This study aims to estimate the risk of
hot flashes relative to natural menopause and to evaluate the associations of
hormone levels, behavioral variables, and demographic variables with the risk of
hot flashes after menopause.
METHODS: We performed annual assessment of 255 women who were premenopausal at baseline and reached natural menopause within 16 years of follow-up.
RESULTS: The prevalence of moderate/severe
hot flashes increased in each premenopausal year, reaching a peak of 46% in the first 2 years after the final menstrual period (
FMP).
Hot flashes decreased slowly after menopause and did not return to premenopausal levels until 9 years after the
FMP. The mean (SD) duration of moderate/severe
hot flashes after the
FMP was 4.6 (2.9) years (for any
hot flashes, 4.9 [3.1] y). One third of women
at 10 years or more after menopause continued to experience moderate/severe
hot flashes. African-American women (obese and nonobese) and obese white women had significantly greater risks of
hot flashes compared with nonobese white women (interaction, P = 0.01). In multivariable analysis, increasing
follicle-stimulating hormone levels before the
FMP (P < 0.001), decreasing
estradiol (odds ratio, 0.87; 95% CI, 0.78-0.96; P = 0.008), and increasing anxiety (odds ratio, 1.05; 95% CI, 1.03-1.06; P < 0.001) were significant risk factors for
hot flashes, whereas higher education levels were protective (odds ratio, 0.66; 95% CI, 0.47-0.91; P = 0.011).
CONCLUSIONS: Moderate/severe
hot flashes continue, on average, for nearly 5 years after menopause; more than one third of women observed for 10 years or more after menopause have moderate/severe
hot flashes. Continuation of
hot flashes for more than 5 years after menopause underscores the importance of determining individual risks/benefits when selecting
hormone or nonhormone
therapy for menopausal symptoms.