Vasomotor Symptoms and Menopause: Findings from the Study of Women's Health Across the Nation (SWAN)

Abstract

• Vasomotor symptoms (VMS), which include hot flashes and night sweats, are key symptoms of menopause.
• SWAN, a large and ethnically diverse longitudinal study, provides insights into VMS prevalence, racial/ethnic differences, risk factors, and implications on women's health.

Key Insights from SWAN

• Enrolled 3,302 midlife women across five racial/ethnic groups, followed for over 10 years.
• Annual data collection on menopause-related symptoms, health behaviors, social and psychological functioning, and physiological indices.

Definition and Epidemiology of VMS

• VMS are experienced by the majority of women during the menopausal transition (60-80% prevalence).
• Occurrence peaks in late perimenopause and early postmenopausal years.
• Some women experience VMS into their 60s and 70s.

Physiology of VMS

Reproductive Hormones

• Onset occurs with reproductive hormone changes in menopause.
• Higher follicle-stimulating hormone (FSH) and lower estradiol (E2) levels associated with VMS.

Thermoregulatory Model

• VMS seen as thermoregulatory heat dissipation events.
• Narrowing of thermoneutral zone triggers hot flashes.

Genetics

• Associations between genetic polymorphisms and VMS noted.

Risk Factors for VMS

Race/Ethnicity

• African American women most likely to report VMS, Japanese women least likely.
• Variations not fully explained by known factors.

Obesity

• Obesity may increase VMS risk during perimenopause/early postmenopause.
• Adiposity, especially abdominal, linked to increased likelihood of VMS.

Health Behaviors

• Smoking significantly associated with increased VMS risk.
• Diet and physical activity show weaker associations.

Negative Affect

• Anxiety, depressive symptoms, and stress linked to higher VMS likelihood.
• Negative affect can amplify VMS reporting.

Other Social and Demographic Factors

• History of child abuse/neglect and low socioeconomic status increase VMS likelihood.

Associated Quality-of-Life Symptoms

Sleep

• VMS strongly linked to perceived sleep disturbances.

Mood

• Complex relationship between VMS and depression.
• VMS can impact mood through sleep disruption.

Cognitive Function

• Transient cognitive performance decline during perimenopause not linked to VMS.

Emerging Links Between VMS and Disease Outcomes

Cardiovascular Risk

• VMS linked to markers of cardiovascular disease (CVD).

Bone Health

• VMS associated with lower bone mineral density and increased bone turnover.

Summary and Conclusions

• VMS deeply impact midlife women's quality of life and may be linked to other health risks.
• SWAN provides critical insights into VMS, with ongoing research to continue advancing knowledge in this area.