|Year : 2018 | Volume
| Issue : 3 | Page : 834-838
Hot flushes among perimenopausal women
Safaa A Badr1, Fatma A El-Esrigy2, Yara M Heikal3
1 Department of Public Health and Community, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Family Health Unit, Toukh Tanmbisha, Menoufia Governorate, Menoufia, Egypt
|Date of Submission||24-Oct-2017|
|Date of Acceptance||03-Dec-2017|
|Date of Web Publication||31-Dec-2018|
Yara M Heikal
Berket El Saba District, Menoufia Governorate 32717
Source of Support: None, Conflict of Interest: None
The aim of this study was to assess the prevalence and factors affecting hot flushes (HFs) among perimenopausal women.
More than 80% of women report physical and psychological symptoms especially HFs that commonly accompany the perimenopausal period and so understanding the factors affecting HFs is important to decrease the severity of HFs and its effects.
Participants and methods
The study was carried out in two randomly selected family healthcare centers in urban and rural areas in Berket El Saba district, Menoufia Governorate during the period from 1 October to 1 December 2016. An analytic cross-sectional study was conducted on a convenient sample of 300 perimenopausal women aged from 45 to less than 60 years. The questionnaire was designed to obtain full history and analysis of HFs.
The prevalence of HFs among the studied perimenopausal women was 86%. In binary logistic regression, the most significant factors affecting HFs were BMI greater than 25 [odds ratio (OR): 42.8, 95%CI: 6.9–264)], followed by basic education (OR: 10.6, 95%CI: 2.6–43.4) followed by sedentary life (OR: 3.5, 95%CI: 1.6–7.7), and being housewife (OR: 3.2, 95%CI: 1.4–7.2). Caffeine consumption did not significantly affect the presence of HFs, but affected their severity (P < 0.05).
Most perimenopausal women suffer from HFs with different degrees of severity. Moreover, the most significant factor was BMI greater than 25.
Keywords: body mass index, factors affecting, hot flushes, perimenopause, prevalence
|How to cite this article:|
Badr SA, El-Esrigy FA, Heikal YM. Hot flushes among perimenopausal women. Menoufia Med J 2018;31:834-8
| Introduction|| |
The term vasomotor symptoms are usually used to describe hot flushes (HFs), which occur during the menopausal period. These HFs typically begin as a sudden sensation of heat centered on the upper chest and face, and lasts from 2 to 4 min. It was associated with profuse perspiration, palpitations, or anxiety. At night, vasomotor instability manifests as HFs or night sweats (NSs) which may represent different physiological mechanisms.
HFs are present in as many as 55% of women even before the onset of the menstrual irregularity that defines entry into the menopausal transition and their incidence and severity increase as women traverse the menopause, peaking in the late transition and decreasing within the next several years, and this is because the estrogen levels are higher by about 20–30%, often with wide fluctuations. These fluctuations cause many of the physical changes during perimenopause as well as during menopause.
The prevalence of such symptoms ranges from 74% of women in Europe, 36–50% in North America, 45–69% in Latin America, and 22–63% in Asia, as reported in different large epidemiological studies.
This prevalence of HFs was shown to vary with menopausal status, age and ethnicity, socioeconomic status, lifestyle, BMI, mood, and menopausal cognitions (beliefs and attitudes toward menopause). It was found to be more prevalent among women during the menopause transition, that is perimenopause and early postmenopause, and less prevalent among East Asians compared with American and European women (55%). The aim of this study was to assess the prevalence and factors affecting HFs among perimenopausal women in Berket El Saba District, Menoufia Governorate.
| Participants and Methods|| |
The study design was reviewed and formally approved by the ethics committee of Faculty of Medicine, Menoufia University. Communications with the university and health professions were oriented to the objectives and procedures of the study and permission was obtained to conduct the study. All participants were informed about the nature of the study and those who consented were included in the study. This study was a cross-sectional analytical study which was conducted on 300 women. It included all perimenopausal women who attended a family healthcare center (urban area) and Toukh Tanmbisha family health unit (rural area) in Berket El Saba district, Menoufia Governorate, during the period from beginning of September 2016 up to the end of July 2017 with a response rate of 88.7 and 90.5%, respectively.
All perimenopausal women aged from 45 years to less than 60 years, experienced irregular menses within the last 12 months or absence of menstrual bleeding for more than 3 months and to less than 12 months were included in the study, whereas the females who were pregnant, had a history of cancer, submitted to chemotherapy or radiotherapy, had regular period or absence of menses for more than 12 months, premature menopause, history of hormonal contraception or history of hormonal therapy for any disease were excluded from the study.
All participants were interviewed using a predesigned questionnaire and were subjected to physical examination.
