Seven years of hot flashes common during, after menopause

View on the News

Troublesome menopausal symptoms persist longer than thought

The study by Dr. Avis and her associates highlights the need to address the persistent and often troubling VMS symptoms that plague many women for years, often long after menopause. The study, which draws strength both from its large sample size and longitudinal design, makes clear that existing clinical guidelines have not recognized the full impact of VMS on women in midlife.

Many treatment strategies that focus on short-term symptom management might need to be revisited in light of this study’s findings. If symptom duration, for many, is longer than previously thought, then clinicians and patients will need to give careful consideration to longer-term risks and benefits for hormonal and nonhormonal treatment options.

Further, counseling regarding treatment initiation and options can now be individualized based on known risk factors. The wide range of treatment options and ongoing research in this area should contribute to improved outcomes for symptomatic women in midlife.

Gloria Richard-Davis, M.D., is affiliated with the department of ob.gyn. at the University of Arkansas Medical Sciences Center, Little Rock; JoAnn E. Manson, M.D., Dr.P.H., is affiliated with the division of preventive medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. This commentary is drawn from the accompanying editorial (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8099]). The authors reported no conflicts of interest.




For many women, vasomotor symptoms, including hot flashes and night sweats, last for more years and persist longer past the final menstrual period than previously thought, a large multiethnic, multiracial observational study has shown.

Of the 3,302 enrollees in the Study of Women’s Health Across the Nation (SWAN), 1,449 reported frequent (6 or more days in the previous 2 weeks) vasomotor symptoms (VMS), reported Nancy E. Avis, Ph.D., and her associates. This group experienced a median 7.4 years of VMS, with a median 4.5 years of symptoms after the final menstrual period (FMP) for the subset of 881 women who identified a definite FMP (JAMA Intern. Med. 2015 Feb. 16 [doi:10.1001/jamainternmed.2014.8063]).


The researchers also identified risk factors for more prolonged duration of VMS and longer persistence after FMP. Ethnicity was a significant factor in VMS variation (P <.001); African American women had the longest duration of VMS at 10.1 years, followed by Hispanic women (8.9 years), non-Hispanic white women (6.5 years), Chinese women (5.4 years), and Japanese women (4.8 years), said Dr. Avis of Wake Forest University, Winston-Salem, N.C., and her associates

African American women in the study also experienced the longest duration of VMS symptoms post-FMP. Depressive symptoms, anxiety, lower educational status, and higher perceived stress were among the other variables significantly associated with longer duration of VMS and longer persistence of symptoms after FMP.

Overall, the strongest single factor predicting both longer duration of VMS and longer symptom persistence after FMP was symptom onset occurring before menopause or during early perimenopause (P <.001).

Dr. Avis and her associates reported several limitations. For example, total VMS duration might have been underestimated. In addition, some women continued to report VMS beyond the 13-year follow-up period, “so longer follow-up is needed to better pinpoint the timing of cessation of VMS,” they noted.

Still, the findings can help clinicians “counsel patients about expectations regarding VMS and assist women in making treatment decisions,” the investigators wrote.

The research was supported by the National Institutes of Health, the Department of Health & Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. One author reported receiving grant support from Cephalon/Teva, serving as a consultant to Noven, and serving on an advisory board for Merck. None of the other study authors reported financial disclosures.

Next Article: