Hot Flashes in the Late Reproductive Years: Risk Factors for African American and Caucasian Women

Abstract

Hot flashes are a primary reason that midlife women seek medical care, but there is little information about the onset or the predictors of hot flashes in the years before the menopause. This study examines women's experience of hot flashes in the late reproductive years, comparing African American and Caucasian women, and identifies hormonal, behavioral, and environmental risk factors for hot flashes associated with ovarian aging. Data are from a population-based prospective cohort study of ovarian aging in women who were ages 35--47, in general good health, and had regular menstrual cycles at study enrollment. Hot flashes were assessed by subject report in a structured interview at the first follow-up period and correlated highly with previous prospective daily ratings of hot flashes (p = 0.0001). Blood samples were obtained in the first 6 days of the menstrual cycle in two consecutive cycles at enrollment and two consecutive cycles at follow-up. Predictor variables include hormone measures, structured interview, and standard questionnaire data. Thirty-one percent of the sample (n = 375) reported hot flashes (mean age 41 years). In bivariate analysis, more African American than Caucasian women reported hot flashes (38% vs. 25%, p = 0.01). Significant predictors of hot flashes in the final multivariable logistic regression model were higher follicle-stimulating hormone (FSH) levels (odds ratio [OR] 3.19), anxiety (OR 1.06), baseline menopausal symptoms (OR 4.91), alcohol use (OR 1.09), body mass index (BMI) (OR 1.04), and parity (OR 1.20). Race did not predict hot flashes after adjusting for these variables. Hot flashes commonly occur before observable menstrual irregularities in the perimenopause and are associated with both hormonal and behavioral factors. The association of hot flashes with increased body mass (BMI) challenges the current "thin" hypothesis and raises important questions about the role of BMI in hormone dynamics in the late reproductive years.

Factors That May Influence the Experience of Hot Flushes by Healthy Middle-Aged Women

“…59 Although the prevalence of HFs has increased in Japan, however, it is still lower than in most Western populations. 16,27,59 These findings, along with those from other studies, such as SWAN, 10,27,52,60 allude to an important observation that race=ethnicity may not independently explain HF prevalence, as no statistically significant association was found between ethnicity=race and HFs after adjustments for such covariates as lifestyle, BMI, smoking, menopausal status, and health-related quality of life.…”

Longitudinal Analysis of the Association Between Vasomotor Symptoms and Race/Ethnicity Across the Menopausal Transition: Study of Women’s Health Across the Nation

“…In contrast to the expectation that higher BMIs will have a protective effect owing to higher estrone production, [14][15][16] the positive relation of BMI to vasomotor symptoms observed in our previous cross-sectional baseline examination 4 was found again in this study and has been reported by others. 6,18,19,63 We observed a statistically significant positive association between BMI and vasomotor Finally, our results indicate no effects of physical activity or caffeine or alcohol intake on reports of vasomotor symptoms, suggesting that changes in these behaviors are not likely to significantly influence vasomotor symptom reporting. The lack of an association with physical activity was consistent with some 4,39,72 but not all 23,[73][74][75][76][77] previous studies; studies of the relationship between alcohol consumption and vasomotor symptoms have shown no 4,7 or modest effects.…”

“…The lack of an association with physical activity was consistent with some 4,39,72 but not all 23,[73][74][75][76][77] previous studies; studies of the relationship between alcohol consumption and vasomotor symptoms have shown no 4,7 or modest effects. 6 …”

“…Two studies have shown higher symptom rates among African American women, [3][4][5][6] whereas another has not. 7 Several studies have reported reduced frequencies of symptoms among Asian women.…”

Menopause and the Asian Woman

“…6 How a woman perceives and responds to the menopause is colored by her culture. This difference that we observe may have their origins in their different genetics, lifestyle and culture.…”