Some of the worst hot flashes and night sweats can occur during the menopause transition…. between our mid- forties and early fifties. Aside from embarrassing perspiration, flushing, a desire to disrobe, as well as a loss of sleep, are women also losing their heart health?
The Study of Women’s Health Across the Nation examined that question and found that, unfortunately the answer was “to some degree, yes.” This study, published in the journal Obstetrics and Gynecology in April, 2012, followed 3,201 women aged 42-52 years for 8 years. They were interviewed once a year and asked to recall the frequency and severity of hot flashes and night sweats during the previous 2 weeks. The women also underwent a physical exam and blood tests were done to check their lipids. The latter included low-density lipoprotein (LDL), high-density lipoprotein (HDL), Apolipoprotein A-1, apolipoprotein B, lipoprotein (a), and triglycerides. Blood estrogen (estradiol) levels and follicle stimulation hormone (FSH) were also checked to see if they had become menopausal. (Estrogen levels plummet and FSH goes up in menopause.) Remember, all of the lipids (think fats in the blood stream) with the exception of the “good lipid” HDL encourage plaque development in blood vessels and subsequent coronary heart disease and stroke.
The average age of the women at the onset of the study was 46. One third of the women had hot flashes; these increased over the years (as they transitioned into menopause) and at the 7th visit, 54% had significant hot flashes and 38% had night sweats. The factors that were associated with a worsening lipid profile at baseline included older age, Hispanic race, smoking, low education, not drinking alcohol, being perimenopausal at a young age, obesity, low physical activity, low estrogen level, high FSH and high anxious or depressive symptoms. But even when they controlled for all these factors which were present at the onset of the study, hot flashes and night sweats, particularly when experienced frequently were associated with higher levels of the lipids over the 8 year study period, most particularly in leaner women. These lipid markers are well known to be associated with elevated cardiovascular risk.
I know it seems weird that the changes in the lipids were more common in thin women with hot flashes rather than obese women who experienced this symptom. The authors hypothesized that the effect of weight and BMI on lipids or vasomotor symptoms may have overwhelmed the more modest associations seen in the study.
What does this mean for women going through a difficult menopausal transition and why the correlation with cardiovascular disease? No one is sure.
This study simply raises concerns: if you experience significant hot flashes and night sweats during the menopause transition, make sure your physician checks your lipid levels. If they are elevated, they may portend the development of cardiovascular problems. You and your doctor should consider appropriate prevention and if necessary, treatment