Beyond frequency

Abstract

Objective Most menopausal women report vasomotor symptoms (hot flashes, night sweats). However, not all women with vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of vasomotor symptom bother beyond symptom frequency. Design The Study of Women’s Health Across the Nation participants reporting vasomotor symptoms at annual visit 7 comprised the sample (N = 1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all– 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately. Results In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR] = 1.27, 95% CI: 1.08–1.51), symptom sensitivity (OR = 1.18, 95% CI: 1.03–1.37), sleep problems (OR = 1.38, 95% CI: 1.04–1.85), poorer health (OR = 1.24, 95% CI: 1.03–1.48), duration of hot flashes (OR = 1.14, 95% CI: 1.06–1.23), younger age (OR = 0.94, 95% CI: 0.89–0.99), and African American race (vs white, OR = 1.59, 95% CI: 1.12–2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR = 1.84, 95% CI: 1.33–2.55) and night sweats duration (OR = 1.10, 95% CI: 1.02–1.20) were associated with night sweats bother. Conclusions Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for vasomotor symptoms might consider addressing modifiable factors related to symptom bother.

Association between personality traits and DSM-IV diagnosis of insomnia in peri- and postmenopausal women

“…This finding supports those of Thurston and colleagues who found that negative affect, a construct related to neuroticism, was a strong predictor of “hot flash bother” and that women who were symptomatic for hot flashes but not bothered by them had low levels of negative affect. 59 However, among the PMI women with vasomotor symptoms in our study, neuroticism was not related to level of interference from the hot flashes/sweats, nor was it related to number of these symptoms. Possibly, some mediating or moderating factor other than neuroticism that is unique to the PMI women causes more bother due to hot flashes.…”

“…In fact, insomnia itself may affect perceived bother of vasomotor symptoms. 59 Our findings need to be considered in light of study limitations. Our study is cross-sectional, therefore, direction of causality cannot be determined.…”

Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition

“…Women with greater BMI had longer total VMS duration, broadly consistent with other findings from SWAN indicating a greater likelihood of reporting hot flashes with higher adiposity. 5,15 However, BMI was no longer significantly associated with total VMS duration herein in multivariable models when considering factors such as race/ethnicity.…”

“…4,5,40–43 Pathways connecting negative affective factors and VMS are likely complex and bidirectional. 15,44–46 A direct physiological link through the hypothalamic-pituitary-gonadal axis between negative affective factors and VMS has been proposed 47 but is not well tested.…”

“…Earlier SWAN data have shown that experiencing VMS for at least 6 days is highly related to anxiety, 17 depression, 18 sleep disturbances, 19 quality of life, 20 cardiovascular risk, 10,21–23 bone health, 11,24 and VMS bothersomeness. 15 …”