Characterizing the trajectories of vasomotor symptoms across the menopausal transition

Tepper, Ping G.; Brooks, Maria M.; Randolph, John F.; Crawford, Sybil L.; Khoudary, Samar R. El; Gold, Ellen B.; Lasley, Bill L.; Jones, Bobby; Joffe, Hadine; Hess, Rachel; Avis, Nancy E.; Harlow, Sioḃán D.; McConnell, Daniel S.; Bromberger, Joyce T.; Zheng, Huiyong; Ruppert, Kristine; Thurston, Rebecca C.

doi:10.1097/gme.0000000000000676

Cited by 100 publications

(88 citation statements)

References 43 publications

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“…Although VMS can persist well beyond the FMP, perhaps at least as long as a decade (Avis et al, 2015; Tepper et al, 2016) and continue to be associated with sleep problems, variability in reproductive hormone concentrations (i.e., E2, FSH) do not share a similarly strong association with sleep complaints in midlife women. Freeman et al (2015) suggested that this lack of association could also be attributed to their analytic models, which included time relative to the FMP, which reflects changing hormone concentrations during the MT.…”

Section: Discussionmentioning

confidence: 99%

“…Use of group-based trajectory modeling accounted for heterogeneity within the sample, allowing us to identify groupings that are both statistically sound and scientifically valid (Tepper et al, 2016). Using the available premenopausal and postmenopausal observations and within-woman duration (i.e., time) we were able to evaluate sleep maintenance trajectories pre- and post-FMP.…”

Section: Discussionmentioning

confidence: 99%

“…Analyses focused on patterns of sleep problems in the years preceding the FMP rather than on women’s menopausal transition stage, and on how the trajectories changed at and following the FMP. Because prior SWAN analyses have demonstrated distinct trajectory patterns of VMS (Tepper et al, 2016) as well as of E2 and FSH (Tepper et al, 2012), and because Freeman et al (2015) found a small ‘at risk’ subgroup for poor sleep, we hypothesized the presence of distinct trajectory patterns of sleep problems before and after the FMP.…”

Section: Introductionmentioning

confidence: 99%

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Sleep Trajectories Before and After the Final Menstrual Period in the Study of Women’s Health Across the Nation (SWAN)

Kravitz

Janssen

Bromberger

et al. 2017

Curr Sleep Medicine Rep

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Purpose of review Longitudinal studies show that the menopausal transition (MT) is associated with poorer self-reported sleep. Increases in sleep disturbances across and beyond the MT are strongly associated with vasomotor symptoms (VMS) but occur even without VMS. We analyzed data from baseline through 13 annual or biennial follow-up assessments from SWAN’s multi-racial/ethnic cohort of midlife women, specifically focusing on patterns of sleep problems in the years preceding and following the final menstrual period (FMP). The FMP demarcated the MT and the postmenopausal period. We addressed the following questions: (1) are there distinct trajectory patterns of sleep problems across the MT, and (2) do pre-FMP sleep trajectories predict sleep problems around the time of FMP (trans-FMP) and post-FMP? Group-based trajectory modeling using repeated measures log-binomial regression with generalized estimating equation methods was used to describe trajectory patterns of the most prevalent sleep problem, waking several times at least 3 nights weekly during the previous 2 weeks, in 1,285 naturally menopausal women. Recent findings We found (1) 4 distinct trajectories for waking several times per night across the MT [low prevalence (n=487; 37.9%), moderate prevalence (n=365; 28.4%), increasing prevalence (n=197; 15.3%), and high prevalence (n=236; 18.4%)], (2) the prevalence of sleep problems increased overall, but in one trajectory group (increasing prevalence) more than in the other three, and (3) trouble falling asleep, early morning awakening, and frequent VMS were strongly associated with problems waking several times that persist into postmenopause. Summary Using trajectory analysis, we showed that, in general, awakenings were stable from pre-FMP to post-FMP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep Trajectories Before and After the Final Menstrual Period in the Study of Women’s Health Across the Nation (SWAN)

Kravitz

Janssen

Bromberger

et al. 2017

Curr Sleep Medicine Rep

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“…In an attempt to study the heterogeneity of temporal patterns of VMS, Tepple et al evaluated 1455 women with nonsurgical menopause over a median follow-up of 15.4 years and described four distinct trajectories: 'early onset' (onset about 11 years before the final menstrual period with decline after menopause), 'late onset' (onset near the final menstrual period with later decline), 'high frequency' (onset early with persistently high frequency) and 'low frequency' (persistently low frequency). In a further analysis, they found that relative to women with a persistently low frequency of VMS, women with persistently high-and early-onset VMS had a more adverse psychosocial and health profile (6). Of course, this begs the question as to what is cause and effect.…”

Section: Neural Mechanism: Wet Flushingmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts

Huguet

Grossman

2017

European Journal of Endocrinology

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Objective: Flushing can be defined as a sensation of warmth accompanied by erythema that most commonly is seen on the face and which occurs in episodic attacks. Such a problem can be clinically problematic, since many conditions and drugs can be related to flushing, and while often there appears to be no underlying organic disease, it is important to exclude disorders since they may be life-threatening conditions. Design and methods: We performed a search in MEDLINE using the terms 'flushing' in combination with 'carcinoid syndrome', 'pheochromocytoma', 'mastocytosis', 'menopausal hot flush' and 'treatment'. European and American guidelines relating to neuroendocrine tumours, mastocytosis and menopause were reviewed. Results: In this review, we discuss the main causes of flushing and propose an algorithm based on pathogenesis, which can be used to guide the clinical evaluation process. We also review recent significant developments in the assessment and treatment of the carcinoid syndrome and menopausal hot flushes, which should guide the clinical practice regarding this common but sometimes confusing condition. Conclusions: When evaluating flushing, a precise systematic approach is needed to exclude potentially serious underlying causes, although despite this, the cause of the disorder is not always found. If symptoms are not progressive, the patient should be advised about its apparently benign nature in order to avoid unnecessary studies or initiating treatments of minimal benefit.

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“…2 Physical symptom severity and changes in subjective measures of wellbeing may also be associated with age of onset of menopause, with earlier onset being associated with greater physical symptom severity and poorer psychosocial functioning. 4 Many areas of the brain related to aging may also be sensitive to changes in hormonal levels, with gonadal changes that occur around mid-life also being thought to be associated with changes in cognitive functioning. 5 Mood symptoms are known to be common throughout the menopause transition period.…”

Section: Introductionmentioning

confidence: 99%