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Characterizing the trajectories of vasomotor symptoms across the menopausal transition

Tepper, Ping G. PhD; Brooks, Maria M. PhD; Randolph, John F. Jr MD; Crawford, Sybil L. PhD; El Khoudary, Samar R. PhD; Gold, Ellen B. PhD; Lasley, Bill L. PhD; Jones, Bobby PhD; Joffe, Hadine MD, MSc; Hess, Rachel MD; Avis, Nancy E. PhD; Harlow, Sioban PhD; McConnell, Daniel S. PhD; Bromberger, Joyce T. PhD; Zheng, Huiyong PhD; Ruppert, Kristine PhD; Thurston, Rebecca C. PhD

doi: 10.1097/GME.0000000000000676
Original Articles

Objective: The aim of the study was to investigate the heterogeneity of temporal patterns of vasomotor symptoms (VMS) over the menopausal transition and identify factors associated with these patterns in a diverse sample of women.

Methods: The Study of Women's Health Across the Nation is a multisite longitudinal study of women from five racial/ethnic groups transitioning through the menopause. The analytic sample included 1,455 women with nonsurgical menopause and a median follow-up of 15.4 years. Temporal patterns of VMS and associations with serum estradiol and follicle-stimulating hormone, race/ethnicity, body mass index, and demographic and psychosocial factors were examined using group-based trajectory modeling.

Results: Four distinct trajectories of VMS were found: onset early (11 years before the final menstrual period) with decline after menopause (early onset, 18.4%), onset near the final menstrual period with later decline (late onset, 29.0%), onset early with persistently high frequency (high, 25.6%), and persistently low frequency (low, 27.0%). Relative to women with persistently low frequency of VMS, women with persistently high and early onset VMS had a more adverse psychosocial and health profile. Black women were overrepresented in the late onset and high VMS subgroups relative to white women. Obese women were underrepresented in the late onset subgroup. In multivariable models, the pattern of estradiol over the menopause was significantly associated with the VMS trajectory.

Conclusions: These data distinctly demonstrate heterogeneous patterns of menopausal symptoms that are associated with race/ethnicity, reproductive hormones, premenopause body mass index, and psychosocial characteristics. Early targeted intervention may have a meaningful impact on long-term VMS.

1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

2Division of Reproductive Endocrinology and Infertility, University of Michigan Health System, Ann Arbor, MI

3Department of Medicine, University of Massachusetts Medical School, Worcester, MA

4Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA

5Department of Population Health & Reproduction, University of California, Davis, CA

6Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

7Women's Hormones and Aging Research Program, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA

8Department of Population Health Sciences, Univerisity of Utah, Salt Lake City, UT

9Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC

10Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Address correspondence to: Maria M. Brooks, PhD, Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, A530 Crabtree Hall/130 DeSoto Street, Pittsburgh, PA 15261. E-mail:

Received 19 November, 2015

Revised 9 March, 2016

Accepted 9 March, 2016

Funding/support: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.

Financial disclosure/conflicts of interest: M.M.B. reported receiving grant support from Gilead Sciences, Inc; H.J. reported receiving grant support from Teva/Cephalon, Merck and serving as an advisory/consultant to Merck, Noven, Mitsubishi, Tanabe. P.G.T. reported receiving grant support from Pfizer. No other disclosures were reported.

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© 2016 by The North American Menopause Society.