Interest in menopausal symptoms in general and hot flushes (HFs) in particular has grown in recent years. This is mostly due to increased awareness and the vast impact these symptoms have on women's lives. Despite the high prevalence of women who experience HFs, a definitive etiology for HFs is yet to be found. Our objective was to review the current literature dealing with associated factors for experiencing HFs and to provide a synthesized overview on this common and often debilitating condition.
Methods:
We systematically searched the English-language literature in the PubMed database using relevant key words and included only those articles that contained information on associated factors for HFs in generally healthy midlife women.
Results:
Both conflicting scientific results between studies documenting factors that influence HFs and the lack of validated measuring tools make it difficult to truly pinpoint associated factors for HFs. Nonetheless, we identified the following clusters of associated factors: the menopausal stages, sex steroid hormones, other endocrine agents, genetic polymorphisms, race/ethnicity, body mass index (BMI) and obesity, mood disorders, smoking, soy isoflavones and phytoestrogens, alcohol consumption, and physical activity.
Conclusions:
No single associated factor was consistently identified as having a major role in experiencing HFs. More resources should be directed to develop a unified study system along with multivariable analyses to get a better understanding of this condition, which often imposes a tremendous social and personal toll on the women who experience it.
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References
1.
KronenbergF, DowneyJA. Thermoregulatory physiology of menopausal hot flashes: A review. Can J Physiol Pharmacol, 1987; 65:1312–1324.
2.
AndrikoulaM, PrelevicG. Menopausal hot flushes revisited. Climacteric, 2009; 12:3–15.
3.
SturdeeDW. The menopausal hot flush—Anything new?Maturitas, 2008; 60:42–49.
4.
DeecherDC. Physiology of thermoregulatory dysfunction and current approaches to the treatment of vasomotor symptoms. Expert Opinion Investig Drugs, 2005; 14:435–448.
SimpkinsJW, BrownK, BaeS, RatkaA. Role of ethnicity in the expression of features of hot flashes. Maturitas, 2009; 63:341–346.
7.
HahnPM, WongJ, ReidRL. Menopausal-like hot flashes reported in women of reproductive age. Fertil Steril, 1998; 70:913–918.
8.
XuJ, BartocesM, NealeAV, DaileyRK, NorthrupJ, SchwartzKL. Natural history of menopause symptoms in primary care patients: A MetroNet study. J Am Board Fam Pract, 2005; 18:374–382.
9.
DeecherDC, DorriesK. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health, 2007; 10:247–257.
10.
HoSC, GaenCS, BingYY, YeeCS, ShamA. Factors associated with menopausal symptom reporting in Chinese midlife women. Maturitas, 2003; 44:149–156.
11.
GoldEB, ColvinA, AvisNet al.Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women's Health Across the Nation. Am J Public Health, 2006; 96:1226–1235.
12.
FreemanEW, SammelMD, LinHet al.Symptoms associated with menopausal transition and reproductive hormones in midlife women. Obstet Gynecol, 2007; 110:230–240.
13.
DennersteinL, LehertP, GuthrieJR, BurgerHG. Modeling women's health during the menopausal transition: A longitudinal analysis. Menopause, 2007; 14:53–62.
14.
BurgerH, WoodsNF, DennersteinL, AlexanderJL, KotzK, RichardsonG. Nomenclature and endocrinology of menopause and perimenopause. Expert Rev Neurother, 2007; 7:S35–S43.
15.
Berecki-GisolfJ, BegumN, DobsonAJ. Symptoms reported by women in midlife: Menopausal transition or aging?Menopause, 2009; 16:1021–1029.
16.
WilliamsRE, KalilaniL, DiBenedettiDBet al.Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric, 2008; 11:32–43.
17.
LohFH, KhinLW, SawSM, LeeJJ, GuK. The age of menopause and the menopause transition in a multiracial population: A nation-wide Singapore study. Maturitas, 2005; 52:169–180.
18.
AvisNE, StellatoR, CrawfordSet al.Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Soc Sci Med, 2001; 52:345–356.
GoldEB, SternfeldB, KelseyJLet al.Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age. Am J Epidemiol, 2000; 152:463–473.
21.
