging at least seven moderate to severe hot flashes per 24h, with a baseline estradiol concentration of less than 50 pg/mL and a normal TSH level, were randomized to receive 7 weeks (nine treatment sessions) of either active acupuncture or placebo acupuncture (placebo needles that did not penetrate the skin at sham acupuncture points). Participants recorded hot flashes in logs that were reported daily. Global indices of the severity and frequency of hot flashes were derived from the participants' daily logs. RESULTS: Participants receiving the active treatment had a greater reduction in hot flash severity (24.5+/-30.7%) compared to those receiving placebo (4.4+/-17.1%, P=0.042). Within group repeated measures analyses of variance revealed a significant reduction in hot flash severity in the active (P=0.042), but not in the placebo treatment group (P=0.15). Although there was no significant group difference in the reduction of hot flash frequency between the active (42.4+/-32.2%) and placebo groups (32.0+/-26.5%; P>or=0.352), within group repeated measures analyses of variance revealed that the reduction was statistically significant in both groups (P相似文献   

Menopausal symptoms and associated factors in HIV-positive women

Objective

To evaluate menopausal symptoms and their associated factors in HIV-positive women.

Methods

A cross-sectional study was conducted with 537 women of 40–60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms.

Results

The mean age of the seropositive women was 47.7 ± 5.8 years compared to 49.8 ± 5.3 for the seronegative women (p < 0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p = 0.009), specifically hot flashes (p < 0.002) and sweating (p = 0.049). Vaginal dryness was also less prevalent in this group (p < 0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR = 2.12; 95%CI: 1.52–2.94). Vaginal dryness was less common in women without a partner (PR = 0.67; 95%CI: 0.49–0.90) and was associated with older age (PR = 1.03; 95%CI: 1.01–1.06) and being in the peri- or postmenopause (PR = 1.69; 95%CI: 1.10–2.60). Depression was inversely associated with being employed (PR = 0.74; 95%CI: 0.58–0.96) and directly associated with the presence of chronic diseases (PR = 1.30; 95%CI: 1.01–1.067). Insomnia was associated with a lower body mass index (PR = 0.96; 95%CI: 0.95–0.97) and with being peri- or postmenopausal (PR = 1.48; 95%CI: 1.11–1.97). No correlation was found between HIV serological status and any of the menopausal symptoms.

Conclusions

In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.     

Duloxetine for major depressive disorder and daytime and nighttime hot flashes associated with the menopausal transition

Background

We sought to obtain preliminary data regarding the efficacy of duloxetine for major depressive disorder (MDD) during the menopausal transition. The secondary outcomes were vasomotor symptoms (VMS, or hot flashes), specifically assessed as daytime or nighttime, and anxiety.

Methods

After a single-blind placebo lead-in, peri- and postmenopausal women with MDD (n = 19) received eight weeks of open-label treatment with duloxetine (60 mg/day). The Hamilton Rating Scale for Depression (17-item) (HAM-D) was the primary outcome measure. Hot flashes were monitored prospectively using daily diaries, the Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale (HFRDIS). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7).

Results

Of 19 participants treated with duloxetine, 16 (84.2%) were evaluable (returned for ≥1 follow up), and 13 (68.4%) completed the study. Three discontinued due to side effects. The pre-treatment and final median HAM-D scores were 15 (interquartile range [IQR] 14–18), and 6.5 (IQR 4–11.5), respectively, reflecting a significant decrease (p = .0006). The response and remission rates were 56.3% (all responders were also remitters, having ≥50% decrease in HAM-D scores and final scores ≤7). Anxiety improved with treatment (p = .012). GCS and HFRDIS scores decreased significantly. Among those who reported hot flashes at baseline, number and severity of hot flashes improved significantly overall (p = .009 and p = .008, respectively). Daytime but not nighttime hot flashes improved significantly.

Conclusions

These data support further study of duloxetine for the treatment of a spectrum of symptoms associated with the menopausal transition.     

