Hot flushes and quality of life during menopause

Hot flushes and quality of life during menopause BioMedCentral BMC Women's Health Commentary Hot flushes and quality of life during menopause Riitta Luoto1,2 Address: 1UKK Institute for Health Promotion, Tampere, Finland and 2National Institute for Health and Welfare, Helsinki, Finland Email: Riitta Luoto - riitta.luoto@uta.fi Published: 18 May 2009 Received: 16 October 2008 Accepted: 18 May 2009 BMC Women's Health 2009, 9:13 doi:10.1186/1472-6874-9-13 This article is available from: ? 2009 Luoto; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Menopausal health is important since this stage of life is not to be avoided. A recent article in BMC Women's Health from the Estonian Postmenopausal Hormone Therapy trial has concluded that quality of life is not related to hormonal therapy use. The commentary article discusses this finding and considers other factors related to symptoms and quality of life during menopause. Important factors known to affect hot flushes and quality of life are smoking and high body weight. Since both these factors are modifiable, menopause is a suitable area for health promotion. However, evidence concerning lifestyle changes in symptom relief or increase of quality of life is weak. More trials in this area are needed before women may consider non-pharmacological treatment of symptoms as a reliable option for menopausal symptom cure. flushes disturbing [6,8-11] and the question of severity Menopausal symptoms are common Menopause is not avoided by any woman but frequency remains to be solved. and severity of menopausal symptoms vary. A recent arti- cle published in BMC Women's Health by Veerus et al [1] Hormone therapy and quality of life During recent years hormonal therapy (HT) has been reported that quality of life did not depend on hormonal therapy (HT) use, although HT users reported less hot introduced as a solution to menopausal symptoms. The flushes and sleeping problems. A number of studies have Women's Health Initiative's (WHI) study results [12] reported the prevalence of menopausal symptoms among showed the pros and cons of HT among women aged 65 mid-aged women. These studies are based on different and over, but HT is known to be an effective relief to hot populations, questions and severity of symptoms. Typical flushes. Veerus et al's study [1] was based on the Estonian menopausal symptoms are vasomotor symptoms (hot Postmenopausal Hormone Therapy (EPHT) trial, which flushes), vaginal dryness [2-4] and sleep disturbances [5]. included 1823 women aged 50 to 64 who were followed The probability of other symptoms is higher if the woman on average for 3.6 years. HT users reported fewer hot has vasomotor symptoms [6,7]. Cross-sectional surveys flushes, sweating and sleep problems but did not have among women of different ages show that hot flushes are better quality of life. The Women's Health Initiative trial most common soon after menopause, but they occur even reported similar findings to that of Veerus et al [13] but in the Heart and Estrogen/Progestin Replacement Study after 10 years [4]. According to a Dutch cross-sectional (HERS) trial HT improved quality of life for women with survey, a third of menopausal women have severe vaso- menopausal symptoms [14]. Both HERS and WHI studies motor symptoms and 7% have symptoms even 10 years after the menopause [6,8]. About half of 50-year old and had shorter follow-up times than EPHT, which, in addi- one quarter of 60-year old Swedish women experienced tion to cultural factors, explains part of the contradictory hot flushes [9]. However, not all women consider hot result. However, the conclusion is now that quality of life Page 1 of 3 (page number not for citation purposes) BMC Women's Health 2009, 9:13 , it is necessary to con- Menopausal health promotion – a future sider other issues. It is known that menopausal transition challenge does not intrinsically lead to poor general quality of life Menopausal transition may make women more aware of (OQL) or satisfaction in life [15]. A crucial factor is pres- future health risks due to increased symptomatology and ence of vasomotor symptoms, which are clearly related to help-seeking behaviour. Motivation for health promotion poor QOL [16]. The result of the Veerus et al study [1] was may be further strengthened if women perceive life-style important, since based on these earlier findings it was modifications as an