Greater risk of developing diabetes found in those reporting frequent vasomotor symptoms related to menopause, Kaiser Permanente study finds
Women undergoing the menopause transition who have frequent vasomotor symptoms — hot flashes and night sweats — were about 50% more likely to develop type 2 diabetes than those who did not have symptoms, according to research published in JAMA Network Open.
The findings offer insight into an important health risk for midlife women, said lead author Monique Hedderson, PhD, a research scientist with the Kaiser Permanente Division of Research (DOR). “There’s a growing body of evidence that women who have these severe symptoms seem to have something else going on as well, in terms of health risks,” Hedderson said. “We need to do more research into understanding what is causing it.”
The women participate in the Study of Women’s Health Across the Nation (SWAN), a multi-site study that has followed patients from enrollment in the mid-1990s through 13 semi-annual visits. The women were perimenopausal (around typical menopause age, between 42 and 52) at the time of enrollment and have been followed for almost 30 years. SWAN investigators such as Hedderson can follow symptoms and related health risks for years during and after the menopause transition.
This study used data from 2,761 SWAN participants who live in various parts of the U.S. and come from racially and ethnically diverse backgrounds. None of the women had a previous diabetes diagnosis. They were followed for 17 years.
The women reported a range of symptom frequency: 28% reported symptoms 1 to 5 days per two-week period; 10% reported symptoms 6 or more days per week; and 62% reported no symptoms. Of the total, 12.2% developed diabetes during the study period.
When examining participants’ trajectories of vasomotor symptoms over time, they were separated into 5 categories: consistently low probability of vasomotor symptoms (26%), persistently high probability of symptoms (31%), early onset-initial high probability of symptoms that decreased over time (25%), late onset-initial low probability of symptoms that increased over time (19%), and unknown (0.2%).
A trajectory of persistent vasomotor symptoms was associated with a 50% increased risk of developing diabetes.
“These findings add to the coalescing research about the importance of vasomotor symptoms to women’s cardiometabolic health, particularly when those symptoms are experienced over long periods of time,” said senior author Rebecca C. Thurston, PhD, director of the Center for Women’s Biobehavioral Health and professor of psychiatry and epidemiology at the University of Pittsburgh. “Is a hot flash just a hot flash?”
The researchers were not able to explain precisely how vasomotor symptoms might relate to diabetes risk, but it is an area of growing research interest. There is evidence that links hot flashes and night sweats to increased risk of cardiovascular disease, which sometimes goes hand-in-hand with diabetes risk. Potential mechanisms include inflammation, poor sleep quality, and increased weight.
“Menopause has been historically understudied,” Hedderson said. “More research is needed to clarify the mechanism underlying vasomotor symptoms and why — when frequent and severe — they associate with adverse health risk.”
The researchers are focusing on people with more severe hot flashes and night sweats for risk of disease. “While 70% of women will experience vasomotor symptoms at some time during the menopause transition, we’re talking about the smaller proportion of women for whom this is a common and severe problem,” she said.
A strength of the study was that it included repeated measurements of vasomotor symptoms over a long period of time — about 20 years, through the menopause transition — rather than a single report, so it could provide a more detailed and accurate view of women’s experiences over time.
The researchers took into account other risk factors for diabetes such as weight, diet, and physical activity, and still found a unique relationship between vasomotor symptoms and diabetes onset.
Hedderson noted the value of SWAN’s tracking of women’s health status over many years, and the potential for future insights into health issues in aging. “One of our next steps is to look at vasomotor symptoms in relationship to other outcomes such as cognition,” Hedderson said.
The study was supported by SWAN, which is funded by the National Institutes of Health.
Additional co-authors were Emily F. Liu, MPH, of the Division of Research; Catherine Lee, PhD, formerly of DOR; Samar R. El Khoudary, PhD, of the University of Pittsburgh; Ellen B. Gold, PhD, of the University of California, Davis; and Carol A. Derby, PhD, of Albert Einstein College of Medicine.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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