Hot flashes and blood pressure in midlife women

Objectives

Recent epidemiological studies suggest that hot flashes may have a detrimental impact on the cardiovascular system. The purpose of this study was to examine the associations between hot flashes and blood pressure among women aged 45–54 years who had never used hormone therapy.

Study design

Data were analyzed from 603 women who participated in the Midlife Health Study, a cross-sectional study conducted in the Baltimore Metropolitan region.

Main outcome measures

All participants came to the clinic where systolic and diastolic blood pressures were measured, height and weight were assessed, and a questionnaire was administered that ascertained detailed data on history of hot flashes and participant demographics and health habits.

Results

The data showed that 56.9% of the participants reported ever experiencing hot flashes. In the age-adjusted analyses, both systolic and diastolic blood pressures were significantly and positively associated with hot flashes. However, the estimates were markedly attenuated and not statistically significant after adjustment for age, race, smoking status, current alcohol use, body mass index, and use of an anti-hypertensive agent or a cholesterol-lowering medication. Similar results were observed for moderate or severe hot flashes, hot flashes experienced for one or more years, and hot flashes experienced within the previous 30 days.

Conclusions

These findings indicate that hot flashes are not significantly associated with blood pressure during midlife.     

Do menopausal hot flashes have any significant effects on arterial blood gas measurements?

Objectives: To evaluate the effects of menopausal hot flashes on arterial blood gas measurements. Methods: Twelve postmenopausal women with frequent hot flashes were enrolled in this study. Blood samples from femoral artery were collected before and during menopausal hot flashes in each subject, and all blood samples were analyzed for pH, pCO₂, pO₂, HCO₃ standard, total CO₂, and base excess. Arterial blood gas parameters before and during menopausal hot flashes were compared statistically. Results: pH measurements decreased significantly during hot flashes (P<0.05); although the difference was found to be statistically significant, the amount of decrease and the range in which the change took place led us to conclude that this change was clinically insignificant. Other parameters did not show any statistically significant differences between the preflash and flash measurements. Conclusions: Our results indicate that menopausal hot flashes do not have any clinically significant effects on arterial blood gas measurements.     

Genetic polymorphisms, hormone levels, and hot flashes in midlife women

OBJECTIVE: Hot flashes disrupt the lives of millions of women each year. Although hot flashes are a public health concern, little is known about risk factors that predispose women to hot flashes. Thus, the objective of this study was to examine whether sex steroid hormone levels and genetic polymorphisms in hormone biosynthesis and degradation enzymes are associated with the risk of hot flashes. METHODS: In a cross-sectional study design, midlife women aged 45-54 years (n=639) were recruited from Baltimore and its surrounding counties. Participants completed a questionnaire and donated a blood sample for steroid hormone analysis and genotyping. The associations between genetic polymorphisms and hormone levels, as well as the associations between genetic polymorphisms, hormone levels, and hot flashes were examined using statistical models. RESULTS: A polymorphism in CYP1B1 was associated with lower dehydroepiandrosterone-sulfate (DHEA-S) and progesterone levels, while a polymorphism in CYP19 (aromatase) was associated with higher testosterone and DHEA-S levels. Lower progesterone and sex hormone binding globulin levels, lower free estradiol index, and a higher ratio of total androgens to total estrogens were associated with the experiencing of hot flashes. A polymorphism in CYP1B1 and a polymorphism in 3betaHSD were both associated with hot flashes. CONCLUSION: Some genetic polymorphisms may be associated with altered levels of hormones in midlife women. Further, selected genetic polymorphisms and altered hormone levels may be associated with the risk of hot flashes in midlife women.     

A comparative study of menopausal hot flashes and their psychosocial correlates in Taiwan and the United States

Objective

To compare the frequency, severity, and interference of menopause-related hot flashes and their psychosocial correlates in Taiwanese and U.S. women.

