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Hot Flashes Linked with Risk Factors for Cardiovascular Disease

New study suggests that physiologically assessed hot flashes may be associated with greater systemic inflammation in midlife women

CLEVELAND, Ohio (Sept 27, 2023)

—Hot flashes have long been known to be linked to a number of adverse health effects. Emerging data suggests an association between them and cardiovascular disease. A new study is the first to link physiologically assessed hot flashes with heightened systemic inflammation which is a risk factor for heart disease. Study results were presented during the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27-30.

Vasomotor symptoms, more often referred to as hot flashes, are one of the most common symptoms identified during the menopause transition, with roughly 70% of midlife women reporting them. Not only do they interfere with a woman’s quality of life, but they have also been related to physical health risks, such as cardiovascular disease.

Previous research linking hot flashes with heightened systemic inflammation has relied on self-reporting to document the frequency and severity of the hot flashes. These self-reports of hot flashes are limited as they ask women to recall hot flashes over weeks or longer and may be subject to memory or reporting biases. A new study that included 276 participants from the MsHeart study, however, utilized sternal skin conductance to physiologically assess hot flashes and tested whether more frequent physiologically assessed hot flashes are associated with heightened system inflammation.

While large increases in inflammatory markers indicate acute infection or clinical disease, small and sustained increases of markers of inflammation that are in the physiologically normal range are predictive of later disease risk. For example, small and/or sustained increases in inflammatory biomarkers (conceptualized as heightened levels of systemic inflammation) have been related to plaque development and atherosclerotic cardiovascular disease.

Based on the results of the study, the researchers concluded that physiologically assessed hot flashes during wake were associated with higher levels of a high-sensitivity C-reactive protein, even after adjusting for potential explanatory factors such as age, education, race/ethnicity, body mass index, and estradiol.

The results were presented during the Annual Meeting of The Menopause Society as part of the presentation entitled “Physiologically measured vasomotor symptoms and systemic inflammation among midlife women.”

“This is the first study to examine physiologically measured hot flashes in relation to inflammation and adds evidence to a growing body of literature suggesting that hot flashes may signify underlying vascular risk and indicate women who warrant focused cardiovascular disease prevention efforts,” says Mary Carson, MS, lead author from the Department of Psychology at the University of Pittsburgh.

Since heart disease is the leading cause of death for women in the US, studies like these are especially valuable,” adds Dr. Stephanie Faubion, medical director of The Menopause Society. “Healthcare professionals need to ask their patients about their hot flash experiences as they not only interfere with their quality of life but may also indicate other risk factors.”

What Your Hair and Saliva Say About Your Risk for Depression and Cognitive Shortfalls During Menopause

New study suggests hair and salivary cortisol levels may be correlated with depression symptom severity and cognitive performance

CLEVELAND, Ohio (Sept 27, 2023)—Stress affects the body and brain in many ways by causing the endocrine system to increase cortisol levels. These spiked levels can be found throughout the body. A new study suggests that elevated cortisol levels in the hair and saliva may affect cognitive and mental health in late peri/early postmenopausal women. Study results were presented during the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27-30.

It’s no secret that stress can take a major toll on the body and mind, causing a number of adverse health conditions. Significant research has been done on the long-term effects of stress. A new study, although small in size (including 43 participants in late perimenopause or early postmenopause), took a different approach to evaluating the impact of stress by determining the degree to which hair and salivary cortisol levels correlated with depression symptom severity and cognitive performance on verbal memory, verbal learning, attention, and working memory tests among healthy women in late peri/early postmenopause.

The researchers found that higher levels of hair cortisol were significantly associated with worse attention and working memory performance. Hair cortisol did not significantly correlate with performance on verbal learning or verbal memory tests. Salivary cortisol did not significantly correlate with verbal memory recall trials, attention, or working memory performance; however, higher salivary cortisol was significantly associated with worse depressive symptom severity.

This work suggests that markers of hypothalamic-pituitary-axis (HPA) activation that capture total cortisol secretion over multiple months, i.e., hair cortisol, strongly correlate with cognitive performance on attention and working memory tasks, whereas measures of more acute cortisol, i.e., salivary cortisol, may be more strongly associated with depression symptom severity.

