Menopause Live - IMS Updates

Date of release: 24 October, 2011

Vasomotor symptoms and negative affect

Vasomotor symptoms (VMS) during the preceding day have been positively associated in a recent study [1] with next-day negative affect expressed as: mood swings, feelings easily hurt, irritable, difficulty concentrating, forgetful, anxious and blue/down in a sample of 625 women aged 42–52 years, of five racial/ethnic groups who reported at least one menstrual period in the last 3 months, were not using sex steroid hormones, had an intact uterus and at least one ovary. Subjects were drawn from a substudy of the Study of Women’s Health across the Nation (SWAN), known as the Daily Hormone Study (DHS). Women were asked to keep a diary during an entire menstrual cycle until bleeding or 50 days, whichever occurred first, of 14 mood and physical states, rating how strongly they were felt using a Likert scale ranging from 1 = ‘not at all’ to 4 = ‘a lot’. They were also asked to register whether or not they had experienced abdominal pain/cramps, trouble sleeping and hot flushes/night sweats during the previous 24 h. Covariates previously related to both VMS and mood such as age, education, site, and ethnic/race group were considered in the analysis. Older age, less education, perimenopause status and poorer health were related to the report of VMS on the previous day, and being Chinese was associated with fewer reports of daily VMS. The most interesting result in this study was the predictive value of reported VMS, adjusted by same-day negative affect as a predictor of next-day negative affect (odds ratio (OR) 1.27; 95% confidence interval (CI) 1.03–1.58; p < 0.01) and negative affect not being predictive of next-day VMS (OR 1.11; 95% CI 0.85–1.35; p = 0.55), thus indicating a consequential effect of VMS over negative affect.


The predictive value of reported VMS on negative affect in an antecedent–consequent direction in this study seems to support the long-held domino hypothesis which places VMS in general and night sweats in particular as predictors of both sleep problems and mood symptoms during the menopause transition, using subjective reported VMS as measurements to evaluate such a relationship. In this study, the predictive power of previous-day VMS over next-day negative mood is meaningful but, in a secondary analysis that added trouble sleeping to the model, the predictive power of VMS for next-day negative mood was reduced (OR 1.24; 95% CI 0.99–1.56; p = 0.06), while reported trouble sleeping per se was a stronger predictor of negative affect (OR 1.97; 95% CI 1.64–2.38; p < 0.001). Whether trouble sleeping was influenced by VMS and/or other somatic symptoms, such as urinary urgency, muscular pains or by mood symptoms such as anxiety, was not reported. A prior study by Burlenson [2] had already found sleep problems as a more robust predictor of both next-day positive (b = -0.08; p < 0.01) and negative (b = 0.10, p <0.001) mood than VMS in general. Thus, a distinction between day-time hot flushes and night sweats in diary reports would be very useful to determine whether previous-day VMS in general or night sweats in particular are predictors of next-day negative mood. The inclusion of other menopause-related symptoms that may influence sleep length and quality in multivariate models would also help to further clarify the VMS–sleep–mood relation. 
Another subanalysis of the SWAN series [3] has further studied the relationship between VMS, sleep problems and mood, using EEG sleep measures, with the surprising result of reported VMS and mood symptoms not being related to either rapid eye movement (REM) latency (the time span between the start of sleeping and the start of REM sleep) or the delta sleep ratio (ratio of slow-wave activity in the first to that in the second non-REM sleep episode). 
These results encourage a more precise measurement of sleep quality and objective physiologic VMS versus subjective recall and report that may be misleading, as was found in the Hilo study of Japanese American women [4]. Finally, mechanisms related to estrogen and other sex steroid variations that affect directly, and not through the occurrence of VMS, sleep quality and length as well as mood during the menopause transition, through their impact on the serotonergic, adrenergic and noradrenergic systems, have been previously analyzed [5] but still need to be explored in order to understand the constant but complex correlation between these menopausal symptoms, especially in severely symptomatic women.


Deborah Legorreta
Mexico City, Mexico


  1. Gibson CJ, Thurston RC, Bromberger JT, Kamarck T, Matthews KA. Negative affect and vasomotor symptoms in the Study of Womens Health Across the Nation Daily Hormone Study. Menopause 2011;Sept 1. Epub ahead of print

  2. Burleson MH, Todd M, Trevathan WR. Daily vasomotor symptoms, sleep problems, and mood: using daily data to evaluate the domino hypothesis in middle-aged women Menopause 2010;17:8795.

  3. Kravitz HM, Avery E, Sowers M, et al. Relationships between menopausal and mood symptoms and EEG sleep measures in a multi-ethnic sample of middle-aged women: The SWAN Sleep Study. Sleep 2011;34:122132.

  4. Brown DE, Sievert LL, Morrison LA, Reza AM, Mills PS. Do Japanese women really have fewer hot flashes than European Americans? The Hilo Womens Health Study. Menopause 2009;16:8706.

  5. Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep 2008;31:97990.