The predesigned questionnaire consisted of three parts, the first part was intended to collect the sociodemographic data related to the studied persons according to Fahmy et al., which includes seven domains (occupation, education, family, economic, family possessions, home sanitation, and health care). The second part focused on the experience of HFs in the past 30 days and different related factors such as personal data, menstrual and obstetric, past medical history, lifestyle factors including caffeine consumption, hot beverage intake, passive smoking, dietary pattern, physical activity, and multivitamin use. The third part: for screening the severity of HFs using HF frequency and problem rating scale: problem rating is calculated as the mean of the scores on three, 10-point scales assessing the extent to which HFs/NSs are problematic, distressing, and causing interference in daily life. Scores for the problem rating range between 0 and 10, with higher scores indicating more problematic HFs/NSs. The HF frequency and problem rating scale has been found to have reasonable test–retest reliability and good concurrent validity. It was used for screening the severity of HFs which was divided to none (0), mild (1–3), moderate (4–6), severe (7–9), and very severe (10).
Physical examination placed special emphasis on weight, height, BMI, and blood pressure.
Statistical design and analysis
The results from the study were collected, revised, coded, tabulated, and statistically analyzed by the statistical package for the social sciences (SPSS version 20 using IBM personal computer (SPSS Inc., Chicago, Illinois, USA)). Quantitative data were expressed as mean and SD and were analyzed applying the t-test. Qualitative data were expressed as number and percentage and analyzed applying χ2-test. A P value of less than 0.05 was considered statistically significant and odds ratio was used to determine the significant factors affecting HFs and stepwise regression test was used to test the association between the variables.
| Results|| |
The prevalence of HFs among the studied perimenopausal women was 86% and about 33.3% had very severe HFs [Figure 1].
The mean age of the studied group was 50.4 ± 2.8 years. There was a statistically significant relation between the presence of HFs, work, and education of the studied perimenopausal women (P < 0.05 and <0.001, respectively) as most of the nonworking women (54.7%) and basic, secondary educated perimenopausal women (32 and 44.6%, respectively) experienced HFs [Table 1].
|Table 1: Relationship between the presence of hot flushes and sociodemographic data among the studied group|
Click here to view
There was a statistically significant relation between the presence of HFs, BMI, and physical activity (P < 0.001 and <0.05, respectively), where 99.2 and 58.1% of the studied women with BMI greater than or equal to 25 and sedentary life represented with HFs [Table 2].
|Table 2: Relationship between presence of hot flushes and general characteristics among the studied group|
Click here to view
Moreover, there was no statistically significant relation between the presence of HFs and caffeine consumption (P > 0.05) [Table 2]. But, there was a statistically significant relation between the severity of HFs and caffeine consumption (P = 0.003) [Figure 2].
|Figure 2: Relation between caffeine consumption and severity of hot flushes.|
Click here to view
In binary logistic regression the most significant factors affecting HFs were BMI greater than 25 (OR: 42.8, 95%CI: 6.9–264), followed by basic education (OR: 10.6, 95%CI: 2.6–43.4), followed by sedentary life (OR: 3.5, 95%CI: 1.6–7.7), and being nonworking (OR: 3.2, 95%CI: 1.4–7.2) [Table 3].
|Table 3: Binary logistic regression for factors affecting hot flushes among the studied group|
Click here to view
| Discussion|| |
More than 80% of women report physical and psychological symptoms especially HFs that commonly accompany the perimenopausal period and so understanding the factors affecting HFs is important to decrease the severity of HFs and its effects. Out of the 300 studied perimenopausal women, 86% experienced HFs, which was close to the result conducted by Nisar and Sohoo, Satpathy, and Al-Olayet et al., who found that the prevalence of HFs were 76.7, 77, and 83%, respectively. But this is against the study conducted by Al Dughaither et al., who found that the prevalence of HFs was 24.4% among the perimenopausal women which was low compared with the previous studies and also against the study conducted by Vijayalakshmi et al., who found that the prevalence of HFs was 35.80%. This variation in prevalence from one geographical region to another could be attributed to the differences in the confounding risk factors such as nutrition and the difference in the sociodemographic criteria of their samples.
There was a statistically significant relation between HFs and the level of education where basically educated women experience HFs by about 10.6 times as demonstrated in the logistic regression, and this was similar to the study conducted by Zhang et al., who found that the level of education was statistically associated with HFs, where a college level or highly educated had a decreased risk of HFs and also Lorenzi et al. reported that menopausal symptoms were less intense among more highly educated women, which could be attributed to the fact that the women with a higher education are more likely to learn about HFs through newspapers, journal articles, lectures, television, and the internet. This may help them prepare for the occurrence of HFs and have a more positive attitude toward them. Women with a higher education may also find it easier to handle the occurrence of HFs, for example, by altering their lifestyle and diet or seeking medical assistance to relieve symptoms.
This was also like Sievert et al. and Huang et al. who found that there was a relation between education and HFs. In contrast to this study, Pimenta et al. found that educational level was not a significant predictor of HFs.
In this study, there was no statistically significant relation between the presence of HFs and marital status, residence, and socioeconomic standard.
This is like Pimenta et al. who found that there was no relation between marital status, work, education, and HFs, although Zhang et al. found that there was a significant relation between marital status, work, and presence of HFs.
There was a significant relation between the severity of HFs and caffeine consumption and where about 86.3% of the women, who had severe HFs, had a history of caffeine consumption. This is against Pimenta et al. who found that caffeine intake was a negative predictor of HF, that is, more consumption of caffeine leads to less severe symptoms.