HardyR, KuhD. Change in psychological and vasomotor symptom reporting during the menopause. Soc Sci Med, 2002; 55:1975–1988.
22.
FuhJL, WangSJ, LuSR, JuangKD, ChiuLM. The Kinmen Women-Health Investigation (KIWI): A menopausal study of a population aged 40–54. Maturitas, 2001; 39:117–124.
23.
Hyde RileyE, InuiTS, KleinmanK, ConnellyMT. Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women. J Gen Intern Med, 2004; 19:740–746.
24.
UtianWH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: A comprehensive review. Health Qual Life Outcomes, 2005; 3:47.
25.
MacLennanAH, BroadbentJL, LesterS, MooreV. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev, 2004; CD002978.
26.
SchillingC, GallicchioL, MillerSR, LangenbergP, ZacurH, FlawsJA. Genetic polymorphisms, hormone levels, and hot flashes in midlife women. Maturitas, 2007; 57:120–131.
27.
MillerSR, GallicchioLM, LewisLMet al.Association between race and hot flashes in midlife women. Maturitas, 2006; 54:260–269.
28.
FentimanIS, AllenD, WheelerM, RymerJ. The influence of premenopausal hormones on severity of climacteric symptoms and use of HRT. Climacteric, 2006; 9:135–145.
29.
WhitemanMK, StaropoliCA, BenedictJC, BorgeestC, FlawsJA. Risk factors for hot flashes in midlife women. J Womens Health, 2003; 12:459–472.
30.
WoodsNF, CarrMC, TaoEY, TaylorHJ, MitchellES. Increased urinary cortisol levels during the menopausal transition. Menopause, 2006; 13:212–221.
31.
LongcopeC. Endocrine function of the postmenopausal ovary. J Soc Gynecol Investig, 2001; 8:S67–S68.
32.
BurgerH. The menopausal transition—Endocrinology. J Sex Med, 2008; 5:2266–2273.
33.
FogleRH, StanczykFZ, ZhangX, PaulsonRJ. Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab, 2007; 92:3040–3043.
34.
DavisonSL, BellR, DonathS, MontaltoJG, DavisSR. Androgen levels in adult females: Changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab, 2005; 90:3847–3853.
35.
LasleyBL, SantoroN, RandolfJFet al.The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. J Clin Endocrinol Metab, 2002; 87:3760–3767.
36.
OverlieI, MorkridL, AnderssonAM, SkakkebaekNE, MoenMH, HolteA. Inhibin A and B as markers of menopause: A five-year prospective longitudinal study of hormonal changes during the menopausal transition. Acta Obstet Gynecol Scand, 2005; 84:281–285.
37.
SammelMD, FreemanEW, LiuZ, LinH, GuoW. Factors that influence entry into stages of the menopausal transition. Menopause, 2009; 16:1218–1227.
38.
FreemanEW, SammelMD, LinH. Temporal associations of hot flashes and depression in the transition to menopause. Menopause, 2009; 16:728–734.
39.
CasperRF, YenSS. Menopausal flushes: Effect of pituitary gonadotropin desensitization by a potent luteinizing hormone-releasing factor agonist. J Clin Endocrinol Metab, 1981; 53:1056–1058.
40.
HaleGE, BurgerHG. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best Pract Res Clin Obstet Gynaecol, 2009; 23:7–23.
41.
SowersM, LuborskyJ, PerdueC, AraujoKL, GoldmanMB, HarlowSD. Thyroid stimulating hormone (TSH) concentrations and menopausal status in women at the midlife: SWAN. Clin Endocrinol (Oxf ), 2003; 58:340–347.
42.
RojasLV, NievesK, SuarezE, OrtizAP, RiveraA, RomagueraJ. Thyroid-stimulating hormone and follicle-stimulating hormone status in Hispanic women during the menopause transition. Ethn Dis, 2008; 18:S2–S4.
43.
BadawyA, StateO, SheriefS. Can thyroid dysfunction explicate severe menopausal symptoms?J Obstet Gynecol, 2007; 27:503–505.
44.
MalacaraJM, Perez-LuqueEL, Martinez-GarzaS, Sanchez-MarinFJ. The relationship of estrogen receptor-alpha polymorphism with symptoms and other characteristics in postmenopausal women. Maturitas, 2004; 49:163–169.
