Having severe hot flashes after menopause is associated with a higher chance of developing metabolic syndrome and high blood pressure later in life, according to new research presented May 14, 2023, at the 25th European Congress of Endocrinology in Istanbul.
Both metabolic syndrome and high blood pressure contribute to heart disease, the No. 1 killer for women in the United States, per the Centers for Disease Control and Prevention, responsible for 1 in every 5 female deaths.
“The findings highlight the importance of cardiovascular risk assessment and patient education,” says lead author Elena Armeni, MD, PhD, a member of the faculty of medicine at National and Kapodistrian University of Athens in Greece.
Women with severe hot flashes need to be aware of the associated cardiovascular risks before deciding on the most appropriate treatment strategy for their menopause symptoms, says Dr. Armeni.
Hot Flashes Are the Most Common Menopause Symptom
Hot flashes, a vasomotor symptom (VMS) of menopause, can come on very suddenly with a surge of heat that can leave the face and neck feeling flushed and the body drenched in sweat, according to Hopkins Medicine. Although they’re often described as a “burst” of heat, a hot flash can last anywhere from 30 seconds to five minutes.
About 3 out 4 women in the United States have hot flashes during the menopause transition, making it the most common menopause symptom, according to the North American Menopause Society (NAMS).
Typically, women experience hot flashes for six months to two years, but in rare cases, they can last up to 10 years. And unfortunately, they don’t automatically go away once a woman goes through menopause — some women can have a recurrence of hot flashes up to a decade after menopause.
Women With Severe Hot Flashes More Likely to Develop Metabolic Syndrome
The study included 825 healthy women between the ages of 40 and 65 years old who had recently gone through menopause, didn’t have any signs of metabolic syndrome, and weren’t taking hormone replacement therapy.
Metabolic syndrome is a group of conditions that together raise your risk of heart disease, diabetes, stroke and other health issues, according to the National Heart, Lung, and Blood Institute. People who have three or more of the following may have metabolic syndrome, according to Hopkins Medicine:
- A large waistline or excess fat at the waist, defined as more than 40 inches around the waist for men, and more than 35 inches for women
- High blood pressure, defined as 130/85 millimeters of mercury (mmHg) or higher
- High blood sugar, defined as fasting blood sugar levels of 100 milligrams per deciliter (mg/dL) or higher
- High triglycerides, defined as more than 150 mg/dL
- Low HDL (“good”) cholesterol, defined as less than 40 mg/dL for men or less than 50 mg/dL for women.
After an initial assessment, women in the study were placed into one of three groups: no hot flashes, mild hot flashes, and moderate to severe hot flashes.
The severity of hot flashes was determined by the subjective report of each person using the standardized menopause assessment tool, the Greene Climacteric scale. Women who indicated they experienced hot flashes “quite a bit” or “extremely” were placed in the moderate-to-severe category.
All participants were monitored for 15 years (from 2006 to 2021) for the development of metabolic syndrome, new onset hypertension, and dyslipidemia (high cholesterol and triglycerides).
Participants with moderate to severe hot flashes were more likely to develop hypertension and metabolic syndrome and were also more likely to be diagnosed earlier compared with women who had no hot flashes or mild hot flashes.
Hot Flashes Have Been Connected to Heart Disease Risk Before
The findings of this study are part of the accumulating data that hot flashes may be a marker for those women who are at greater cardiovascular risk in the future, says Stephanie Faubion, MD, director of the Mayo Clinic’s Center for Women’s Health in Jacksonville, Florida, and medical director for NAMS.
“We should be more proactive in identifying these women earlier to initiate preventive strategies,” she says.
Previous studies have also shown an association between hot flashes and cardiovascular health risk, but this association has never been studied in women with varying degrees of symptoms on such a large scale, according to the authors.
“This study showed that those women with moderate to severe hot flashes were more likely to develop hypertension and metabolic syndrome. We know there is a link between the risk factors for heart disease and VMS, but we don’t know if there is some shared common mechanistic pathway linking the two,” says Dr. Faubion.
What’s also unknown is whether hot flashes are causing the increased risk for metabolic syndrome or vice versa — though that’s less likely, she adds.
Has Hormone Therapy Been Proven to Reduce the Risk of Developing Metabolic Syndrome?
The findings highlight the importance of cardiovascular-disease prevention strategies — including the potential use of hormone replacement therapy — which should be implemented shortly after menopause, says Armeni.
Even though the guidelines of many national and international societies specify that hormone therapy is indicated for moderate-to-severe hot flashes, the women in this study weren’t being treated, and many went on to develop metabolic syndrome, says Armeni.
That being said, the benefits and risks of hormone therapy need to be considered on an individual basis; it’s not appropriate for everyone, she adds.
“From prior studies, hormone therapy appears to have a beneficial effect on the components of metabolic syndrome, including lean body mass, abdominal fat, and waist circumference. All of this contributes to a lower risk of diabetes,” says Faubion.
But more research is needed to know whether treatment of hot flashes with hormones reduces the future risk of hypertension and heart disease, she says.
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