Up to 14 Years of Hot Flashes Found in Menopause Study

Conventional wisdom has it
that hot flashes, which afflict
up to 80 percent of middle-
aged women, usually persist
for just a few years. But hot
flashes can continue for as
long as 14 years, and the
earlier they begin the longer
a woman is likely to suffer, a
study published on Monday
in JAMA Internal Medicine
found.
In a racially, ethnically and
geographically diverse group
of 1,449 women with
frequent hot flashes or night
sweats — the largest study to
date — the median length of
time women endured
symptoms was 7.4 years. So
while half of the women were
affected for less than that
time, half had symptoms
longer — some for 14 years,
researchers reported.
“It’s miserable, I’ll tell you
what,” said Sharon Brown, 57,
of Winston-Salem, N.C., who
has endured hot flashes for
six years. At her job at a tax
and accounting office, she has
had to stop wearing silk.
“I keep one of the little fans
with me at all times — one in
my purse, a couple in my
desk, some in just random
places in the office,” she said.
“I’ll be so glad when they stop
— if they ever stop.”
Over all, black and Hispanic
women experienced hot
flashes for significantly
longer periods than white or
Asian women. And in a
particularly unfair hormonal
twist, the researchers found
that the earlier hot flashes
started, the longer they were
likely to continue.
Among women who got hot
flashes before they stopped
menstruating, the hot flashes
were likely to continue for
years after menopause,
longer than for women whose
symptoms began only when
their periods had stopped.
“That having symptoms
earlier in the transition
bodes ill for your symptoms
during menopause — that
part is certainly new to me,”
said Dr. C. Neill Epperson,
director of the University of
Pennsylvania’s Center for
Women’s Behavioral
Wellness , who was not
involved in the study.
Perhaps, she and others
suggested, early birds are
more biologically sensitive to
hormonal changes.
And many women fall into
the early bird category. In
this study, only a fifth of cases
started after menopause.
One in eight women began
getting hot flashes while still
having regular periods. For
two-thirds of women, they
began in perimenopause,
when periods play hide and
seek but have not completely
disappeared.
In numerical terms, women
who started getting hot
flashes when they were still
having regular periods or
were in early perimenopause
experienced symptoms for a
median of 11.8 years. About
nine of those years occurred
after menopause, nearly
three times the median of 3.4
years for women whose hot
flashes did not start until
their periods stopped.
“If you don’t have hot flashes
until you’ve stopped menses,
then you won’t have them as
long,” said Nancy Avis, a
professor of social sciences
and health policy at Wake
Forest Baptist Medical Center
and the study’s first author.
“If you start later, it’s a
shorter total duration and it’s
shorter from the last period
on.”
Hot flashes, which can seize
women many times a day and
night — slathering them in
sweat, flushing their faces —
are linked to drops in
estrogen and appear to be
regulated by the
hypothalamus in the brain.
Studies have found that
women with hot flash
symptoms also face increased
risk of cardiovascular
problems and bone loss.
Researchers followed the
women in the study, who
came from seven American
cities, from 1996 to 2013. All
of them met the researchers’
definition for having
frequent symptoms: hot
flashes or night sweats at
least six days in the previous
two weeks.
None had had a hysterectomy
or both ovaries removed, and
none were on hormone
therapy. (If they started
taking hormone therapy
during the study period, their
data stopped being included,
Dr. Avis said.)
Although some smaller
studies have also found that
symptoms can last many
years, the new research drew
praise from experts because,
among other things, it
included a larger and much
more diverse group of
women. One-third of them
were African-Americans in
Pittsburgh, Boston, Chicago
and Ypsilanti, Mich. It also
included women of Japanese
descent in Los Angeles;
women of Chinese descent in
Oakland, Calif.; and Hispanic
women in Newark — about
100 in each group.
“It’s such a real-world study
of women we are seeing day
in and day out,” said Dr. Risa
Kagan, an obstetrician-
gynecologist at the University
of California, San Francisco,
and the Sutter East Bay
Medical Foundation in
Berkeley. “There is no other
study like this.”
Researchers found significant
differences between ethnic
groups. African-Americans
reported the longest-lasting
symptoms, continuing for a
median of 10.1 years — twice
the median duration of Asian
women’s symptoms. The
median for Hispanic women
was 8.9 years; for non-
Hispanic whites, 6.5 years.
Reasons for ethnic
differences are unclear. “It
could be genetic, diet,
reproductive factors, how
many children women have,”
Dr. Avis said.
The study also found that
women with longer-lasting
symptoms tended to have less
education, greater perceived
stress, and more depression
and anxiety.
“I’m not at all suggesting that
hot flashes are
manifestations of depression,
but they’re both brain-
related phenomena, and
depression is also more
common in the same groups,”
said Dr. Andrew Kaunitz, an
obstetrician-gynecologist at
the University of Florida who
was not involved in the study.
It is unclear if stress and
emotional issues help cause
hot flashes or result from
them.
“Women with more stress in
their lives may be more
aware of their symptoms and
perceive them to be more
bothersome,” said Dr. JoAnn
E. Manson, chief of
preventive medicine at the
Harvard-affiliated Brigham
and Women’s Hospital and an
author of a commentary
accompanying the study. “But
also having significant night
sweats that interrupt sleep
can lead to stress.”
Dr. Manson said the new
study should help women and
doctors anticipate that
symptoms may continue
longer, and might suggest
that some women try
different approaches at
different times.
Women who are still
menstruating, she said, “can
become pregnant,” so low-
dose contraceptives, which
also tame hot flashes, might
be recommended until
menopause. Hormone
therapy might then be
prescribed for several years,
she said.
But hormone therapy has
been linked to increased risk
of breast cancer and heart
disease for some women.
Effective non-hormonal
therapies also exist, experts
said, including low-dose
antidepressants.
Dr. Manson, a past president
of the North American
Menopause Society, has
helped the society develop a
free app, MenoPro, to assist
women deal with hot flashes,
starting with nonmedical
approaches like lowering the
thermostat and cutting back
on spicy foods, caffeine and
alcohol.
Ms. Brown and Mary
Hairston, 53, tried
acupuncture in another study
by Dr. Avis and colleagues,
and found it helped. Before
that, Ms. Hairston said,
“every night I would just
wake up, dripping wet.”
Now, when she starts
sweating at the Italian
restaurant where she
waitresses, “I go stand in the
cooler,” she said. “I used to
get cold all the time and I
would say I couldn’t wait to
have hot flashes. Well, I got
over that real quick.”