Hot flush severity during the menopausal transition and early postmenopause: beyond hormones.BACKGROUND
 Understanding factors promoting symptom severity is essential to developing innovative symptom management models.


 To investigate hot flush severity during the menopausal transition (MT) and early postmenopause and effects of age, MT stages, age of onset of late stage and final menstrual period (FMP), estrogen, follicle stimulating hormone (FSH), cortisol, anxiety, perceived stress, body mass index, smoking, alcohol use and exercise.


 A subset of participants in the Seattle Midlife Women's Health Study (n = 291 with up to 6973 observations) provided data during the late reproductive, early and late MT stages and early postmenopause, including menstrual calendars, annual health questionnaires, and symptom diaries and urine specimens assayed for hormones several times per year.  Multilevel modeling with an R program was used to test models accounting for hot flush severity.


 RESULTS
 Hot flush severity persisted through the MT stages and peaked during the late MT stage, diminishing after the second year postmenopause.  In individual analyses, hot flush severity was associated with being older, being in the late MT stage or early postmenopause, beginning the late MT stage at a younger age and reporting greater anxiety.  In a model including only endocrine factors, hot flush severity was significantly associated with higher FSH and lower estrone levels.  An integrated model revealed dominant effects of late MT stage and early postmenopause, with anxiety contributing to hot flush severity.


 Hot flush severity was affected largely by reproductive aging and anxiety, suggesting symptom management models that modulate anxiety and enhance women's experience of the menopausal transition and early postmenopause.
R
Hot flush severity during the menopausal transition and early postmenopause: beyond hormones.BACKGROUND
 Understanding factors promoting symptom severity is essential to developing innovative symptom management models.


 To investigate hot flush severity during the menopausal transition (MT) and early postmenopause and effects of age, MT stages, age of onset of late stage and final menstrual period (FMP), estrogen, follicle stimulating hormone (FSH), cortisol, anxiety, perceived stress, body mass index, smoking, alcohol use and exercise.


 A subset of participants in the Seattle Midlife Women's Health Study (n = 291 with up to 6973 observations) provided data during the late reproductive, early and late MT stages and early postmenopause, including menstrual calendars, annual health questionnaires, and symptom diaries and urine specimens assayed for hormones several times per year.  Multilevel modeling with an R program was used to test models accounting for hot flush severity.


 Hot flush severity persisted through the MT stages and peaked during the late MT stage, diminishing after the second year postmenopause.  In individual analyses, hot flush severity was associated with being older, being in the late MT stage or early postmenopause, beginning the late MT stage at a younger age and reporting greater anxiety.  In a model including only endocrine factors, hot flush severity was significantly associated with higher FSH and lower estrone levels.  An integrated model revealed dominant effects of late MT stage and early postmenopause, with anxiety contributing to hot flush severity.


 CONCLUSIONS AND IMPLICATIONS
 Hot flush severity was affected largely by reproductive aging and anxiety, suggesting symptom management models that modulate anxiety and enhance women's experience of the menopausal transition and early postmenopause.
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