Study design

Cross-sectional study, using a convenience sample of 101 Taiwanese and 121 U.S. midlife women.

Main outcome measures

Hot-flash measures, including frequency, severity (Women's Health Initiative Symptom Scale), hot flash related daily interference; and psychosocial measures: Attitudes toward Menopause and Aging Scale, Coping Strategies Questionnaire, Sense of Coherence Questionnaire, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventory, and State-Trait Anger Scale.

Results

Using ANCOVA with demographic variables as covariates, U.S. women reported greater frequency and daily interference from hot flashes compared with Taiwanese women. Greater depression, greater catastrophizing about hot flashes, lower sense of coherence, lower state/trait anger, and more positive attitudes toward aging were reported in the U.S. cohort. The groups were similar in their frequency of specific coping strategies, and they did not differ significantly in menopause symptom severity, attitudes towards menopause, state/trait anxiety, or overall negative psychosocial characteristics. Hierarchical multiple regression analyses indicated that hot-flash related daily interference was predicted by marital status, frequency of hot flashes, and negative psychosocial characteristics among the U.S. women; and by frequency of hot flashes and negative psychosocial characteristics among the Taiwanese women.

Conclusions

Despite differences in the frequency and daily interference from hot flashes in the two samples, the predictors of interference were similar. Results highlight the importance of considering both psychosocial factors and cultural differences in providing guidance and treatment for women experiencing menopause-related hot flashes.     

Resistance training for hot flushes in postmenopausal women: Randomized controlled trial protocol

ObjectivesHot flushes and night sweats affect 75% of all women after menopause and is a common reason for decreased quality of life in mid-aged women. Hormone therapy is effective in ameliorating symptoms but cannot be used by all women due to contraindications and side effects. Engagement in regular exercise is associated with fewer hot flushes in observational studies, but aerobic exercise has not proven effective in randomized controlled trials. It remains to be determined whether resistance training is effective in reducing hot flushes and improves quality of life in symptomatic postmenopausal women. The aim of this study is to investigate the effect of standardized resistance training on hot flushes and other health parameters in postmenopausal women.Study designThis is an open, parallel-group, randomized controlled intervention study conducted in Linköping, Sweden. Sixty symptomatic and sedentary postmenopausal women with a mean of at least four moderate to severe hot flushes per day or 28 per week will be randomized to an exercise intervention or unchanged physical activity (control group). The intervention consists of 15 weeks of standardized resistance training performed three times a week under supervision of a physiotherapist.Main outcome measuresThe primary outcome is hot flush frequency assessed by self-reported hot flush diaries, and the difference in change from baseline to week 15 will be compared between the intervention group and the control group.ConclusionThe intention is that this trial will contribute to the evidence base regarding effective treatment for hot flushes.     

A critical view of the effects of phytoestrogens on hot flashes and breast cancer risk

The increased risk of breast cancer recently observed with some specific estro-progestin associations has raised concerns about the harmful effects of menopausal hormone replacement therapy (HRT). It has been proposed that phytoestrogens (PEs), which have a similar chemical structure to estrogens, could be used as HRT. The main selling points of these preparations concern the management of hot flashes and their potential beneficial effects on breast tissue. In this review, we will address the effects of PE on hot flashes and breast cancer risk as well as the questions raised on a chemical point of view. We conclude that the efficacy of a PE rich diet or nutritional supplements is not clearly established. The use of PE as an alternative for HRT cannot be advocated for now, due to insufficient and conflicting data on efficacy and safety. Moreover, due to the hormone dependence of breast cancer, PE use must be contraindicated in breast cancer survivors.     

Lifestyle alterations for the amelioration of hot flashes

Hot flashes are a common complaint among women as they transition through menopause. This article reviews the evidence of lifestyle alterations for the amelioration of hot flashes including obesity, exercise, smoking, relaxation techniques, and acupuncture. Further randomized controlled trials regarding these lifestyle alterations are needed to determine their full potential benefits regarding hot flashes.     

