Burden of menopausal hot flashes increased during past 50 years
Click Here to Manage Email Alerts
Women born in 1954 and 1966 were nearly twice as likely to experience daily hot flashes at age 50 years than women born in 1918 and 1930, regardless of obesity, smoking status, stress and hormonal therapy, according to study data.
“Several researchers have investigated the impact of vasomotor symptoms in women’s lives describing troublesome and long-standing effects that can have a significant negative impact on overall quality of life,” Cecilia Björkelund, MD, PhD, professor in the department of primary health care in the Institute of Medicine at the University of Gothenburg in Sweden, and colleagues wrote. “Furthermore, there are a number of recent studies indicating associations between the severity of vasomotor symptoms and an increased risk of cardiovascular disease in women.”
In a prospective longitudinal study, the researchers evaluated data from the Prospective Population Study of Women in Gothenburg from 1,308 women aged 50 years from four population-based samples — born in 1918 (n = 390), 1930 (n = 325), 1954 (n = 286) and 1966 (n = 307) — who were examined in 1968-1969, 1980-1981, 2004-2005 and 2016-2017. Participants responded to questions regarding hot flashes frequency throughout all follow-up examinations, and researchers analyzed changes between these generations.
Although prevalence of any hot flashes was similar between the groups, more women aged 50 years from the 1954 and 1966 birth cohorts reported daily vasomotor symptoms (35%) compared with those born in 1918 and 1930 (24%), with an increased likelihood of daily hot flashes in the 1954 and 1966 group compared with the 1918 and 1930 group (OR = 1.74; 95% CI, 1.37-2.22).
After adjustment for smoking, perceived level of high stress, BMI, waist-to-hip ratio, hormone therapy and hormonal contraceptives, the more recent birth cohorts had even greater odds of daily hot flashes compared with the earlier cohorts (OR = 1.92; 95% CI, 1.46-2.52).
Among the 1954 and 1966 birth cohorts, smoking frequency was substantially lower compared with the earlier-born cohorts in 1918 and 1930 (17% vs. 39%). More current smokers in the later-born cohorts reported daily hot flashes compared with earlier-born current smokers (50% vs. 26%; P < .001).
In addition, menopausal HT was a strong predictor of hot flashes among the 1930 (OR = 4.1; 95% CI, 2.12-8.11) and 1954 (OR = 5.4; 95% CI, 2.23-13.04) cohorts. Sixteen percent of women in the later-born cohort reported high stress levels compared with 7% in the earlier-born cohort. Women in the later-born cohort also had a higher percentage of women reporting daily hot flashes and perceived stress compared with the earlier-born cohort (43% vs. 27%; P = .06).
“In our study, we cannot find any explanatory factor, and further studies including the pathophysiological mechanism of hot flashes are needed, as well as studies that take into account potential risk factors in the environment and societal development over time, that is, impacts of endocrine-disrupting chemicals, changes in lifestyle, diet, and working conditions,” the researchers wrote.
Perspective
Back to Top
An interesting study that is thought-provoking. It is rare to have a cohort study conducted over such a long period, with such a high response rate, with the questions asked in exactly the same way. The women in both the earlier and later birth cohorts reported the same overall prevalence of hot flashes, a little more than half in both cohorts, but the reporting of daily hot flashes was more prevalent in the later-born cohort.
This could be due to several things. First, of course, there may be a true increase in the prevalence of daily hot flashes over time, perhaps in association with more stress associated with modern life. The authors allude to possible environmental exposures. Ultimately, though, they do not have a ready explanation for why this would be the case.
It is also possible that perception of hot flashes and awareness of hot flashes have changed over time, such that women in earlier-born cohorts are more likely to minimize their symptoms because hot flashes were considered undesirable and not something they wanted to be associated with, whereas women in later-born cohorts are more comfortable reporting their symptoms.
There has also been a decrease in the use of hormone therapy, and this might be related to the increased reporting of daily hot flashes. The authors were able to adjust for hormone use, but they cannot really adjust for lack of hormone use. It may be that symptomatic women are less likely to turn to hormone therapy to treat their hot flashes because of the perceived risks.
Collapse
Read more about
Click Here to Manage Email Alerts