Elsevier

Maturitas

Volume 91, September 2016, Pages 1-7
Maturitas

Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: The role of hysterectomy with ovarian conservation

https://doi.org/10.1016/j.maturitas.2016.05.011Get rights and content

Highlights

  • There has been limited longitudinal analysis of hysterectomy and vasomotor symptoms.

  • The present study found that hysterectomy with ovarian conservation is associated with persistent hot flushes and night sweats.

  • Obesity, smoking and a lower level of education/occupation are also associated with persistent symptoms.

Abstract

Objectives

There is limited research on hot flushes and night sweats in women with a hysterectomy with ovarian conservation. We aimed to describe the patterns of these symptoms in a cohort of Australian women and to investigate the relationship between distinct symptom patterns and hysterectomy status.

Study design and outcome measures

Repeated-measures latent class analysis (LCA) was used to identify hot flushes and night sweats symptom patterns across seven surveys (over 17 years) in the mid-cohort of the Australian Longitudinal Study on Women⿿s Health. Multinomial logistic regression was used to assess the associations of the symptom patterns in women with a hysterectomy with ovarian conservation (n = 1129) versus women without a hysterectomy (n = 4977).

Results

A higher proportion of women with a hysterectomy than of those without experienced a constant pattern of hot flushes (15% versus 30%) and night sweats (9% versus 19%). Women with a hysterectomy had higher odds of constant hot flushes versus minimal hot flushes (OR = 1.97, 95% CI: 1.64, 2.35) and constant versus minimal night sweats (OR = 2.09, 95% CI: 1.70, 2.55). Smoking, a ⿿lower level of education to non-professional occupation⿿ pathway and body mass index (BMI) patterns of ⿿always obese⿿ and ⿿increasingly obese⿿ were also associated with a higher risk of constant symptoms.

Conclusions

Women who have a hysterectomy (with ovarian conservation) have a higher risk of hot flushes and night sweats that persist over an extended period.

Introduction

On average, 30⿿40% of women aged in their 40s and 50s experience hot flushes and night sweats (vasomotor symptoms) [1]. Depending on frequency, duration and severity, these symptoms can have a major impact on a woman⿿s overall quality of life, productivity and social relations.

Between 20 and 40% of women in more economically developed countries have a hysterectomy by the time they are 60 years old [2], [3], and this surgery remains one of the most common gynaecological procedures performed worldwide [4]. Women who have a hysterectomy with bilateral oophorectomy (both ovaries removed) are consistently reported to have a higher risk of more frequent and/or severe hot flushes and night sweats, which is thought to be related to the abrupt decline in oestrogen levels post-surgery [5]. For women who have a hysterectomy with ovarian conservation (one or both ovaries retained) the reported associations are less consistent [6], [7], [8]. The proportion of women who retain one or both ovaries at the time of hysterectomy varies by country, ranging from 46% to 82% [4], highlighting the need to increase our understanding of the symptom experiences of these women.

Many studies of vasomotor symptoms are cross-sectional, examining associations at a point in time; or, if longitudinal data are available, symptom information is averaged over a specified time period [9]. For both the women experiencing these symptoms and their health practitioners, information on the different symptom patterns that sub-groups of women may experience at different time points may be of use in providing advice on symptom management and timing of treatment. Mishra and Dobson [9] modelled vasomotor symptom profiles (over a 14 year period) in women who experienced natural menopause and found four distinct trajectories related to age at menopause and labelled them ⿿early severe⿿, ⿿late severe⿿, ⿿moderate⿿ and ⿿mild⿿. There has been no equivalent analysis of vasomotor symptoms patterns by hysterectomy status or whether women with a hysterectomy may be at higher risk of particular symptom profiles.

Lower socioeconomic status and smoking have been associated with higher risk of hot flushes and night sweats [10], [11]. Higher BMI, alcohol consumption, and physical inactivity have also been associated with vasomotor symptoms, but less consistently [10], [12]. We were also interested in exploring whether any of these factors may moderate the relationships between symptom patterns and hysterectomy status.

Therefore, the aims of this current study were to describe symptom patterns for hot flushes and night sweats over a 17 year period by hysterectomy status and to investigate the relationship between these symptom patterns in women with a hysterectomy with ovarian conservation versus women without a hysterectomy.

Section snippets

Study population

The Australian Longitudinal Study on Women⿿s Health (ALSWH) is a prospective population-based study that explores factors associated with health and well-being in Australian women. Details of recruitment methods and response rates have been described elsewhere [13]. Briefly, the ALSWH study population was sourced from the Medicare Australia database, which covers all citizens and permanent residents of Australia, including refugees and immigrants. Three cohorts of women born in 1973⿿1978,

Results

Of the 13,715 women recruited at baseline, 2622 were excluded a priori and a further 4987 were excluded due to missing data. The sampling strategy with exclusion criteria is summarised in Fig. 1. In general, women who were excluded because of incomplete data were more likely to be obese, current smokers, do low levels of exercise, reside in rural/remote areas and have lower education levels transitioning into non-professional occupations (Supplementary Data available online).

For both hot

Discussion

To the best of our knowledge, this is the first longitudinal study that has explored latent class patterns for hot flushes and night sweats symptoms by hysterectomy status over the longer term. Of particular note is that women with a hysterectomy (with ovarian conservation) had twice the odds of experiencing persistent (i.e. constant) hot flushes and night sweats over an extended time period compared to women without a hysterectomy. This higher risk was not explained by differences in lifestyle

Conclusions

We have identified that women who have a hysterectomy (with ovarian conservation) before the age of 50 years have a higher risk of experiencing both hot flushes and night sweats that persist for well over a decade. Further research is needed to identify whether the different indications for hysterectomy (such as endometriosis, fibroids or dysfunctional uterine bleeding) play a role in determining the symptom profiles. Future research looking at outcomes of hysterectomy should investigate

Conflict of interest

None declared.

Funding

The Australian Longitudinal Study on Women⿿s Health is funded by the Australian Government Department of Health. GDM was supported by an Australian Research Council Future Fellowship (FT120100812). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethical approval

Ethical approval for the Australian Longitudinal Study on Women⿿s Health was obtained from the Human Research Ethics Committees of the University of Newcastle and the University of Queensland.

Contributors

LFW designed the research, performed the statistical analysis, wrote the manuscript, and had primary responsibility for the final content of the manuscript.

NP and GDM contributed to the design of the research, interpretation of results, and critical revision of the manuscript for important intellectual content.

JB contributed to the interpretation of results and critical revision of the manuscript for important intellectual content.

Provenance and peer review

This article has undergone peer review.

Acknowledgements

The Australian Longitudinal Study on Women⿿s Health was conceived and developed at the Universities of Newcastle and Queensland and is funded by the Australian Government Department of Health. GDM was supported by an Australian Research Council Future Fellowship (FT120100812).

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