![]() SWAN analyses show that levels of endogenous hormones are associated with VMS. Reproductive hormones likely play an integral role, as evidenced by the onset of VMS occurring in the context of the dramatic reproductive hormone changes of the menopausal transition and by the therapeutic role of exogenous estrogen in their treatment. The physiology of hot flashes is not fully understood, and likely represents interplay between multiple central and peripheral physiologic systems. 3, 4 Given the prevalence and duration of VMS among midlife women, it is critical to understand the underlying biology of this symptom, the extent to which VMS may impair quality- of-life, and whether VMS may serve as a marker for other important health conditions. However, research from a range of studies has shown that a sizable minority of women report VMS earlier in midlife, before the onset of menstrual cycle changes, 2 and well into their 60’s and 70’s, decades after the menopause transition. 1 Research from SWAN indicates that the occurrence and frequency of VMS peak in the late perimenopause and early postmenopausal years, 1 or the several years surrounding the final menstrual period. In SWAN, 60-80% of women experience VMS at some point during the menopausal transition, with prevalence rates varying by racial/ethnic group. VMS are experienced by the majority of women during the menopausal transition. VMS are episodes of profuse heat accompanied by sweating and flushing, experienced predominantly around the head, neck, chest, and upper back. VMS, or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. We emphasize findings from SWAN given the wealth of information gained from this unique cohort study. Specifically, we review the epidemiology and physiology of VMS, risk factors for VMS, and associated quality of life and health conditions. Below we summarize some of the insights gained from SWAN about this common and often troublesome midlife symptom. Thus, SWAN, with its longitudinal design, multiethnic sample, and biopsychosocial perspective, has allowed unique insights into vasomotor symptoms (VMS), serving to advance the field of midlife women’s health. During this time, a wealth of information about SWAN participants was collected annually, including information about vasomotor and other menopause-related symptoms, health behaviors, social and psychological functioning, as well as a range of physiologic indices. SWAN enrolled 3,302 midlife women across five racial/ethnic groups, and has followed these women for over 10 years. SWAN is one of the largest and most ethnically diverse longitudinal studies of the menopausal transition.
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