Somatic and affective anxiety symptoms and menopausal hot flashes

Lermer, Miriam A.; Morra, Angela; Moineddin, Rahim; Manson, Judith; Blake, Jennifer; Tierney, Mary C.

doi:10.1097/gme.0b013e3181ec58f8

Cited by 25 publications

(22 citation statements)

References 14 publications

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“…Anxiety symptoms have been identified as a strong risk factor for hot flashes, 8, 10, 21, 28–30 but it is not known whether anxiety amplifies or is primarily a predictor of hot flashes. 31 It has also been suggested that the association between anxiety symptoms and hot flashes is due to an overlap of somatic symptoms of both disorders rather than to the psychological condition of anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…31 It has also been suggested that the association between anxiety symptoms and hot flashes is due to an overlap of somatic symptoms of both disorders rather than to the psychological condition of anxiety. 30 Both anxiety and hot flashes have physiologic and psychological components that are difficult to disentangle, and whether anxiety is associated with responses to hot flash treatments is also not known. Increased understanding of the role of anxiety in hot flashes might lead to treatments that reduce both anxiety and hot flashes, but further studies that evaluate these issues are needed.…”

Section: Discussionmentioning

confidence: 99%

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Risk of long-term hot flashes after natural menopause

Sammel²,

2014

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Objectives To estimate the risk of hot flashes relative to natural menopause and evaluate associations of hormone levels, behavioral and demographic variables with the risk of hot flashes following menopause. Methods Annual assessments of 255 women who were premenopausal at baseline and reached natural menopause during 16 years of follow-up. Results The prevalence of moderate/severe hot flashes increased in each premenopausal year, reaching a peak of 46% in the first two years after the final menstrual period (FMP). Hot flashes decreased slowly following menopause and did not return to premenopausal levels until 9 years after FMP. The mean duration of moderate/severe hot flashes after FMP was 4.6 (SD2.9) years (4.9, SD3.1 years for any hot flashes). One-third of women at 10 or more years following menopause continued to experience moderate/severe hot flashes. African American women (obese and non-obese) and obese white women had significantly greater risk of hot flashes compared to non-obese white women (interaction P=0.01). In multivariable analysis, increasing FSH levels before FMP (P<0.001), decreasing estradiol (OR 0.87, 95% CI: 0.78–0.96, P=0.008), and increasing anxiety (OR 1.05, 95% CI: 1.03–1.06, P<0.001) were significant risk factors for hot flashes, while higher education levels were protective (OR 0.66, 95% CI: 0.47–0.91, P=0.011). Conclusions Moderate/severe hot flashes continued on average for nearly 5 years following menopause; more than one- third of women observed for 10 or more years following menopause had moderate/severe hot flashes. Continuation of hot flashes for more than 5 years following menopause underscores the importance of determining individual risk/benefit when selecting hormone or non-hormonal therapy for menopausal symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of long-term hot flashes after natural menopause

Sammel²,

2014

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“…We hypothesized an effect modification of menopausal stage on dimensions of somatic and affective anxiety, with increased associations in the menopause transition. Based on evidence in previous studies, 8,11 we also hypothesized that somatic anxiety was an independent risk factor of menopausal hot flashes.…”

Section: Introductionmentioning

confidence: 98%

“…7–14 Conflicting findings are in part due to the varied manifestations of anxiety syndromes and disorders and to the nature of the somatic symptoms of anxiety, which are similar to somatic complaints of hot flashes, and the consequent difficulty of disentangling the two conditions. 11, 14, 15 There is also little evidence to indicate whether anxiety is a precursor or a consequence of hot flashes, and whether anxiety influences perceptions of hot flashes or augments the event of hot flashes. 12 …”

Section: Introductionmentioning

confidence: 99%

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

Freeman¹,

Sammel

2016

Menopause

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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.

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“…However, it is suggested that this association is due to the overlapping of anxiety's somatic symptoms and the hot fl ushes' physical manifestations, given that these vasomotor symptoms are connected with the somatic dimension of anxiety, but not with the affective one (Lermer et al, 2011).…”

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confidence: 99%

Hot Flushes and Night Sweats in Midlife: Why do Some Women Have Them and Others do Not?

Pimenta¹,

Marôco²,

Ramos³

et al. 2015

Psicol. Reflex. Crit.

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This study investigated what predicts the occurrence of hot fl ushes (HF) and night sweats (NS). A community sample of 992 women (42-60 years) answered a questionnaire to collect socio-demographic, health and menopause-related, as well as lifestyle information. Depressive mood and stress, as well as HF and NS (in terms of presence, frequency and intensity), were also assessed. Structural equation modelling was used to build a structural model to predict the occurrence of both vasomotor symptoms. Results: Stress predicted NS (β =.154; p =.006), whereas depressive mood was linked to the occurrence of HF's (β =.149; p =.006). Being peri-menopausal and post-menopausal, among several other characteristics, were also signifi cant predictors of the occurrence of both HF and NS. This study supports a distinguished infl uence of stress and depressive mood in NS and HF respectively, probably due to the nature of psychological symptoms. Moreover, signifi cant associations between vasomotor symptoms and socio-demographic, health and menopause-related characteristics, and alcohol were confi rmed. Keywords: Hot fl ushes, night sweats, stress, depressive mood, structural equation modelling. ResumoEste estudo investigou os preditores da ocorrência de afrontamentos (Af) e de suores noturnos (SN). Foi utilizada uma amostra comunitária de 992 mulheres (42-60 anos), que respondeu a um questionário para a recolha de informação sociodemográfi ca, de estado de saúde e menopausa, e sobre o estilo de vida. Os níveis de humor deprimido e estresse, tal como a ocorrência, frequência e intensidade dos Af e SN, foram avaliados. Modelos de equações estruturais foram utilizados para construir o modelo estrutural para predizer a ocorrência de ambos os sintomas vasomotores. Os resultados indicaram que estresse predisse os SN (β =0,154; p =0,006), enquanto o humor deprimido associou-se à ocorrência de Af (β =0,149; p =0,006). Estar na peri-menopausa ou na pós-menopausa, entre outras características, associou-se igualmente à ocorrência de Af e SN. Este estudo suporta uma infl uência diferenciada do estresse e do humor deprimido na ocorrência de SN e Af, respetivamente, provavelmente devido à natureza dos sintomas psicológicos. Adicionalmente confi rmou-se uma associação signifi cativa entre os sintomas vasomotores e características sociodemográfi cas, de saúde, de menopausa e consumo de álcool. Palavras-chave: afrontamentos, suores noturnos, estresse, humor deprimido, modelos de equações estruturais.

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Somatic and affective anxiety symptoms and menopausal hot flashes

Cited by 25 publications

References 14 publications

Risk of long-term hot flashes after natural menopause

Risk of long-term hot flashes after natural menopause

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

Hot Flushes and Night Sweats in Midlife: Why do Some Women Have Them and Others do Not?

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