Freeman Ellen W, Sammel Mary D, Sanders Richard J
From the Departments of 1Obstetrics and Gynecology and 2Psychiatry, and Centers for 3Clinical Epidemiology and Biostatistics and 4Research in Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Menopause. 2014 Sep;21(9):924-32. doi: 10.1097/GME.0000000000000196.
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.
We performed annual assessment of 255 women who were premenopausal at baseline and reached natural menopause within 16 years of follow-up.
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).
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.
本研究旨在评估潮热相对于自然绝经的风险，并评估激素水平、行为变量和人口统计学变量与绝经后潮热风险之间的关联。
我们对255名基线时处于绝经前且在随访16年内达到自然绝经的女性进行了年度评估。
中度/重度潮热的患病率在绝经前的每一年都有所增加，在最后一次月经（FMP）后的头两年达到峰值，为46%。绝经后潮热缓慢下降，直到FMP后9年才恢复到绝经前水平。FMP后中度/重度潮热的平均（标准差）持续时间为4.6（2.9）年（任何潮热为4.9 [3.1]年）。绝经后10年或更长时间的女性中有三分之一继续经历中度/重度潮热。与非肥胖白人女性相比，非裔美国女性（肥胖和非肥胖）以及肥胖白人女性潮热风险显著更高（交互作用，P = 0.01）。在多变量分析中，FMP前促卵泡激素水平升高（P < 0.001）、雌二醇降低（比值比，0.87；95%可信区间，0.78 - 0.96；P = 0.008）以及焦虑增加（比值比，1.05；95%可信区间，1.03 - 1.06；P < 0.001）是潮热的显著危险因素，而较高的教育水平具有保护作用（比值比，0.66；95%可信区间，0.47 - 0.91；P = 0.011）。
绝经后中度/重度潮热平均持续近5年；绝经后观察10年或更长时间的女性中有超过三分之一有中度/重度潮热。绝经后潮热持续超过5年凸显了在选择激素或非激素疗法治疗更年期症状时确定个体风险/益处的重要性。
