occurrence and number of hotflashes. However, there have been questions about
the clinical significance of hotflashes that are not experienced, underscoring the
clinical utility of self-reported hotflashes and the primacy of a woman’s experience
(Sievert 2012 ). Concerns about the only moderate correlations between physiologic
and self-reported hotflashes in the ambulatory setting have also been expressed,
leading to questions about the validity of physiologic hotflash measures. It is
notable that moderate correlations observed between self-report and physiologic
indices are not exclusive to hotflashes and in fact are similar in other health-related
indices (e.g., sleep; McCall and McCall 2012 ). Self-report and physiologic indices
can be conceptualized as slightly distinct but related phenomena, both of which
have importance in understanding the full construct of hotflashes and their expe-
rience. Ultimately, the optimal hotflash measure should be tailored to the research
question. If a research question requires information on the precise number, timing,
and occurrence of hotflashes including during sleep, physiologic measures may be
important to incorporate (together with self-report measures). If a question exclu-
sively pertains to a woman’s experience of her hot flashes, then self-reported
measures may be most appropriate. Ultimately, the research question should guide
the study design, including the choice of study instruments. Both self-report and
physiologic measures have important roles to play in research on hotflashes.
Summary and Recommendations
Hotflashes are a highly prevalent symptom experienced by women transitioning
through menopause, as well as by men and women undergoing certain
cancer-related treatments (Carpenter et al. 1998 ; Hanisch et al. 2007 ; Spetz et al.
2001 ; Savard et al. 2009 ). Though many individuals do notfind these symptoms
troublesome, others suffer from severe and frequent symptoms and related decre-
ments in sleep, psychological well-being, sexual health, and overall quality of life.
In order to develop a better understanding of the etiology and treatment options for
hotflashes, accurate measurement is vital. Four categories of hotflash measurement
tools are currently employed: symptom scales based on retrospective reporting over
weeks and months, daily diaries completed by end of the day, daily diaries com-
pleted at the time of the hotflash, and physiologic measures of hotflashes (typically
via sternal skin conductance). Self-report measures are commonly used for hotflash
research, but limitations include issues of recall, compliance, and cultural variance
in interpretation. Several physiologic measures have been employed to index hot
flashes, with sternal skin conductance being the most sensitive and specific to-date.
The choice of the hotflash measurement approach should be tailored to the research
question of interest.
Further research into the etiology and sequelae of hotflashes could pave the way
for dramatic improvements in measurement technology and methodology. We
recommend further development and validation of both self-report and physiologic
measures. These measures would ideally be evaluated for validity across women
246 W.I. Fisher and R.C. Thurston