Differential diagnosis of hot flashes

Objective: The purpose of this study is to present the physiology and differential diagnosis of hot flashes, other than associated with menopause, in order to facilitate the proper evaluation of symptomatic patients with hot flashes. Study Design: Literature search using Med-Line computer access. Results: Interest in flushing reaction began in historic times. With the rapidly expanding population of women over the age of 45 and prevalence of hot flashes as menopausal symptoms, physicians need to be aware of other medical conditions which may mimic hot flashes. These include flushing due to systemic diseases, carcinoid syndrome, systemic mast cell disease, pheochromocytoma, medullary carcinoma of the thyroid, pancreatic islet-cell tumors, renal cell carcinoma, neurological flushing, emotional flushing, spinal cord injury, flushing reaction related to alcohol and drugs, flushing associated with food additives, and eating. Conclusion: There is a wide variety of disease processes that can cause hot flashes. Knowledge of the nature of these disease processes is necessary for quick recognition of patients with hot flashes who do not respond to estrogen replacement treatment, and to facilitate the proper evaluation of atypical patients.     

Determinants of hot flashes and night sweats

Primary Objective: The purpose of this study was to identify determinants of hot flashes and night sweats, two vasomotor symptoms associated with the hormonal changes of the menopause transition.

Methods: Participants were 293 women, aged 45 to 55, randomly selected from automated demographic and membership records of a health maintenance organization in the northeast USA. Letters were mailed to eligible women, followed by face-to-face interviews.

Results: Hot flashes during the month before interview were reported by 57% of the participants, although only 9% of the entire sample reported hot flashes to be “bothersome”. Night sweats were reported by 36% of all participants, with 6% reporting night sweats to be “bothersome”. Fifty-four percent of women reporting hot flashes also reported night sweats. In logistic regression analyses that controlled for menopause status and use of hormone therapy (HT), daily alcohol consumption significantly increased the risk of hot flashes, night sweats, and bothersome night sweats. Higher education and an excellent self-rating of health decreased the risk of night sweats, but not hot flashes. Smoking increased the risk of bothersome hot flashes, but not bothersome night sweats.

Conclusions: In logistic regression analyses, alcohol consumption was a significant predictor of vasomotor symptoms. A slightly different set of variables were associated with hot flashes compared to night sweats.

Résumé. Objectif premier: Cette étude a pour objet d’identifier les déterminants des bouffées de chaleur et des sudations nocturnes, deux symptômes vasomoteurs associés aux changements hormonaux de la transition ménopausique.

Méthodes: Les participants sont 293 femmes choisies au hasard à partir d’enregistrements automatiques de données démographiques des membres d’une organisation de surveillance de la santé du nord ouest des USA. Des lettres ont été adressées aux femmes retenues, suivies d’entretiens face à face.

Résultats: 57% des participantes on fait état de la survenue de bouffées de chaleur dans le mois qui a précédé l’entretien, mais seulement 9% ont mentionné en avoir été incommodées. 36% ont connu des sudations nocturnes, dont 6% ont été incommodées. 54% des femmes ayant fait état de bouffées de chaleur ont également connu des sudations nocturnes. Les analyses de régression logistique qui stabilisent l’effet du statut de la ménopause et du traitement hormonal (TH) indiquent que la consommation quotidienne d’alcool accroît les risques de bouffées de chaleur, de sueurs nocturnes et de sudation nocturne incommodante. Une plus grande éducation et un excellent auto contrôle de la santé diminuent les risques de sudations nocturnes, mais non de bouffées de chaleur.

Conclusion: Les analyses de régression logistique montrent que la consommation d’alcool est un excellent prédicateur des symptômes vasomoteurs. Les bouffées de chaleurs sont associées à un groupe de variables légèrement différent de celui des sueurs nocturnes.

