Lifestyle factors associated with hot flash frequency and daily interference: highlighting the role of sleep quality, diet quality and physical activity

Objective: To examine associations of lifestyle and demographic factors with hot flash frequency (HFF) and hot flash–related daily interference (HFRDI) in a multicultural Australian convenience sample. The study fills an evidence gap by investigating how lifestyle factors interact with ethnicity and self-reported menopausal status in Australia’s diverse population, an area with limited prior research. Methods: A cross-sectional online survey conducted in 2024-2025 included a convenience sample of women who self-identified as being in perimenopause and postmenopause (mean age: 56.1±6.6 y). All demographic, menopause, lifestyle, medication-use, and symptom information was self-reported through the online questionnaire. Demographic characteristics, lifestyle factors, menopause status, and symptom outcomes were self-reported. Diet quality, physical activity, and sleep were assessed using an adapted Global Diet Quality Score, an International Physical Activity Questionnaire-based measure, and a modified Pittsburgh Sleep Quality Index, respectively. Menopause status was self-reported, and duration in that status was recorded; Stages of Reproductive Aging Workshop (STRAW) +10 informed the terminology but was not used to assign specific reproductive-aging substages. Outcomes included HFF and HFRDI. Ordinal logistic models estimated adjusted associations controlling for age, menopause status/duration, and ethnicity. Results: Sleep quality was the strongest correlate of HFF and HFRDI. For HFF, each one-category worsening in sleep quality was associated with higher odds of being in a higher frequency category (adjusted odds ratio [aOR]=2.44; P =0.001); older age was inversely associated (aOR=0.42; P =0.002). For HFRDI, poorer sleep was strongly associated with greater interference (aOR=4.93; P <0.001). Ethnicity was not associated with frequency ( P =0.687) but was associated with daily interference (aOR=2.66; P =0.037). Diet quality showed a nonsignificant inverse association for daily interference ( P =0.077). Physical activity showed a small, nonsignificant tendency toward higher frequency ( P =0.135). Conclusion: Findings suggest the importance of routine sleep quality for symptom burden and may inform lifestyle-focused approaches to symptom management.