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In their report, Li et al describe vasomotor symptoms (VMS) experienced by 187 Chinese women followed during the menopause transition and into post-menopause [1]. The women were enrolled in the study when they were pre-menopausal or early in the menopause transition and then followed for, on average, 7 years. They completed questionnaires about their symptoms annually and also kept monthly menstrual and VMS diaries. The results reported included the prevalence and severity of VMS as well as the association between severity of symptoms and the stage of menopause at which symptoms started as well as the association between prevalence of symptoms and a range of other factors. The main findings of the study include that:

• hot flushes and night sweats were common amongst Chinese women, resembling the picture described in Western women

• the prevalence of symptoms peaked in the late perimenopause

• the duration of symptoms was shorter than reported in other studies

• women who experienced an earlier onset of symptoms also experienced symptoms for a longer period

• factors associated with more severe symptoms included higher BMI and higher levels of self-reported stress.



This study of Li et al is one of the few prospective cohort studies of the menopause transition and such studies provide different information from cross-sectional studies. Prospective cohort studies are challenging – they are time-consuming, expensive and suffer the bias introduced by loss to follow-up, so it is not surprising that most studies of menopausal symptoms are cross-sectional. Cross-sectional studies have their own challenges, although they can generally afford to be larger than longitudinal studies. As Li et al point out in their discussion section, the symptoms experienced by women who have a short duration of VMS are more likely to be missed in a cross-sectional study so that study design can impact the pattern of symptoms documented. Although in Li et al.’s study menopausal symptoms were not assessed with a validated questionnaire, the women were asked about the frequency and severity of their VMS in a consistent manner on an annual basis. Moreover, although some of the reported observations are not novel, such as that earlier onset of symptoms is associated with symptoms which are more persistent [2] and that women with a higher BMI tend to have more severe symptoms[3], these observations have now been made in Chinese women in China. Li et al.’s observation that self-reported stress contributed to the likelihood of reporting hot flushes is consistent with our own observation that depressive symptoms contribute to the reporting of vasomotor symptoms [4] however this association may also be bi-directional [5]. The shorter duration of symptoms in Chinese women in Li et al’s study was also reported in Chinese women in the longitudinal part of the SWAN study and suggests an ethnic or genetic component to variation in this aspect of VMS. Overall the picture of VMS in the women in this study is similar to what has been described in studies in Western countries. It has been a widely held belief that Asian women experience fewer VMS than Western women[6] although they may report other symptoms such as joint pain. Our recent systematic reviews suggested that, if vasomotor symptoms are assessed using validated questionnaires in adequately powered, community-based samples of women, the picture of VMS in Asian women is similar to that for women in Western countries [7, 8]. Our subsequent studies of VMS and other menopausal symptoms in women both in Bangladesh and Iran, bear this out [9, 10].


  • Robin Bell
    Deputy Director, Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia


  1. Li J, Luo M, Tang R, Sun X, Wang Y, Liu B, Cui J, Liu G, Lin S and Chen R. Vasomotor symptoms in aging Chinese women: findings from a prospective cohort study. Climacteric. 2019:1-7
  2. Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, Hess R, Joffe H, Kravitz HM, Tepper PG, Thurston RC and Study of Women’s Health Across the N. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175:531-9.
  3. Thurston RC, Sowers MR, Chang Y, Sternfeld B, Gold EB, Johnston JM and Matthews KA. Adiposity and reporting of vasomotor symptoms among midlife women: the study of women’s health across the nation. Am J Epidemiol. 2008;167:78-85.
  4. Worsley R, Bell RJ, Gartoulla P, Robinson PJ and Davis SR. Moderate-Severe Vasomotor Symptoms Are Associated with Moderate-Severe Depressive Symptoms. J Womens Health (Larchmt). 2017;26:712-718.
  5. Worsley R, Bell R, Kulkarni J and Davis SR. The association between vasomotor symptoms and depression during perimenopause: a systematic review. Maturitas. 2014;77:111-7.
  6. Lock M. Symptom reporting at menopause: a review of cross-cultural findings. J Br Menopause Soc. 2002;8:132-6.
  7. Islam MR, Gartoulla P, Bell RJ, Fradkin P and Davis SR. Prevalence of menopausal symptoms in Asian midlife women: a systematic review. Climacteric. 2015;18:157-76.
  8. Islam RM, Bell RJ, Rizvi F and Davis SR. Vasomotor symptoms in women in Asia appear comparable with women in Western countries: a systematic review. Menopause. 2017;24:1313-1322.
  9. Islam RM, Bell RJ, Billah B, Hossain MB and Davis SR. Prevalence and severity of vasomotor symptoms and joint pain in women at midlife in Bangladesh: a population-based survey. Menopause. 2016;23:731-9.
  10. Fooladi E, Bell RJ, Masoumi M, Azizi M, Atarod Z and Davis SR. Bothersome menopausal symptoms amongst postmenopausal Iranian women. Climacteric. 2018;21:586-593.
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