45.
CrandallCJ, CrawfordSL, GoldEB. Vasomotor symptom prevalence is associated with polymorphisms in sex steroid-metabolizing enzymes and receptors. Am J Med, 2006; 119:S52–S60.
46.
SowersMR, JannauschML, McConnellDS, KardiaSR, RandolphJFJr. Menstrual cycle markers of ovarian aging and sex steroid hormone genotypes. Am J Med, 2006; 119:S31–S43.
47.
TakeoC, NegishiE, NakajimaAet al.Association of cytosine-adenine repeat polymorphism of the estrogen receptor-beta gene with menopausal symptoms. Gend Med, 2005; 2:96–105.
48.
Massad-CostaAM, Nogueira-de-SouzaNC, de CarvalhoCVet al.CYP17 polymorphism and hot flushes in postmenopausal women. Climacteric, 2008; 11:404–408.
49.
VisvanathanK, GallicchioL, SchillingCet al.Cytochrome gene polymorphisms, serum estrogens, and hot flushes in midlife women. Obstet Gynecol, 2005; 106:1372–1381.
50.
LurieG, MaskarinecG, KaaksR, StanczykFZ, Le MarchandL. Association of genetic polymorphisms with serum estrogens measured multiple times during a 2-year period in premenopausal women. Cancer Epidemiol Biomarkers Prev, 2005; 14:1521–1527.
51.
WoodsNF, MitchellES, TaoY, ViernesHM, StapletonPL, FarinFM. Polymorphisms in the estrogen synthesis and metabolism pathways and symptoms during the menopausal transition: Observations from the Seattle Midlife Women's Health Study. Menopause, 2006; 13:902–910.
52.
FreemanEW, SammelMD, GrissoJA, BattistiniM, Garcia-EspagnaB, HollanderL. Hot flashes in the late reproductive years: Risk factors for Africa American and Caucasian women. J Womens Health Gend Based Med, 2001; 10:67–76.
53.
FreemanEW, GrissoJA, BerlinJ, SammelM, Garcia-EspanaB, HollanderL. Symptom reports from a cohort of African American and white women in the late reproductive years. Menopause, 2001; 8:33–42.
54.
GoldEB, BlockG, CrawfordSet al.Lifestyle and demographic factors in relation to vasomotor symptoms: Baseline results from the Study of Women's Health Across the Nation. Am J Epidemiol, 2004; 159:1189–1199.
55.
FreemanEW, SherifK. Prevalence of hot flushes and night sweats around the world: A systematic review. Climacteric, 2007; 10:197–214.
56.
BrownDE, SievertLL, MorrisonLA, RezaAM, MillsPS. Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women's Health Study. Menopause, 2009; 16:870–876.
57.
IshizukaB, KudoY, TangoT. Cross-sectional community survey of menopause symptoms among Japanese women. Maturitas, 2008; 61:260–267.
58.
LockM, KaufertP, GilbertP. Cultural construction of the menopausal syndrome: The Japanese case. Maturitas, 1988; 10:317–332.
59.
MelbyMK. Vasomotor symptom prevalence and language of menopause in Japan. Menopause, 2005; 12:250–257.
60.
SchnatzPF, SerraJ, O'SullivanDM, SoroskyJI. Menopausal symptoms in Hispanic women and the role of socioeconomic factors. Obstet Gynecol Surv, 2006; 61:187–193.
61.
AndersonGS. Human morphology and temperature regulation. Int J Biometeorol, 1999; 43:99–109.
62.
HaymesEM, McCormickRJ, BuskirkER. Heat tolerance of exercising lean and obese prepubertal boys. J Appl Physiol, 1975; 39:457–461.
63.
ThurstonRC, SowersMR, ChangYet al.Adiposity and reporting of vasomotor symptoms among midlife women: The Study of Women's Health Across the Nation. Am J Epidemiol, 2008; 167:78–85.
64.
StaropoliCA, FlawsJA, BushTL, MoultonAW. Predictors of menopausal hot flashes. J Womens Health, 1998; 7:1149–1155.
65.
