Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort

OBJECTIVE: The aim of this study was to identify temporal associations of anxiety dimensions with menopausal hot flashes in women progressing through the menopausal transition. We hypothesized that associations of both somatic and affective dimensions of anxiety with hot flashes increased in the menopausal transition, and that somatic anxiety was an independent risk factor for menopausal hot flashes. METHODS: Hot flashes, anxiety symptoms, hormone levels, and other psychosocial variables were assessed annually for 14 years of follow-up. The 233 women were premenopausal at baseline and continued through 1 year or more after the final menstrual period. Anxiety dimensions were assessed with the Zung Anxiety Scale, a validated measure of affective anxiety and somatic anxiety. Summed item scores were divided by the number of items rated, so that ranges of the two dimensions were comparable. RESULTS: Seventy-two percent of the sample reported moderate/severe hot flashes during the 14-year interval. There was no significant interaction between anxiety dimensions and menopausal stages. When adjusted for menopausal stage, the magnitude of association between somatic anxiety and hot flashes, however, dramatically increased (odds ratio OR, 3.03; 95% CI, 2.12-4.32; P < 0.001), whereas the association between affective anxiety and hot flashes increased to a lesser extent (OR, 1.27; 95% CI, 1.03-1.57; P = 0.024). Women with high levels of somatic anxiety (top third of the sample) had the greatest risk of hot flashes (P < 0.001). When the anxiety dimensions were considered in combination, the additive effect of high affective anxiety symptoms was minimal, with no significant difference between the group with high affective/low somatic symptoms and the low symptom group in incident hot flashes at each menopausal stage (P = 0.54). In multivariable analysis, somatic anxiety increased the risk of hot flashes more than three times (OR, 3.13; 95% CI, 2.16-4.53; P < 0.001), but affective anxiety was not significantly associated with hot flashes after adjustment for other study variables (OR, 1.19; 95% CI, 0.96-1.48; P = 0.117). Time-lagged somatic anxiety scores significantly predicted hot flashes, with a 71% increase in risk (OR, 1.71; 95% CI, 1.21-2.41; P = 0.002). Time-lagged affective anxiety scores did not predict hot flashes (OR, 1.06; 95% CI, 0.87-1.31; P = 0.58). CONCLUSIONS: This study showed a strong predictive association of somatic anxiety with the risk of menopausal hot flashes. The temporal associations suggest that somatic anxiety is not simply a redundant measure of hot flashes but predicts the risk of menopausal hot flashes and may be a potential target in clinical management of perimenopausal women.