alternative, non-pharmacological, expected that quality of life would increase if vasomotor way of managing menopausal symptoms. However, more symptoms are decreased. evidence on effectiveness and efficacy of lifestyle changes, especially exercise, on decreasing hot flushes and increas- ing quality of life is urgently needed. In the future, meno- Lifestyle and menopausal symptoms Early onset of menopause [17] as well as long perimeno- pause may act as a window of opportunity for health pausal phase [18] are risk factors for deteriorated well- promotion and life-modifications. Studies from rand- being in menopause. Other risk factors for increased expe- omized trials such as Veerus et al [1] are necessary before rience of hot flushes are smoking and high body mass taking the next steps in menopausal women's health. index (BMI). High BMI (at least 25 kg/m2) has been asso- ciated with the risk of any or daily hot flushes in many Authors' contributions recent studies [19-22]. All previous studies concluded that RL originated the idea for the commentary article and is in associations between hot flushes and BMI were found charge of the article. only among pre- or perimenopausal women, but not among postmenopausal women. Associations between Acknowledgements Colleagues and co-workers in the project "Menopause, quality of life and hot flushes and smoking have been shown in many earlier lifestyle" are greatly acknowledged for their collaboration. Academy of Fin- studies [20,23,24]. land has supported financially the project during years 2007–2010 (project number 115088). The quality of life of smokers and persons with high BMI is known to be low and an increase in hot flushes does not References alleviate their situation, quite the opposite. There is a clear 1. Veerus P, Fischer K, Hovi S-L, Karro H, Rahu M, Hemminki E: Symp- need for general health promotion and obesity prevention tom reporting and quality of life in the Estonian Postmeno- pausal Hormone Therapy Trial. BMC Women's health 2008:5. during the menopausal age in order to increase quality of doi:10.1186/1472-6874-8-5 life. Lifestyle changes, such as increasing physical activity, 2. Hemminki E, Topo P, Kangas I: Experience and opinions of cli- is one alternative to HT. Evidence on reducing cardiovas- macterium by Finnish women. European Journal of Obstetrics & cular disease by physical activity exists especially among Gynecology and Reproductive Biology 1995, 62:81-87. 3. Berg JA, Taylor DL: Symptom Experience of Filipino American postmenopausal women [25,26]. However, evidence on Midlife Women. Menopause 1999, 6:105-114. 4. whether physical activity reduces menopausal symptoms Kronenberg F: Hot Flashes: Epidemiology and Physiology. Ann NY Acad Sci 1990, 592:52-86. is still inconclusive. Earlier studies have suggested physi- 5. Polo-Kantola P, Saaresranta T, Polo O: Aetiology and treatment cal activity may act as a possible tool for decreasing some of sleep disturbancies during perimenopause and postmeno- menopausal vasomotor symptoms [20,27]. At least main- pause. CNSDrugs 2001, 15:445-452. 6. Oldenhave A, Netelenbos C: Pathogenesis of climacteric com- taining or increasing physical activity in SWAN (Study of plaints: ready for the change? Lancet 1994, 343:649-653. 7. Women across Nation) cohort resulted in maintenance or Bardel A, Wallander MA, Svarsudd K: Hormone replacement therapy and symptom reporting in menopausal women. A decrease of body weight [28]. Only a few randomized population-based study of 35–65-year-old women in mid- clinical trials on exercise and menopausal symptom Sweden. Maturitas 2002, 41:7-15. 8. Oldenhave A, Jaszmann LJB, Haspels AA, Everaerd WT: Impact of reduction have been performed [27,29]. Wilbur et al [27] climacteric on well-being: a survey based on 5213 women 39 concluded that women in the exercise intervention group to 60 years old. Am J Obstet Gynecol 1993, 168:772-780. 9. had fewer vasomotor symptoms and improved sleep as Rödström K, Bengtsson C, Lissner L, Milsom I, Sundh V, Björkelund C: A longitudinal study of the treatment of hot flushes: the compared to controls. Aiello et al [29] study showed an population study of women in Gothenburg during a quarter increase in hot flash severity and decreased risk of mem- of a century. Menopause 2002, 9:156-161. 