Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort

Abstract

Objective The aim of this study was to identify temporal associations of anxiety dimensions with menopausal hot flashes in women progressing through the menopause transition. We hypothesized that associations of both somatic and affective dimensions of anxiety with hot flashes increased in the menopause transition, and that somatic anxiety was an independent risk factor for menopausal hot flashes. Methods Hot flashes, anxiety symptoms, hormone levels and other psychosocial variables were assessed annually for 14 years of follow-up. The 233 women were premenopausal at baseline and continued through one year or more after the final menstrual period. Anxiety dimensions were assessed with the Zung Anxiety Scale (ZAS), a validated measure of affective anxiety and somatic anxiety. Summed item scores were divided by the number of items rated, so that ranges of the two dimensions were comparable. Results Seventy-two percent of the sample reported moderate/severe hot flashes during the 14-year interval. There was no significant interaction between anxiety dimensions and menopausal stages. However, when adjusted for menopausal stage, the magnitude of association between somatic anxiety and hot flashes dramatically increased (OR 3.03, 95% CI: 2.12, 4.32, P<0.001), while the association between affective anxiety and hot flashes increased to a lesser extent (OR 1.27, 95% CI: 1.03, 1.57, P=0.024). Women with high levels of somatic anxiety (top third of the sample) had the greatest risk of hot flashes (P<0.001). When the anxiety dimensions were considered in combination, the additive effect of high affective anxiety symptoms was minimal, with no significant difference between the group with high affective/low somatic symptoms and the low symptom group in incident hot flashes at each menopausal stage (P=0.54). In multivariable analysis, somatic anxiety increased the risk of hot flashes more than 3 times (OR 3.13, 95% CI: 2.16, 4.53, P<0.001), but affective anxiety was not significantly associated with hot flashes after adjustment for other study variables (OR 1.19, 95% CI: 0.96, 1.48, P=0.117). Time-lagged somatic anxiety scores significantly predicted hot flashes, with a 71% increase in risk (OR 1.71, 95% CI: 1.21, 2.41, P=0.002). Time-lagged affective anxiety scores did not predict hot flashes, (OR 1.06, 95% CI: 0.87, 1.31, P=0.58). Conclusions This study showed a strong predictive association of somatic anxiety with the risk of menopausal hot flashes. The temporal associations suggest that somatic anxiety is not simply a redundant measure of hot flashes but predicts the risk of menopausal hot flashes and may be a potential target in clinical management of perimenopausal women.

Valerian Root in Treating Sleep Problems and Associated Disorders—A Systematic Review and Meta-Analysis

“…Concurring sleep problems and anxiety are frequently observed and their onset and course are interrelated. 100,101 In addition, these disorders are associated with a number of comorbid conditions including depression, [101][102][103] dementia, 5,6 OCD, 104 and hot flashes [105][106][107] (Figure 6). Our results demonstrated that sleep promotion and anxiolytic effects were the major therapeutic benefits expected of valerian (V. officinalis), and this herb could be also useful in treating OCD, cognitive dysfunction, menopausal hot flashes, as well as menstrual problems.…”

“Is it menopause or bipolar?”: a qualitative study of the experience of menopause for women with bipolar disorder

“…Psychological distress during the menopausal transition has been associated with history of depression and sexual abuse, body mass index, and stressful life events at midlife [ 29 , 30 ]. Increased prevalence of physical menopausal symptoms, such as hot flushes is also a risk factor [ 29 , 31 ], with estradoil variability potentially enhancing emotional reactivity to psychosocial stress [ 32 ]. However, negative mood change is often attributed to menopause because of broader cultural discourse [ 33 ].…”

The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium

“…A systematic review of 13 studies also suggests that women with more negative attitudes towards the menopause report more menopausal symptoms, but more prospective studies are needed to determine causality (Ayers et al , 2010). In addition to negative mood, anxiety was also found to be a predictor of VMS even after the adjustment of depression (Freeman and Sammel, 2016). The SWAN study even found that the association with anxiety appeared to be stronger than the association with depressive symptoms (Gold et al , 2006).…”