GallicchioL, VisvanathanK, MillerSRet al.Body mass, estrogen levels, and hot flashes in midlife women. Am J Obstet Gynecol, 2005; 193:1353–1360.
66.
SchillingC, GallicchioL, MillerSR, LangenbergP, ZacurH, FlawsJA. Relation of body mass and sex steroid hormone levels to hot flushes in a sample of mid-life women. Climacteric, 2007; 10:27–37.
67.
KumariM, StaffordM, MarmotM. The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms. J Clin Epidemiol, 2005; 58:719–727.
68.
FordK, SowersM, CrutchfieldM, WilsonA, JannauschM. A longitudinal study of the predictors of prevalence and severity of symptoms commonly associated with menopause. Menopause, 2005; 12:308–317.
69.
ThurstonRC, SowersMR, Sutton-TyrrellKet al.Abdominal adiposity and hot flashes among midlife women. Menopause, 2008; 15:429–434.
70.
JoffeH, SoaresCN, ThurstonRC, WhiteDP, CohenLS, HallJE. Depression is associated with worse objectively and subjectively measured sleep, but not more frequent awakenings, in women with vasomotor symptoms. Menopause, 2009; 16:671–679.
71.
BrownJP, GallicchioL, FlawsJA, TracyJK. Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas, 2009; 62:184–189.
72.
CohenLS, SoaresCN, VitonisAF, OttoMW, HarlowBL. Risk for new onset of depression during the menopausal transition: The Harvard Study of Moods and Cycles. Arch Gen Psychiatry, 2006; 63:385–390.
73.
JoffeH, HallJE, SoaresCNet al.Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care. Menopause, 2002; 9:392–398.
74.
OzturkO, EraslanD, MeteHE, OzsenerS. The risk factors and symptomatology of perimenopausal depression. Maturitas, 2006; 55:180–186.
75.
WoodsNF, Smith-DijulioK, PercivalDB, TaoEY, MariellaA, MitchellS. Depressed mood during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women's Health Study. Menopause, 2008; 15:223–232.
76.
AvisNE, CrawfordS, StellatoR, LongcopeC. Longitudinal study of hormone levels and depression among women transitioning through menopause. Climacteric, 2001; 4:243–249.
77.
FreemanEW, SammelMD, LinH, GraciaCR, KapoorS, FerdousiT. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 2005; 12:258–266.
78.
ThurstonRC, JoffeH, SoaresCN, HarlowBL. Physical activity and risk of vasomotor symptoms in women with and without a history of depression: Results from the Harvard Study of Moods and Cycles. Menopause, 2006; 13:553–560.
79.
ThurstonRC, BrombergerJ, ChangYet al.Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women. Menopause, 2008; 15:16–22.
80.
ParkMK, SatohN, KumashiroM. Mental workload under time pressure can trigger frequent hot flashes in menopausal women. Ind Health, 2008; 46:261–268.
81.
GreendaleGA, GoldEB. Lifestyle factors: Are they related to vasomotor symptoms and do they modify the effectiveness or side effects of hormone therapy?Am J Med, 2005; 118:148–154.
82.
MichnoviczJJ, HershcopfRJ, NaganumaH, BradlowHL, FishmanJ. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med, 1986; 315:1305–1309.
83.
BaronJA, La VecchiaC, LeviF. The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol, 1990; 162:502–514.
84.
MattisonDR. The mechanisms of action of reproductive toxins. Am J Ind Med, 1983; 4:65–79.
85.
BengtssonM, MonteliusJ, MankowitzL, RydstromJ. Metabolism of polycyclic aromatic hydrocarbons in the rat ovary. Comparison with metabolism in adrenal and liver tissues. Biochem Pharmacol, 1983; 32:129–136.
86.
LutterodtMC, SorensenKP, LarsenKB, SkoubySO, AndersenCY, ByskovAG. The number of oogonia and somatic cells in the human female embryo and fetus in relation to whether or not exposed to maternal cigarette smoking. Hum Reprod, 2009; 24:2558–2566.
87.
TuttleAM, StampfliM, FosterWG. Cigarette smoke causes follicle loss in mice ovaries at concentrations representative of human exposure. Hum Reprod, 2009; 24:1452–1459.