The results will be presented during the Annual Meeting of The Menopause Society as part of the presentation entitled, “Stress in the body, on the brain: hair and salivary cortisol levels linked with depressive symptom severity and cognitive performance among healthy late peri/early postmenopausal women.”

“This work provides initial evidence linking longer-term HPA activation with worse attention and memory during perimenopause. Other research has demonstrated that interventions can decrease HPA activation; my next steps will be to study whether longer-term HPA is a modifiable marker and if by decreasing HPA activation with interventions we can improve executive functioning during the perimenopause,” says Dr. Christina Metcalf, Assistant Professor and lead author from the Department of Psychiatry at the University of Colorado Anschutz Medical Campus in Aurora, CO.

“This study, although small in size, provides insight into considering HPA activity when evaluating a patient’s cognitive and mental health,” adds Dr. Stephanie Faubion, medical director of The Menopause Society. “This may be helpful in the future to identify patients who may be at higher risk for depression and cognitive decline.”

The Impact of Menopause Stage on Age-Related Changes in the Brain

New study suggests association between menopause transition and changes in cerebral hemodynamics

CLEVELAND, Ohio (Sept 27, 2023)—Driven by changing estrogen levels, the menopause transition has a major influence on physiology during aging. Estrogen receptors populate numerous brain regions which explains why cerebral glucose metabolism is affected during the perimenopause stage. A new study investigated the association between the menopause stage and cerebral hemodynamics during typical aging. Study results were presented during the 2023 Annual Meeting of The Menopause Society in Philadelphia September 27-30.

It has been suggested that changes in cerebral physiology during aging may precede the appearance of structural biomarkers of neurodegeneration. The characterization of such age-related changes is crucial for improving our understanding of typical, vs. atypical, aging. However, little is known about the relationship between the menopause transition and age-related changes in cerebral physiology.

In this new study that compared differences in mean cerebral blood flow (the perfusion rate of blood to brain tissue) and arterial transit time (the time taken for blood that is magnetically labeled at the level of neck to travel to brain tissue) between women at each menopause stage and age-matched men, researchers investigated the role of menopause stage on how the brain ages.

The cross-sectional study included 131 women and 125 men between the ages of 40 and 60 years. Widespread significant differences in mean cerebral blood flow and arterial transit time were confirmed between women at each menopause stage and age-matched men. Distinct spatial distributions were also observed.

In contrast to prior work suggesting that menopause stage has a profound effect on cerebral hemodynamics, no statistically significant differences were observed between menopause stages. Nevertheless, men and women showed differences in both mean cerebral blood flow and arterial transit time. Compared to men, women in the premenopausal stage showed significant differences in the middle temporal cortex for arterial transit time and inferior parietal cortex for cerebral blood flow. When comparing men and perimenopausal women, significant differences were identified within the superior parietal and frontal cortices for both arterial transit time and cerebral blood flow. And, significant differences between men and postmenopausal women were found in the prefrontal and inferior parietal cortices. These sex differences therefore were more evident than any effect of menopause stage.

Based on the results, the researchers surmised that physiological neuroprotective mechanisms may exist during the menopause transition in typically aging individuals. Validation of these findings requires additional analysis that, among other things, will investigate the impact of lifestyle, medical history and cardiometabolic risk.

Study results were presented at this year’s Annual Meeting of The Menopause Society as part of the presentation entitled “Effect of menopause stage on cerebral hemodynamics during typical aging.”

“We hope that our findings highlight the importance of understanding the relationship between this significant life transition and cerebral physiology,” says Dr. Nikou Louise Damestani, lead author from the Department of Radiology at Massachusetts General Hospital in Boston.

“The impact of menopause stage on age-related changes in the brain is definitely of interest to those involved in midlife women’s health,” says Dr. Stephanie Faubion, medical director for The Menopause Society. “We look forward to the additional analysis that will investigate the impact of lifestyle, medical history, and cardiometabolic risk.”