Zusammenfassung. Studienziel: Sinn dieser Studie war es, Determinanten für Hitzwallungen und Nachtschweiß zu identifizieren, zwei vasomotorische Symptome, die mit den hormonellen Veränderungen des menopausalen Überganges einhergehen.

Methoden: Teilnehmerinnen waren 293 Frauen von 45 bis 55 Jahren, die nach Zufallskriterien aus elektronischen demographischen und Mitglieder-Verzeichnissen einer Gesundheitsorganisation im Nordosten der USA gezogen worden waren. Briefe wurden an auffindbare Frauen verschickt, gefolgt von persönlichen Interviews.

Ergebnisse: Hitzewallungen in den Monaten vor dem Interview wurden von 57% der Teilnehmerinnen angegeben, aber nur 9% der gesamten Stichprobe berichteten, dass ihnen die Hitzewallungen unangenehm seien. Nachtschweiß wurde von 36% aller Teilnehmerinnen angegeben, von denen 6% berichteten, dass ihnen das nächtliche Schwitzen unangenehm sei. 54% der Frauen, die über Hitzewallungen berichteten, gaben auch an, unter Nachtschweiß zu leiden. Unter Zugrundelegung desselben menopausalen Status und derselben begleitender Hormonbehandlung zeigte sich in logistischen Regressionsanalysen, dass täglicher Alkoholkonsum das Risiko von Hitzewallung, Nachtsschweiß und das Unwohlsein bei Nachtschweiß signifikant erhöhte. Höhere Bildung und eine besonders gute Selbsteinschätzung der eigenen Gesundheit senkten das Risiko von Nachtschweiß, nicht aber das von Hitzewallungen. Rauchen erhöhte das Risiko von Unwohlsein bei Hitzewallungen, nicht aber das Unwohlsein bei Nachtschweiß.

Zusammenfassung: In logistischen Regressionsanalysen erwies sich Alkoholkonsum als signifikantes Vorhersagekriterium für vasomotorische Symptome. Verglichen mit Nachtschweiß war ein leicht veränderter Satz von Variablen mit Hitzewallungen verknüpft.

Resumen. Objetivo principal: el propósito de este estudio fue identificar los determinantes de los sofocos y sudores nocturnos, dos síntomas vasomotores asociados con los cambios hormonales de la transición menopáusica.

Métodos: las participantes fueron 293 mujeres, de 45 a 55 años de edad, seleccionadas aleatoriamente a partir de registros automatizados demográficos y de afiliación a una organización para el mantenimiento de la salud, en el nordeste de EE.UU. Se enviaron cartas circulares a las mujeres potencialmente elegibles, que fueron seguidas de entrevistas personales.

Resultados: el 57% de las participantes dijeron haber tenido sofocos durante el mes anterior a la entrevista, aunque sólo el 9% de toda la muestra indicó que los sofocos habían sido “molestos”. Los sudores nocturnos fueron reportados por el 36% de las participantes, el 6% de las cuales señaló que los sudores nocturnos eran “molestos”. El cincuenta y cuatro por ciento de las mujeres que experimentaron sofocos también dijeron haber tenido sudores nocturnos. En los análisis de regresión logística que controlaban el status de menopausia y el uso de terapia hormonal (HT), se comprobó que el consumo diario de alcohol incrementaba el riesgo de padecer sofocos, sudores nocturnos y sudores nocturnos molestos. Un nivel educativo alto y una excelente valoración de la propia salud disminuían el riesgo de padecer sudores nocturnos, pero no de sofocos. El consumo de tabaco incrementaba el riesgo de sufrir sofocos molestos, pero no de sudores nocturnos molestos.

Conclusiones: en los análisis de regresión logística, el consumo de alcohol fue un predictor significativo de los síntomas vasomotores. El conjunto de variables asociadas con los sofocos era ligeramente diferente al de las variables asociadas con los sudores nocturnos.     

