Sequelae of Hot Flashes
Hotflashes have been associated with a number of negative mental and physical
health outcomes, including poor sleep and fatigue, impaired sexual function, neg-
ative affect, poorer cognitive performance, and poorer quality of life (Stein et al.
2000 ; Chedraui et al. 2012 ; Kronenberg 1994 ; Hunter et al. 2012 ; Lambrinoudaki
et al. 2012 ; Maki et al. 2008 ). One of the most common complaints by women
transitioning through menopause is poor sleep. In fact, in epidemiologic studies,
reported hotflashes are one of the most consistent predictors of sleep problems,
such as self-reported difficulties falling asleep, waking up several times during the
night, and early morning wakening (Kravitz et al. 2008 ). Women frequently attri-
bute their poor sleep to hotflashes waking them up at night (Xu et al. 2012 ).
However, as discussed below, the precise nature of the relation between hotflashes
and sleep is not well understood, as hotflashes may cause awakenings, be a
correlate of sleep problems, or be related to sleep problems via a third factor. The
precise relation between hotflashes and sleep is apparently sensitive to the mea-
sures of hotflashes and sleep utilized.
Hotflashes are also frequently associated with negative mood. In fact, reported
hotflashes are consistently associated with depressed mood and, to a lesser extent,
major depressive episodes during the menopausal transition (Bromberger et al.
2007 ). One study of 170 women aimed to tease out the temporal nature of relations
between negative mood and hotflashes,finding that over a 10-year follow-up
period depressed mood tended to precede hotflashes rather than hotflashes pre-
ceding depressed mood (Freeman et al. 2009 ). Conversely, diary studies have
shown that negative mood tends to follow hotflashes (Gibson et al. 2011 ).
Moreover, anxiety is robustly associated with hotflashes (Hanisch et al. 2008 ; Gold
et al. 2006 ; Freeman et al. 2005 ). In one study, women with high anxiety werefive
times more likely to report hotflashes than their less anxious counterparts (Freeman
et al. 2005 ). Other negative psychological factors, including low self-esteem, have
also been associated with hotflash reporting (Hunter and Liao 1995 ). Thus, the
precise nature of the relation between negative affect and hotflashes is likely
complex, as negative affect may render women more likely to report hotflashes
(Gold et al. 2006 ), act as an acute trigger for hotflash reporting (Thurston et al.
2005 ), or be an outcome of having hotflashes (Gibson et al. 2011 ). As discussed
below, the measure of hotflashes utilized can impactfindings regarding the precise
nature of the relation between hotflashes and negative mood.
Finally, hotflashes have been associated with poorer quality of life. In the Study
of Women’s Health Across the Nation (SWAN), a large cohort study of 3302
women transitioning through menopause, the occurrence of hotflashes was asso-
ciated with greater odds of poor quality of life across physical, emotional, and
social domains in fully adjusted statistical models over a 7-year time period (Avis
et al. 2009 ). Similar findings have been demonstrated across several studies
(Kronenberg 1994 ; Stein et al. 2000 ; Oldenhave et al. 1993 ; Freeman et al.2011b).
234 W.I. Fisher and R.C. Thurston