Thursday, March 22, 2012

Three Things You Didn’t Know About Menopause

I spend a significant amount of time every week reading medical research abstracts. Most of what you come across while doing that is fairly typical, especially if you’re a naturopathic physician concerned with diet and exercise – study after study will show that regular exercise, not smoking, and a healthy diet prevents a large number of diseases and symptoms. Of course, each study examines a slightly different aspect of a healthy lifestyle, with one looking at omega-3 fats, another at fiber, and a third at moderate physical exercise, but in total, they more or less reinforce each other.

Occasionally, however, you come across really unexpected information, the sort of stuff that makes you stand up and say, ‘What?!’ Today’s column is devoted to three such articles relating to menopause.

The first is about night sweats. In a study of 867 women conducted over 11.5 years, it was discovered that women who had both hot flashes and night sweats had a 30% lower risk of all-cause mortality than women who did not have this combination of symptoms. Women who had hot flashes alone did not have this benefit. Adding further interest to the finding is the fact that women who had night sweats but not hot flashes had a similar protective benefit, though in this case it extended only to cardiovascular disease and coronary heart disease. The researchers controlled rigorously for a variety of risk factors, including hormonal therapy, further strengthening the finding.

The main question to ask ourselves with this study is – why could this possibly be happening? The causes of vasomotor symptoms associated with menopause are poorly understood, so we can really only speculate as to why night sweats apparently provide a protective benefit. I’ll be on the lookout for more info on this.

The second is about hot flashes. A team of Greek researchers found that women with increased subclinical atherosclerosis suffered from more severe hot flashes. You lay people are probably wondering what this means – here’s a brief explanation: researchers measured the amount of plaque in the carotid arteries of 110 women via ultrasound, and discovered that those women who suffered more severe hot flashes also had thicker deposits of plaque in their artery walls. Carotid artery plaque is routinely used as marker for atherosclerosis throughout the body. The increases in plaque were minor, and the study population was somewhat small, but the findings were statistically significant, and appeared to correlate to the severity of the symptoms – the women were classified as having no symptoms, minor symptoms, or moderate to severe symptoms, and it was clear that progressively severe symptoms were correlated to progressively severe plaquing.

Here again, because menopausal symptoms are so poorly understood, we can only guess at why atherosclerosis might play a role in their prevalence. What’s interesting though, is that hot flashes may help to alert clinicians to cardiovascular risk in the future.

Finally, severity of menopausal symptoms may be largely influenced by the time of year in which you were born. I’ll admit that this research left me astounded. A group of Italian researchers found that menopausal symptoms are significantly more severe in women born during the spring and summer, as opposed to women born the fall. Not only was this finding statistically significant, but the effect was also remarkably strong – the women born in the spring and summer had symptom scores that were more than twice as high as their counterparts born in the fall. This applied more strongly to symptoms of anxiety and depression, but also quite strongly to somatic symptoms as well.

Despite reading a lot of research, this really counts as one of the most surprising studies I’ve seen. I was tempted initially to dismiss the findings, but this study was done on quite a large group of women – over 2500 – and once you get groups that large, the chance of having fluke results diminishes. The clinical significance of this result has yet to be borne out, but for the time being, this is a fascinating result to read about.