General Obstetrics and Gynecology: GynecologyBody mass, estrogen levels, and hot flashes in midlife women
Section snippets
Materials and methods
A case-control study of hot flashes among midlife women (45-54 years) was conducted during 2000 through 2004 among residents of the Baltimore metropolitan region who reported their history of hot flashes and other information through a survey and donated a blood sample for measurement of hormone levels. All women gave written informed consent according to procedures approved by the University of Maryland School of Medicine and Johns Hopkins University Institutional Review Boards.
Names and
Variable definitions
A detailed hot flash history was obtained through a series of questions on the enrollment questionnaire that asked for information on the following: whether the woman had experienced hot flashes within the last 30 days; the number of hot flashes experienced within the last 30 days; the age when hot flashes first occurred; and the severity and frequency of the hot flashes. Outcomes examined were the experiencing of any hot flashes, moderate to severe hot flashes, and daily hot flashes. Severity
Measurement of hormone levels
Samples were stored at −20°C until the hormone assays were conducted. Plasma concentrations of estradiol and estrone were measured using enzyme-linked immunosorbent assays (ELISA). ELISA kits and reagents for the estradiol assay were obtained from Diagnostic Systems Laboratories, Inc (Webster, TX). ELISA kits and reagents for the estrone assay were obtained from American Laboratory Products Company (Windham, NH). The assays were run according to the manufacturers' instructions and published
Statistical analyses
For this analysis, women were excluded if they did not have data on BMI (n [case] = 1) or days since last menstrual period (n [case] = 9; n [control] = 1). Characteristics of cases and controls were compared by using χ2 analyses. Unadjusted associations between BMI and the experiencing of any hot flashes, severe/moderate hot flashes, and daily hot flashes were examined by using logistic regression. Multivariable logistic regression models were created to examine the association between BMI and the
Results
Characteristics of the cases and controls are presented in Table I. Cases were significantly older than controls and were significantly more likely to be perimenopausal, to smoke at the time of enrollment, and to report prior use of hormone replacement therapy. In addition, cases were less likely to be of white race and to report current alcohol use than the controls. The mean plasma concentrations of both estradiol and estrone were significantly lower among the cases compared with the controls.
Comment
The results of this case-control study confirm previous cross-sectional reports that high BMI increases a woman's likelihood of experiencing any and more severe hot flashes during the menopausal transition.3, 4, 5, 7, 15, 16, 17 Importantly, we found that the significant increase in risk of any or more severe hot flashes was present among women who were very obese (≥35.0 kg/m2), a group not examined in the previous literature. Similar to previous reports, we observed an elevated risk of any and
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Cited by (69)
Association between body mass index and surgical menopausal symptoms in patients with early stage endometrial cancer
2019, Gynecologic OncologyCitation Excerpt :Previously reported data is limited to patients undergoing natural menopause and those women without an underlying malignancy, but have suggested patients with a high BMI have significantly more vasomotor symptoms than women with a lower BMI [13]. An Australian study identified patients with BMI >35 have lower estradiol and estrone than those with BMI <25 [14]. Our study cohort is unique as compared to the women included in prior studies for three reasons.
Evaluating the prevalence and predictive factors of vasomotor and psychological symptoms in prostate cancer patients receiving hormonal therapy: Results from a single institution experience
2018, Clinical and Translational Radiation OncologyCitation Excerpt :The greater peripheral conversion of androgens to oestrogen in adipose tissue [27], which can have protective effects on thermoregulation through modulation of the serotonin receptor suggest that those who are overweight should experience less flushes and is at odds to what was observed in this study. However, there may be several other explanations for a high BMI and hot flushes including a greater degree of insulation with adiposity which increases core body temperature [28,29] and recognition that other hormones produced by adipose tissue such as IL-8 may also be influencing thermoregulation [30]. This may in part account for the BMI not being predictive of hot flushes or sweating in our logistic regression analysis, although heavier patients were more likely to have grade 4 toxicity than experience no toxicity
This study was supported by NIH grant AG18400.