10. ory problems among the intervention group women com- Holte A: Prevalence of climacteric complaints in a represent- pared to controls. Both studies were quite small and not ative sample of middle-aged women in Oslo, Norway. J Psy- chosom Obstet Gynaecol 1991, 12:303-317. all participants had symptoms at baseline. Randomized 11. Stearns V, Ullmer L, Lopez JF, Smith J, Isaacs C, Hayes DF: Hot flushes. Lancet 2002, 360:1851-61. clinical trials are needed to further address the effect of 12. Writing group for the Women's Health Initiative investigators: Risks physical activity for symptoms experienced by midlife and benefits of the estrogen plus progestin in healthy post- women. menopausal women: principal results from the Women's health Initiative randomized controlled trial. Journal of the American Medical Association 2002, 288:321-33. 13. Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, Aragaki AK, Shumaker SA, Brzyski R, LaCroix AZ, Granek IA, Valanis BG: Women's Health Initiative Investigators. Effects of Page 2 of 3 (page number not for citation purposes) BMC Women's Health 2009, 9:13 , 348:1839-54. 14. Hlatky MA, Boothroyd D, Vittinghoff E, Sharo P, Whooley MA, Hear and Estrogen/Progestin Replacement Study (HERS) Research Group: Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002, 287:591-7. 15. Avis NE, Assmann SF, Kravitz HM, Ganz PA, Ory M: Quality of life in diverse groups of midlife women: assessing the influence of menopause, health status and psychosocial and demo- graphic factors. Qual Life Res 2004, 13:933-46. 16. Kumari M, Stafford M, Marmot M: The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms. J 17. Clin Epidemiol 2005, 58:719-727. Koster A, Eplov LF, Garde K: Anticipations and experiences of menopause in a Danish female general population cohort born in 1936. Arch Women Ment Health 2002, 5:9-13. 18. Mishra G, Kuh D: Perceived change in quality of life during the 19. menopause. Soc Sci Med 2006, 62:93-102. den Tonkelaar I, Seidell JC, vanNoord PA: Obesity and fat distri- bution in relation to hot flashes in Dutch women from the 20. Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, Sala- DOM-project. Maturitas 1996, 23:301-5. mone L, Stellato R: Relation of demographic and lifestyle fac- tors to symptoms in multi-racial/ethnic population of women 40–55 years of age. American Journal of Epidemiology 2000, 152:463-73. 21. Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA: Smoking, body mass, and hot flashes in midlife women. Obstet Gynecol 2003, 101:264-72. 22. Riley EH, Inui TS, Kleinman K, Connelly MT: Differential associa- tion of modifiable health behaviours with hot flashes in peri- menopausal and postmenopausal women. J Gen Intern Med 2004, 19:740-46. 23. Staropoli CA, Flaws JA, Bush TL, Moulton AW: Predictors of men- opausal hot flashes. J Womens Health 1998, 7:1149-55. 24. Avis NE, Crawford SL, McKinlay SM: Psychosocial, behavioural, and health factors related to menopause symptomatology. Womens Health 1997, 3:103-20. 25. Kushi LH, Fee RM, Folsom Arm Mink PJ, Anderson KE, Sellers TA: Physical activity and mortality in postmenopausal women. JAMA 1997, 277:1287-92. 26. Asikainen T-M, Kukkonen-Harjula K, Miilunpalo S: Exercise for health for early postmenopausal women. Sports Med 2004, 34:753-78. 27. Wilbur JE, Miller AM, McDevitt J, Wang E, Miller J: Menopausal sta- tus, moderate-intensity walking and symptoms in midlife women. Research and theory for nursing practice: an International Jour- nal 2005, 19:163-180. 28. Sternfeld B, Wang H, Quesenberry CP, Abrams B, Everson-Rose SA, Greendale G, Matthews KA, Torrens JI, Sowers M: Physical activity and changes in weight and waist circumference in midlife women: findings from the study of Women's health Across 29. the Nation. Americal Journal of Epidemiology 2004, 160:912-22. Aiello EJ, Yasui Y, Tworoger SS, Ulrich CC, Irwin ML, Bowen D, Schwartz RS, Kumai C, Potter JD, McTiernan A: Effect of a year- long, moderate-intensity exercise intervention on the occur- rence and severity of menopause symptoms in postmenopausal women. Menopause 2004, 11:382-388. Publish with BioMedCentral and every scientist can read your work free of charge Pre-publication history "BioMed Central will be the most significant development for The pre-publication history for this paper can be accessed disseminating the results of biomedical research in our lifetime." here: Sir Paul Nurse, Cancer Research UK Your research papers will be: peer reviewed and publishedimmediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright BioMedcentral Submit your manuscript here: Page 3 of 3 (page number not for citation purposes)