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Participants were weighed at baseline and at 6 months using digital scales Tanita BWB ; Tanita Corporation of America Inc, Arlington Heights, Illinois , and height was measured using wall-mounted stadiometers. Heart rate and blood pressure were measured with the patient in the sitting position Dinamap Monitor Pro 10; GE Healthcare, Buckinghamshire, England , following standardized protocols. All analyses were restricted to participants who reported being at least slightly bothered by hot flushes at baseline and thus had the potential to show improvement during the trial. Among these participants, the baseline characteristics of women randomized to the intervention vs control group were compared by mixed linear regression for normally distributed continuous variables, ranked mixed linear regression for nonnormally distributed continuous variables, and proportional odds regression for categorical variables, using generalized estimating equations.
Among participants reporting bothersome hot flushes at baseline, the effects of the intervention vs control program on weight, BMI, abdominal circumference, physical activity, calorie intake, blood pressure, and overall physical and mental functioning during 6 months were examined using mixed linear regression for normally distributed continuous variables and ranked mixed linear regression for nonnormally distributed continuous variables, 22 again controlling for clinical site and accounting for clustering of outcomes among women participating in the same behavior change or health education sessions.
Intervention effects on self-reported hot flushes during 6 months were then examined using repeated-measures proportional odds regression, using all available data from any study visit, after checking that there were no major violations of the proportional odds assumption. Repeated-measures regression was chosen to ensure efficient use of information about time-dependent covariates and to minimize loss of information resulting from loss to follow-up.
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Odds ratios ORs in these models were scaled to reflect improvement in hot-flush bothersomeness by 1 Likert category eg, from quite a bit to moderately or moderately to slightly bothersome. To address possible bias introduced by the use of oral or transdermal estrogen use or selective serotonin reuptake inhibitor medication use, intervention effect models were run with and without adjustment for estrogen and selective serotonin reuptake inhibitor use at baseline and at 6 months.
Next, associations between change in weight, BMI, abdominal circumference, physical activity, calorie intake, blood pressure, and overall physical and mental functioning and change in hot flushes during 6 months were examined using repeated-measures proportional odds regression, combining data from the intervention and control groups. Finally, to assess for possible mediation of intervention effects by change in these variables, additional repeated-measures proportional odds models were developed to compare the effects of the intervention vs control program on hot flushes while adjusting for improvement in weight, BMI, abdominal circumference, physical activity, calorie intake, blood pressure, and overall functioning.
All analyses were performed using SAS statistical software, version 9. Of the participants in PRIDE, were randomized to the intensive weight loss intervention and to the control group Figure 1.
Approximately half of participants in each group 99 in the intervention and 55 in the control group reported being at least slightly bothered by flushing at baseline and were eligible for our analyses. Of these participants, Eighty-nine of participants Compared with control individuals, women randomized to the intervention reported slightly greater physical activity at baseline but did not differ significantly with regard to other characteristics, including hot flushes Table 1.
Among women reporting hot flushes at baseline, those randomized to the intervention group were significantly more likely to remain in the study and contribute hot-flush data at 6 months compared with controls 96 of 99 women [ Among women who were at least slightly bothered by flushing at baseline, the intensive lifestyle intervention was associated with significantly greater decreases in weight, BMI, abdominal circumference, and systolic and diastolic blood pressure relative to the control group Table 2.
No statistically significant effect of the intervention on self-reported physical activity, total calorie intake, or overall physical or mental functioning was observed.
Persistent Hot Flushes in Older Postmenopausal Women
After 6 months, 65 of participants In aggregate analyses of all women reporting bothersome hot flushes at baseline, decrease in weight, decrease in BMI, and decrease in abdominal circumference were each associated with improvement in self-reported hot flushes during 6 months Table 3. No significant associations between changes in physical activity, calorie intake, blood pressure, or overall self-reported physical and mental functioning and change in flushing bothersomeness were observed. In this randomized controlled trial of an intensive behavioral weight loss intervention vs a structured health education program in women who were overweight or obese and had urinary incontinence, women with bothersome hot flushes who were randomized to the intensive intervention reported significantly greater improvement in flushing bothersomeness after 6 months compared with controls.
Improvements in weight, BMI, and abdominal circumference but not self-reported physical activity, calorie intake, overall physical and mental functioning, or measured blood pressure were associated with improvement in bothersome hot flushes in this population.
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The effect of the intensive intervention on bothersome hot flushes was partly but not completely explained by improvements in weight, BMI, and abdominal circumference. Multiple observational studies have documented that women with a higher BMI report more frequent or severe hot flushes during menopause, but the mechanisms underlying this association are poorly understood. Women who are overweight or obese are known to have higher circulating estrogen levels as a result of adipocyte-based aromatization of estrone and conversion of androstenedione to estrone, which might be expected to decrease rather than increase the severity of their menopausal symptoms.