88.
SchwinglPJ, HulkaBS, HarlowSD. Risk factors for menopausal hot flashes. Obstet Gynecol, 1994; 84:29–34.
89.
LongcopeC, JohnstonCCJr. Androgen and estrogen dynamics in pre- and postmenopausal women: A comparison between smokers and nonsmokers. J Clin Endocrinol Metab, 1988; 67:379–383.
90.
GallicchioL, MillerSR, VisvanathanKet al.Cigarette smoking, estrogen levels, and hot flashes in midlife women. Maturitas, 2006; 53:133–143.
91.
CochranCJ, GallicchioL, MillerSR, ZacurH, FlawsJA. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstet Gynecol, 2008; 112:1037–1044.
92.
SievertLL, MorrisonL, BrownDE, RezaAM. Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii. Menopause, 2007; 14:261–269.
93.
UmlandEM. Treatment strategies for reducing the burden of menopause-associated vasomotor symptoms. J Managed Care Pharm, 2008; 14:14–19.
94.
SongWO, ChunOK, HwangIet al.Soy isoflavones as safe functional ingredients. J Med Food, 2007; 10:571–580.
95.
D'AnnaR, CannataML, MariniHet al.Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: A 2-year randomized, double-blind, placebo-controlled study. Menopause, 2009; 16:301–306.
96.
KronenbergF. Hot flashes: Epidemiology and physiology. Ann NY Acad Sci, 1990; 592:52–86.
97.
GavalerJS, Van ThielDH. The association between moderate alcoholic beverage consumption and serum estradiol and testosterone levels in normal postmenopausal women: Relationship to the literature. Alcohol Clin Exp Res, 1992; 16:87–92.
98.
GavalerJS. Alcohol effects on hormone levels in normal postmenopausal women and in postmenopausal women with alcohol-induced cirrhosis. Recent Dev Alcohol, 1995; 12:199–208.
99.
GavalerJS. Alcoholic beverages as a source of estrogens. Alcohol Health Res World, 1998; 22:220–227.
100.
GavalerJS, DealSR, Van ThielDH, ArriaA, AllanMJ. Alcohol and estrogen levels in postmenopausal women: The spectrum of effect. Alcohol Clin Exp Res, 1993; 17:786–790.
101.
SchillingC, GallicchioL, MillerSRet al.Current alcohol use is associated with a reduced risk of hot flashes in midlife women. Alcohol Alcohol, 2005; 40:563–568.
102.
IvarssonT, SpetzAC, HammarM. Physical exercise and vasomotor symptoms in postmenopausal women. Maturitas, 1998; 29:139–146.
103.
LiS, HolmK. Physical activity alone and in combination with hormone replacement therapy on vasomotor symptoms in postmenopausal women. West J Nurs Res, 2003; 25:274–288.
104.
WhitcombBW, WhitemanMK, LangenbergP, FlawsJA, RomaniWA. Physical activity and risk of hot flashes among women in midlife. J Womens Health, 2007; 16:124–133.
105.
KemmlerW, von StengelS, WeineckJ, LauberD, KalenderW, EngelkeK. Exercise effects on menopausal risk factors of early postmenopausal women: 3-yr Erlangen Fitness Osteoporosis Prevention Study results. Med Sci Sports Exerc, 2005; 37:194–203.
106.
RomaniWA, GallicchioL, FlawsJA. The association between physical activity and hot flash severity, frequency, and duration in mid-life women. Am J Hum Biol, 2009; 21:127–129.
107.
Di DonatoP, GiuliniNA, BacchiMAet al.Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy. Maturitas, 2005; 52:181–189.
108.
HammarM, BergG, LindgrenR. Does physical exercise influence the frequency of postmenopausal hot flushes?Acta Obstet Gynecol Scand, 1990; 69:409–412.
109.
GuthrieJR, SmithAM, DennersteinL, MorseC. Physical activity and the menopause experience: A cross-sectional study. Maturitas, 1994; 20:71–80.
110.
AlbertsonAJ, SkinnerDC. A novel animal model to study hot flashes: No effect of gonadotropin-releasing hormone. Menopause, 2009; 16:1030–1036.
