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American Journal of Epidemiology Advance Access originally published online on September 19, 2007
American Journal of Epidemiology 2008 167(1):78-85; doi:10.1093/aje/kwm244
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Adiposity and Reporting of Vasomotor Symptoms among Midlife Women

The Study of Women's Health Across the Nation

Rebecca C. Thurston1,2, MaryFran R. Sowers3, Yuefang Chang4, Barbara Sternfeld5, Ellen B. Gold6, Janet M. Johnston2 and Karen A. Matthews1,2

1 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
2 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
3 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
4 Department of Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA
5 Division of Research, Kaiser Permanente Northern California, Oakland, CA
6 Department of Public Health Sciences, University of California, Davis, Davis, CA

Correspondence to Dr. Rebecca C. Thurston, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213 (e-mail: thurstonrc{at}upmc.edu).

Received for publication May 9, 2007. Accepted for publication July 31, 2007.

It has long been hypothesized that increased adiposity would be associated with decreased vasomotor symptoms during menopause because of conversion of androgens to estrogens in body fat. However, recent thermoregulatory models have postulated that increased adipose tissue would be associated with a greater likelihood of vasomotor symptoms. The authors evaluated these hypotheses in the Study of Women's Health Across the Nation, a multiethnic, community-based observational study of US women transitioning through menopause. The sample included 1,776 women aged 47–59 years with an intact uterus and at least one ovary who completed bioelectrical impedance analysis for assessment of body composition at the sixth annual study visit (2002–2004). Assessments also included reported vasomotor symptoms (hot flashes, night sweats) and serum levels of follicle-stimulating hormone, estradiol, and sex hormone-binding globulin-adjusted estradiol (free estradiol index). Results indicated that a higher percentage of body fat was associated with increased odds of reporting vasomotor symptoms (per standard deviation increase in percent body fat, odds ratio = 1.27, 95% confidence interval: 1.14, 1.42) in age- and site-adjusted models. Associations persisted in fully adjusted models and were not reduced when models included reproductive hormones. These findings support a thermoregulatory model of vasomotor symptoms.

adipose tissue; adiposity; body composition; body fat distribution; climacteric; hot flashes; menopause


Abbreviations: BIA, bioelectrical impedance analysis; CI, confidence interval; FEI, free estradiol index; FSH, follicle-stimulating hormone; OR, odds ratio; SD, standard deviation; SHBG, sex hormone-binding globulin; SWAN, Study of Women's Health Across the Nation


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