Recently proposed explanations for the observed association between BMI and hot flushes have included greater insulation against heat loss owing to increased peripheral fat, 23 abnormal sympathetic neural activity associated with increased visceral fat, 24 and alterations in leptin and other cytokines expressed by adipocytes that affect thermoregulatory function. Our findings indicate that women who are overweight or obese and experience bothersome hot flushes may also experience improvement in these symptoms after pursuing behavioral weight loss strategies; however, improvements in weight or body composition may not be the only mediators of this effect.
Given that the behavioral intervention in PRIDE could not be masked, 1 possible explanation for the apparent incomplete mediation of the intervention effect by weight loss is that participants' reporting of their symptoms at 6 months was influenced by knowledge of their treatment assignment. It is notable, however, that women randomized to the intensive intervention did not report greater improvement in other quality-of-life outcomes, such as physical or mental functioning as measured by the SF, compared with controls, even though these were also self-reported outcomes with the potential to be influenced by knowledge of treatment assignment.
Furthermore, because the primary outcome of the PRIDE trial was change in frequency of urinary incontinence rather than improvement in menopausal symptoms, participants were given no special counseling about hot flushes and had no particular reason to expect that their flushing symptoms would be influenced by the study intervention. Several previous studies of physical activity interventions have reported conflicting effects on menopausal symptoms, with one nonrandomized trial suggesting that physical activity is protective against hot flushes, 26 another randomized trial suggesting that physical activity may worsen hot flushes, 10 and other studies reporting no effect on flushing.
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In our study, we did not find that increased self-reported physical activity was associated with either improvement or worsening in bothersome flushing among women who were symptomatic at baseline, and change in physical activity did not explain intervention effects. Physical activity may be overestimated when assessed by self-report, 30 however, and it is possible that more objective or precise quantification may have yielded a different pattern of associations with flushing symptoms.
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Limited previous research has explored the role of calorie consumption and other dietary factors in influencing women's experience of hot flushes. Several other limitations of this research should be noted. First, participants in PRIDE had urinary incontinence at baseline, which may limit the generalizability of our findings to women without incontinence.
Urinary incontinence is associated with decreased overall health and depression in women, which have the potential to influence the perceived bothersomeness of other health-related symptoms. To date, however, epidemiologic research has not supported an association between incontinence and menopause in women, 34 and in the PRIDE population itself, we found no evidence that women with more bothersome hot flushes had more severe or frequent incontinence at baseline.
Second, hot flushes were assessed by a single self-report measure emphasizing the bothersomeness of symptoms during the past month, which may be vulnerable to memory and reporting biases and which may reflect not only the frequency of symptoms but also the effect of symptoms on women's sense of well-being. Newer versions of treatments developed since may reduce the risks of using hormones for women experiencing the menopausal transition, but studies are needed to evaluate the long-term safety of these newer treatments.
If you use hormone therapy, it should be at the lowest dose, for the shortest period of time it remains effective, and in consultation with a doctor. Talk with your doctor about your medical and family history and any concerns or questions about taking hormones. You may have heard about black cohosh, DHEA, or soy isoflavones from friends who are using them to try to treat their hot flashes. These products are not proven to be effective, and some carry risks like liver damage.
Phytoestrogens are estrogen-like substances found in some cereals, vegetables, and legumes like soy , and herbs. They might work in the body like a weak form of estrogen, but they have not been consistently shown to be effective in research studies, and their long-term safety is unclear. At this time, it is unknown whether herbs or other "natural" products are helpful or safe. The benefits and risks are still being studied. Always talk with your doctor before taking any herb or supplement to treat your hot flashes or other menopausal symptoms.
For most women, hot flashes and trouble sleeping are the biggest problems associated with menopause. But, some women have other symptoms, such as irritability and mood swings, anxiety and depression, headaches, and even heart palpitations. Many of these problems, like mood swings and depression, are often improved by getting a better night's sleep. Discussing mood issues with your doctor can help you identify the cause, screen for severe depression, and choose the most appropriate intervention.
For depression, your doctor may prescribe an antidepressant medication. If you want to change your lifestyle to see if you can reduce your symptoms, or if you decide any of your symptoms are severe enough to need treatment, talk with your doctor. Deciding whether and how to treat the symptoms of the menopausal transition can be complicated and personal.
Discuss your symptoms, family and medical history, and preferences with your doctor. No matter what you decide, see your doctor every year to talk about your treatment plan and discuss any changes you want to make. Learn more about the signs and symptoms of menopause , as well as tips to help you get a better night's sleep during the menopausal transition.
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Hot Flashes: What Can I Do?
North American Menopause Society info menopause. Sex and Menopause: Treatment for Symptoms. Lifestyle Changes to Improve Hot Flashes Before considering medication, first try making changes to your lifestyle. Here are some other lifestyle changes you can make: Dress in layers, which can be removed at the start of a hot flash.
Carry a portable fan to use when a hot flash strikes. Avoid alcohol , spicy foods, and caffeine. These can make menopausal symptoms worse. If you smoke, try to quit , not only for menopausal symptoms, but for your overall health. Try to maintain a healthy weight.