Cardiovascular autonomic responsiveness in postmenopausal women with and without hot flushes

Objectives

During menopausal transition autonomic balance is known to shift towards sympathetic dominance, but the role of vasomotor hot flushes in this phenomenon is not understood. We compared cardiovascular autonomic responsiveness between women with and without hot flushes.

Study design and main outcome measures

One hundred fifty recently postmenopausal healthy women with varying degree of hot flushes (none, mild, moderate, severe) underwent comprehensive cardiovascular autonomic nervous testing (controlled and deep breathing, active orthostatic test, Valsalva manoeuvre and handgrip test) assessing both sympathetic and parasympathetic activity. The responses of heart rate, heart rate variability and blood pressure in these tests were evaluated.

Results

Responses in heart rate showed differences between the study groups only in the Valsalva manoeuvre where the tachycardia ratio in all symptomatic women was lower (p = 0.041) than in women without hot flushes. Neither change in the heart rate variability analyses nor the blood pressure responses were affected by hot flush status. However, there was a non-significantly higher maximum systolic (140 (112–182) mmHg vs. 135 (102–208) mmHg) and diastolic blood pressure (94 (72–112) mmHg vs. 90 (66–122) mmHg) following the handgrip test in women without hot flushes vs. all the symptomatic women.

Conclusions

Menopausal hot flushes seem to be associated with a possibly increased sympathetic preponderance without an effect on parasympathetic activity in cardiovascular autonomic responses. This may imply a potentially negative impact on cardiovascular health in women experiencing hot flushes.     

Treatment of menopausal hot flashes with 5-hydroxytryptophan

Objective

Much recent research has focused on nonhormonal treatments for menopausal hot flashes. The purpose of the present study was to determine the effects of 5-hydroxytroptophan (5-HTP), the immediate precursor of serotonin, upon menopausal hot flashes. Selective, serotonergic, reuptake inhibitors (SSRIs), which increase the amount of serotonin in the synaptic gap, have shown some promise in the amelioration of hot flashes.

Methods

We administered 5-HTP or placebo, in double-blind fashion, to 24 postmenopausal women reporting frequent hot flashes. Treatment outcome was measured using a miniature, electronic, hot flash recorder.

Results

No significant effects of 150 mg/day 5-HTP upon hot flash frequency were found. The 5-HTP group had 23.8 ± 5.7 (SD) hot flashes/24 h prior to treatment and 18.5 ± 9.6 at the end of treatment. The placebo group had 18.5 ± 9.6 before treatment and 22.6 ± 12.4 at treatment completion.

Conclusions

At the dose given, 5-HTP does not significantly ameliorate frequency of menopausal hot flashes, as measured objectively with an electronic recorder. Given the small size, this study must be considered preliminary in nature.     

The relation of physiological changes to subjective symptoms in postmenopausal women with and without hot flushes

This study was designed to fully correlate the temporal relationship between augmented digital perfusion, (vasodilatation) and hot flushes, peripheral temperature, plasma luteinizing hormone, (LH) epinephrine and norepinephrine. Plasma samples were measured every 3 min for 2–4 h, in 5 symptomatic women before and after estrogen replacement and in 3 asymptomatic post-menopausal women. In all 5 symptomatic women the augmented digital perfusion occurred at a mean (±SEM) of 1.5±0.2 min before the initiation of the flush, at least 3 min before the initial rise in temperature and 9 min before the LH rise. There was a significant (P < 0.05) rise in epinephrine but not norepinephrine at 3 and 6 min after the initiation of augmented digital perfusion. Although subjective improvement occurred in all 3 women receiving estrogen, all measured parameters disappeared in only 1 subject and the 2 others continued having augmented digital perfusion, flushes, and temperature vasomotor changes although the related LH increase was absent. Surprisingly, asymptomatic women who never received estrogens also demonstrated similar augmented digital perfusion and temperature changes, but failed to show the LH related rise, as observed in women with short-term estrogen treatment. In conclusion, these results demonstrate that augmented digital perfusion consistently precedes the hot flush, the rise in temperature and plasma LH in symptomatic post-menopausal women. The increase in epinephrine may be a homeostatic mechanism to compensate for the peripheral vasodilatation. The finding that augmented digital perfusion and temperature changes also occur in asymptomatic post-menopausal women indicates that objective changes are more specific and reliable indicators of vasomotor instability than the subjective sensation of hot flushes.     

Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy

OBJECTIVE: To evaluate the prevalence of premalignant and malignant polyps and their association with menopausal status, hormone therapy and clinical characteristics in perimenopausal and postmenopausal women. METHODS: A surgical database was used to select pre- and postmenopausal women >or=40 years of age, submitted to hysteroscopic resection of endometrial polyps. The medical records of 475 women were reviewed and clinical characteristics and histological diagnosis of resected polyps were assessed. RESULTS: The majority of women had benign endometrial lesions, 78.53% of which were endometrial polyps and 13.47% polyps with simple or complex endometrial hyperplasia without atypia. Polyps with endometrial hyperplasia with atypia comprised 1.05% of cases, while 2.74% were carcinomatous polyps. Analysis using prevalence ratios showed that premalignant and malignant lesions were associated with age and postmenopausal bleeding. Women >60 years of age had a prevalence ratio 3.28 times greater (95%CI: 1.19-9.07) of premalignant or malignant polyps. When only postmenopausal women were evaluated for the effect of age, those over 60 years of age had a prevalence 5.31 times greater (95%CI: 1.22-23.09), while those with postmenopausal bleeding had an age-adjusted prevalence ratio of 3.71 (95%CI: 1.21-11.34) compared to asymptomatic women. No significant association was found between arterial hypertension, diabetes mellitus, obesity, use of hormone therapy or tamoxifen and premalignancy or malignancy. CONCLUSIONS: There was a low prevalence of premalignant and malignant lesions in endometrial polyps. Older women and those with postmenopausal bleeding had a greater prevalence of malignancy and in these cases hysteroscopic resection of endometrial polyps is mandatory.     

Perceived control, lifestyle, health, socio-demographic factors and menopause: impact on hot flashes and night sweats

Objective

To develop a model to predict the perceived severity of hot flashes (HF) and night sweats (NS) in symptomatic middle-aged women.

Methods

This was a cross-sectional study of a community-based sample of 243 women with vasomotor symptoms. Menopausal status was ascertained using the ‘Stages of Reproductive Aging Workshop’ criteria. Women's ‘perceived control’ over their symptoms was measured by a validated Portuguese version of the Perceived Control over Hot Flushes Index. Structural equation modelling was employed to construct a causal model of self-reported severity of both HF and NS, using a set of 20 variables: age, marital status, parity, professional status, educational level, family annual income, recent diseases and psychological problems, medical help-seeking behaviour to manage menopausal symptoms, use of hormone therapy and herbal/soy products, menopause status, intake of alcohol, coffee and hot beverages, smoking, physical exercise, body mass index and perceived control.

Results

Significant predictors of perceived severity were the use of hormone therapy for both HF (β = −.245; p = .022) and NS (β = −.298; p = .008), coffee intake for both HF (β = −.234; p = .039) and NS (β = −.258; p = .029) and perceived control for both HF (β = −1.0; p < .001) and NS (β = −1.0; p < .001). The variables explained respectively 67% and 72% of the variability in the perceived severity of HF and NS. Women with high perceived control had a significantly lower frequency (t(235) = 2.022; p = .044) and intensity of HF (t(217) = 3.582; p < .001); similarly, participants with high perceived control presented a lower frequency (t(235) = 3.267; p < .001) and intensity (t(210) = 3.376; p < .001) of NS.

Conclusion

Perceived control was the strongest predictor of the self-reported severity of both HF and NS. Other causal predictors were hormone therapy and caffeine intake. All three were associated with less severe vasomotor symptoms.