Freeman E W, Sammel M D, Grisso J A, Battistini M, Garcia-Espagna B, Hollander L
Department of Obstetrics/Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
J Womens Health Gend Based Med. 2001 Jan-Feb;10(1):67-76. doi: 10.1089/152460901750067133.
Hot flashes are a primary reason that midlife women seek medical care, but there is little information about the onset or the predictors of hot flashes in the years before the menopause. This study examines women's experience of hot flashes in the late reproductive years, comparing African American and Caucasian women, and identifies hormonal, behavioral, and environmental risk factors for hot flashes associated with ovarian aging. Data are from a population-based prospective cohort study of ovarian aging in women who were ages 35--47, in general good health, and had regular menstrual cycles at study enrollment. Hot flashes were assessed by subject report in a structured interview at the first follow-up period and correlated highly with previous prospective daily ratings of hot flashes (p = 0.0001). Blood samples were obtained in the first 6 days of the menstrual cycle in two consecutive cycles at enrollment and two consecutive cycles at follow-up. Predictor variables include hormone measures, structured interview, and standard questionnaire data. Thirty-one percent of the sample (n = 375) reported hot flashes (mean age 41 years). In bivariate analysis, more African American than Caucasian women reported hot flashes (38% vs. 25%, p = 0.01). Significant predictors of hot flashes in the final multivariable logistic regression model were higher follicle-stimulating hormone (FSH) levels (odds ratio [OR] 3.19), anxiety (OR 1.06), baseline menopausal symptoms (OR 4.91), alcohol use (OR 1.09), body mass index (BMI) (OR 1.04), and parity (OR 1.20). Race did not predict hot flashes after adjusting for these variables. Hot flashes commonly occur before observable menstrual irregularities in the perimenopause and are associated with both hormonal and behavioral factors. The association of hot flashes with increased body mass (BMI) challenges the current "thin" hypothesis and raises important questions about the role of BMI in hormone dynamics in the late reproductive years.
潮热是中年女性寻求医疗护理的主要原因，但关于绝经前几年潮热的发作情况或预测因素的信息却很少。本研究调查了处于生殖后期的女性潮热经历，比较了非裔美国女性和白人女性，并确定了与卵巢衰老相关的潮热的激素、行为和环境风险因素。数据来自一项基于人群的前瞻性队列研究，研究对象为年龄在35 - 47岁、总体健康状况良好且在研究入组时月经周期规律的女性卵巢衰老情况。在第一次随访期间，通过结构化访谈中受试者的报告来评估潮热情况，其与之前前瞻性每日潮热评分高度相关（p = 0.0001）。在入组时连续两个月经周期的第1至6天以及随访时连续两个月经周期采集血样。预测变量包括激素测量值、结构化访谈和标准问卷数据。样本中有31%（n = 375）报告有潮热（平均年龄41岁）。在双变量分析中，报告有潮热的非裔美国女性比白人女性更多（38%对25%，p = 0.01）。在最终的多变量逻辑回归模型中，潮热的显著预测因素为较高的促卵泡激素（FSH）水平（比值比[OR] 3.19）、焦虑（OR 1.06）、基线绝经症状（OR 4.91）、饮酒（OR 1.09）、体重指数（BMI）（OR 1.04）和产次（OR 1.20）。在对这些变量进行调整后，种族并不能预测潮热情况。潮热通常在围绝经期可观察到的月经不规律之前出现，并且与激素和行为因素都有关。潮热与体重增加（BMI）之间的关联对当前的“瘦”假说提出了挑战，并引发了关于BMI在生殖后期激素动态变化中作用的重要问题。
