Abstract and Introduction
Abstract
Objective: Most menopausal women report vasomotor symptoms (hot flashes, night sweats). However, not all women with vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of vasomotor symptom bother beyond symptom frequency.
Design: The Study of Women's Health Across the Nation participants reporting vasomotor symptoms at annual visit 7 comprised the sample (N=1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all- 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately.
Results: In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR]=1.27, 95% CI: 1.08-1.51), symptom sensitivity (OR=1.18, 95% CI: 1.03-1.37), sleep problems (OR=1.38, 95% CI: 1.04-1.85), poorer health (OR=1.24, 95% CI: 1.03-1.48), duration of hot flashes (OR=1.14, 95% CI: 1.06-1.23), younger age (OR=0.94, 95% CI: 0.89-0.99), and African American race (vs white, OR=1.59, 95% CI: 1.12-2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR=1.84, 95% CI:1.33-2.55) and night sweats duration (OR=1.10, 95% CI: 1.02-1.20) were associated with night sweats bother.
Conclusions: Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for vasomotor symptoms might consider addressing modifiable factors related to symptom bother.
Introduction
The majority of women report vasomotor symptoms (VMS), or hot flashes and night sweats, during the menopausal transition. Although most women experience VMS for the several years around the final menstrual period, a sizable minority of women report VMS that persist for decades. VMS are associated with impairments in quality of life, poor sleep, and negative mood and are a leading reason women seek menopause-related medical care. As VMS are associated with no known physical health risk, their clinical significance derives mainly from the interference that they pose on women's quality of life. In the wake of the early termination of the Women's Health Initiative hormone therapy (HT) arms and subsequent discontinuation of HT by many women, there has been considerable interest in better understanding VMS to inform a wider range of treatments for them.
Whereas the majority of women experience VMS, not all women are bothered by them. Thus, additional factors beyond symptom frequency may predict bother associated with VMS. However, it is often assumed that VMS frequency is the sole predictor of bother associated with VMS. Results from menopause symptom scales that variously assess frequency or bother are often used interchangeably. Women targeted in treatment studies are those with frequent VMS, and clinically significant treatment responses are usually based on changes in symptom frequency. However, although treatments aim to reduce VMS frequency, they are ultimately aimed at improving quality of life and reducing the interfering nature of VMS.
A wider range of factors beyond VMS frequency are likely to predict bother and impairment associated with VMS. It is well established that psychological factors involved in the perception and appraisal of pain and other symptoms influence symptom interference and impairment. For example, independent of differences in objective health indicators, negative affect and the tendency to focus on physical sensations, or symptom sensitivity, predict increased reporting of and impairment associated with symptoms. Moreover, some women report sleep problems during the menopausal transition, which are frequently attributed to nighttime VMS, or night sweats. Sleep problems may influence the perceived bother of VMS. Further, experiencing VMS for a longer duration has been suggested to be associated with more distress and symptom interference. Understanding who is most bothered by VMS or, conversely, characteristics of women coping effectively with high levels of symptomatology can provide important information to inform VMS management strategies.
The aim of this investigation was to determine what factors predict bother associated with VMS above and beyond symptom frequency. It is hypothesized that, controlling for symptom frequency, women with higher negative affect, a greater sensitivity to physical symptoms, and a greater number of years of having VMS will report more VMS-associated bother. Wealso hypothesized that women with more sleep problems will report more bother associated with night sweats, beyond night sweats frequency. Racial/ethnic differences in VMS bother were examined in an exploratory fashion.