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Beyond frequency: who is most bothered by vasomotor symptoms?

Thurston, Rebecca C. PhD1,4; Bromberger, Joyce T. PhD4; Joffe, Hadine MD, MSc5; Avis, Nancy E. PhD6; Hess, Rachel MD, MSc2,5; Crandall, Carolyn J. MD, MS7; Chang, Yuefang PhD3; Green, Robin PsyD2,8; Matthews, Karen A. PhD1,4

doi: 10.1097/gme.0b013e318168f09b

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.

Above and beyond the frequency of vasomotor symptoms, factors associated with rating vasomotor symptoms as bothersome include negative affect, sensitivity to physical symptoms, a greater number of years reporting the symptom, the presence of sleep problems, younger age, and race. In addition to reducing frequency, interventions for vasomotor symptoms might consider addressing modifiable factors related to symptom bother.

From the Departments of 1Psychiatry, 2Medicine, and 3Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; 5Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 6Department of Social Science and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; 7Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; and 8Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY.

Received November 18, 2007; revised and accepted January 15, 2008.

Funding/support: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging (NIA), the National Institute of Nursing Research and the NIH Office of Research on Women's Health (grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). Dr. Thurston (K23 AG029216), Dr. Crandall (K12 AG01004), and Dr. Hess (K23 AG024254) received grant support from the NIH through the NIA.

Financial disclosure: None reported.

Address correspondence to: Rebecca C. Thurston, PhD, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213. E-mail:

©2008The North American Menopause Society