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Original Investigation
October 27, 2008

Persistent Hot Flushes in Older Postmenopausal Women

Author Affiliations

Author Affiliations: Departments of Medicine (Drs Huang, Grady, and Bauer), Epidemiology and Biostatistics (Drs Grady, Bauer, and Sawaya), and Obstetrics, Gynecology, and Reproductive Sciences (Drs Jacoby and Sawaya), University of California–San Francisco; General Internal Medicine Section, San Francisco Veterans Affairs Medical Center (Dr Grady); and California Pacific Medical Center Research Institute (Ms Blackwell), San Francisco.

Arch Intern Med. 2008;168(8):840-846. doi:10.1001/archinte.168.8.840

Objective  To examine the prevalence, natural history, and predictors of hot flushes in older postmenopausal women.

Methods  Prevalence, severity, and 3-year change in severity of hot flushes were assessed by questionnaire in 3167 older postmenopausal women with osteoporosis. Logistic regression was used to identify characteristics associated with symptoms at baseline and after 3 years of follow-up.

Results  At baseline, 375 women (11.8%) reported bothersome hot flushes. Women were more likely to have baseline symptoms if they were less educated (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.06-1.53 per 4-year decrease), more recently menopausal (OR, 1.44; 95% CI, 1.34-1.56 per 5-year decrease), had previously used estrogen (OR, 1.57; 95% CI, 1.23-2.00), or had undergone hysterectomy (OR, 1.51; 95% CI, 1.14-1.99). Hot flushes were also associated with higher body mass index (OR, 1.22; 95% CI, 1.08-1.38 per 1 SD), higher follicle-stimulating hormone levels (OR, 1.34; 95% CI, 1.20-1.51 per 1 SD), lower high-density lipoprotein levels (OR, 1.17; 95% CI, 1.03-1.34 per 1 SD decrease), vaginal dryness (OR, 1.52; 95% CI, 1.19-1.93), and trouble sleeping (OR, 2.48; 95% CI, 1.94-3.16), but not estradiol levels. Of the 375 women with baseline symptoms, 278 contributed 3-year data, and 157 (56.5%) of these women reported persistent symptoms after 3 years. Fewer years since menopause (OR, 1.15; 95% CI, 1.01-1.32 per 5-year decrease) and trouble sleeping (OR, 1.97; 95% CI, 1.19-3.26) were associated with symptom persistence.

Conclusions  For a substantial minority of women, hot flushes are a persistent source of discomfort into the late postmenopausal years. Identification of risk factors for hot flushes may help guide evaluation and treatment in this population.