It is in line with Karacam and Seker who found that there was an association between experiencing menopausal symptoms and consumption of caffeine.
In this study, there was a significant relation between the presence of HFs, BMI, and physical activity, and this was similar to Silva et al., who reported that 73.6% of the participants were not physically active which may contribute to the presence of more intense symptoms and also against Tepper et al.. Another study showed that obese women are at an increased risk of HFs compared with normal weight women, Alexander et al..
It was against the study by Capistrano et al. who showed that there were no associations between physical activity, BMI, and severity of menopausal symptoms.
| Conclusion|| |
Most perimenopausal women suffer from HFs with different degrees of severity. Moreover, obesity, sedentary life, basic education, nonworking had a significant effect on the experience of HFs. So, health promotion of these women through screening for HFs and lifestyle modification (weight reduction, increase physical activity, and decrease caffeine intake) is mandatory to decrease the severity of HFs and its effect.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zhang Q, Li F, Yu Y, Yu X, Sheng Q, Zhang X. Differential factors associated with hot flashes in Chinese perimenopausal and postmenopausal women. Maturitas 2009; 63
Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, et al.
Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. Clin Endocrinol Metab 2015; 100
Reed SD, Lampe JW, Qu C, Copeland WK, Gundersen G, Fuller S, et al.
Premenopausal vasomotor symptoms in an ethnically diverse population. Menopause 2014; 21
Chichester M, Ciranni P. Approaching menopause (but not there yet!): caring for women in midlife. Nurs Womens Health 2011; 15
Palacios S, Henderson W, Siseles N, Tan D, Villaseca P. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric 2010; 13
Hunter MS, Gentry-Maharaj A, Ryan M, Burnel M, Lanceley A, Fraser L, et al.
Prevalence, frequency and problem rating of hot flushes persist in older post menopausalwomen: impact of age, BMI, hysterectomy, lifestyle and mood in a cross sectional cohort study of 10,418 British women aged 54 – 65. Br J Obstet Gynaecol 2012; 119
Fahmy SI, Nofal LM, Shehata SF, El Kady HM, Ibrahim HK. Updating indicators for scaling the socioeconomic level of families for health research. J Egyptian Public Health Assoc 2015; 90
Hunter MS, Haqqani JR. An investigation of the discordance between subjective perception and physiological measures of menopausal hot flushes. Climacteric 2011; 13
Nisar N, Sohoo NA. Frequency of menopausal symptoms and their impact on the quality of life of women: a hospital based survey. J Pak Med Assoc 2009; 59
Satpathy MA. Study on age at menopause, menopausal symptoms and problems among urban women from Western Odisha, India. Int J Sci Res Pub 2016; 6
Al-Olayet AY, Al-Qahtani IF, Al-Essa DI, Al-Saleek FH, Al-Moutary RN, Al-Mudimeg LM, et al.
Severity of menopausal symptoms, and knowledge attitude and practices towards menopause among Saudi women. Sci Res Essays 2010; 5
AlDughaither A, AlMutairy H, Alateeq M. Menopausal symptoms and quality of life among saudi women visiting primary care clinics in Riyadh, Saudi Arabia. Int J Womens Health 2015; 7
Vijayalakshmi S, Chandrababu R, Victoria E. Menopausal transition among northernindian women. NUJHS 2013; 3
Lorenzi DRS, Danelon C, Saciloto B, Padilha IJr. Predicting factors of climacteric symptoms. Rev Bras Ginecol Obstet 2005; 27
Sievert LL, Flanagan EK. Geographical distribution of hot flash frequencies: considering climatic influences. Am J Phys Anthropol 2005; 128
Huang AJ, Grady D, Jacoby VL, Blackwell TL, Bauer DC, Sawaya GF. Persistent hot flushes in older postmenopausal women. Arch Intern Med 2008; 168
Pimenta F, Leal I, Maroco Jand Ramos C. Perceived control, lifestyle, health, socio-demographic factors and menopause: impact on hot flashes and night sweats. Maturitas 2011; 69
Karacama Z, Seker SE. Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. Maturitas 2007; 58
Silva RT, Câmara SM, Moreira MA, Nascimento RA, Vieira MC, Morais MS. Correlation of menopausal symptoms and quality of life with physical performance in middle-aged women. Rev Bras Ginecol Obstet 2016; 38
Tepper PG, Brooks MM, Crawford SL, El Khoudary SR, Gold EB, Lasley BL, et al.
Characterizing the trajectories of vasomotor symptoms across the menopausal transition. North Am Menopause Soc 2016; 23
Alexander CJ, Kulp J, Schilling C, Lipari C, Flaws J, Zacur HA. BMI, hot flashes, and aromatase in adipose tissue from midlife women. Fertil Steril 2006; 86
Capistrano EJM, Dombek K, Da Costa ACC, Marinheiro LPF. Factors associated with the severity of menopausal symptoms in postmenopausal Brazilian women. Reprod Clim 2015; 30
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]