Results of recent trials highlight the risks of hormone therapy, increasing the importance of identifying preventive lifestyle factors related to menopausal symptoms. The authors examined the relation of such factors to vasomotor symptoms in the multiethnic sample of 3,302 women, aged 42-52 years at baseline (1995-1997), in the Study of Women's Health Across the Nation (SWAN). All lifestyle factors and symptoms were self-reported. Serum hormone and gonadotropin concentrations were measured once in days 2-7 of the menstrual cycle. After adjustment for covariates using multiple logistic regression, significantly more African-American and Hispanic and fewer Chinese and Japanese than Caucasian women reported vasomotor symptoms. Fewer women with postgraduate education reported vasomotor symptoms. Passive exposure to smoke, but not active smoking, higher body mass index, premenstrual symptoms, perceived stress, and age were also significantly associated with vasomotor symptoms, although a dose-response relation with hours of smoke exposure was not observed. No dietary nutrients were significantly associated with vasomotor symptoms. These cross-sectional findings require further longitudinal exploration to identify lifestyle changes for women that may help prevent vasomotor symptoms.

ORMONAL AGENTS HAVE BEEN the predominant therapy for menopausal hot flashes, but their use decreased substantially following the shifts in riskbenefit ratios that were identified in the Women's Health Initiative Estrogen plus Progestin randomized controlled trial. 1,2 However, no other treatments have US Food and Drug Administration approval for menopausal hot flashes, and the efficacy of alternative pharmacologic and nonpharmacologic agents is inconclusive. [3][4][5] Selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs) have been investigated for hot flash treatment with mixed results [6][7][8][9][10][11] ; a pooled analysis of 7 SSRI and SNRI studies showed that decreases in hot flash scores ranged from 3% to 41% compared with placebo. 6 Differences among the serotonergic antidepressants, 11 study popu-

The effects of age, sex, renal function, and seasonal variation on serum parameters within the vitamin D endocrine system were studied cross-sectionally in a healthy population of 167 men and 114 women, aged 20-94 yr. Serum 25-hydroxy- and 1,25-dihydroxyvitamin D [25OHD and 1,25-(OH)2D] did not decline with age in either sex. Nonlinear regression using a sine function showed a significant seasonal variation in 25OHD and 1,25-(OH)2D in both sexes (P less than 0.005). Serum intact PTH increased significantly by 35% over the age span in both sexes (P less than 0.005). In women, serum phosphorus and total and ionized calcium remained constant with age. In sharp contrast, males had a marked 25% fall in phosphorus across the age span (r = -0.564; P less than 0.0001) and a slight but significant 4% decline in total and ionized calcium. Creatinine clearance declined markedly with age, but was not related to 1,25-(OH)2D in either sex. Only in men was there a significant but modest inverse relationship between creatinine clearance and PTH (r = -0.212; P less than 0.05), which was multicollinear with age. We conclude that in healthy individuals 1) compromised vitamin D status or serum 1,25-(OH)2D levels are not a normal concomitant of aging; 2) declining glomerular filtration does not appear to be the principle cause of the age-related rise in PTH; and 3) there are marked male-female differences in phosphorus metabolism across the age span.