And the Heat Goes On

Summary and Comment |
March 10, 2015

And the Heat Goes On

  1. Diane E. Judge, APN/CNP

In the SWAN study, mean duration of menopausal vasomotor symptoms was 7.4 years, and persistence varied with time of onset and race and ethnicity.

  1. Diane E. Judge, APN/CNP

Up to 80% of women experience vasomotor symptoms (VMS) during the menopause transition (MT). Traditional wisdom is that the symptoms resolve after a few years, although at least one study found them to be longer lasting (NEJM JW Womens Health Jun 2011 and Obstet Gynecol 2011; 117:1095). Now, findings from the Study of Women's Health Across the Nation (SWAN), a longitudinal observational study of the MT, confirm that moderate to severe VMS often persist for many years.

Among 1449 participants with frequent VMS (occurring on ≥6 of the preceding 14 days), unadjusted median VMS duration was 7.4 years. In a subset of 881 women with an identifiable final menstrual period (FMP), early onset of symptoms (i.e., during pre- or perimenopause) was associated with longer overall and post-FMP persistence (median, >11.8 and 9.4 years, respectively). Women with postmenopausal onset of VMS had the shortest total symptom duration (median, 3.4 years). VMS persistence varied with race and ethnicity (black, 10.1 years; Hispanic, 8.9; non-Hispanic white, 6.5; Chinese, 5.4; Japanese, 4.8). Women who were married or partnered, better educated, less financially stressed, and had greater social support had shorter duration of symptoms. Physical activity and alcohol intake did not affect symptom duration.


These findings confirm what patients have been telling us all along: Bothersome VMS may persist for more than “a few” years. The results also lend a new twist to the guidelines for hormone therapy (“lowest effective dose, shortest duration”). Women may need a range of options, including hormonal and nonhormonal therapies as well as behavioral and lifestyle adaptations, for a decade or more. The SWAN results will help us individualize counseling as we educate women about the risks and benefits of each strategy.

Editor Disclosures at Time of Publication

  • Disclosures for Diane E. Judge, APN/CNP at time of publication Nothing to disclose


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