Several recent articles suggest that the burden of menopausal symptoms is greater than generally perceived. About 80% of women experience vasomotor symptoms (VMS) – hot flashes and night sweats — as they transition into the menopause phase. For most, the symptoms are manageable, but for a sizeable subset of midlife women, these symptoms can negatively affect sleep, mood, and quality of life. While clinical guidelines suggest that menopausal vasomotor symptoms (VMS) typically last from 6 months to 2 years, new research suggests that for many women, the duration of symptoms is much longer.
Researchers recently analyzed data from 1449 perimenopausal women included in the Study of Women’s Health Across the Nation (SWAN), an observational study of women entering menopause. They observed that the median total duration of VMS was 7.4 years. The majority of the women included in this study experienced vasomotor symptoms for more than five years.
Another study assessed 2,020 women aged 40 to 65 years in Australia, measuring the prevalence of vasomotor symptoms using the Menopause-Specific Quality of Life Questionnaire. The prevalence of moderate to severe VMS was 17.1% in perimenopausal women, 28.5% in postmenopausal women younger than 55 years, 15.1% in postmenopausal women aged 55 to 59 years, and 6.5% in postmenopausal women aged 60 to 65 years. Pharmacologic therapy for menopausal symptoms was used by 135 women (6.7%): 120 women using hormone therapy and 15 using non-hormonal medication.
The studies were different in design – one longitudinal and the other cross-sectional – but the findings were similar and indicate that moderate to severe vasomotor symptoms are relatively common in midlife women and are not restricted to the perimenopause but may persist for many years beyond the last menstrual period. Also of note is the finding in the second study, where they assessed treatment, that only about 6.7% of the women were receiving treatment for their vasomotor symptoms.
These reports give us a much better sense of the trajectory of menopausal vasomotor symptoms. A sizeable proportion of women experience vasomotor symptoms over a period of 5 or more years. Given this finding, many women may not want to “tough it out” without treatment and will require interventions that are both safe and well-tolerated over long-term use.
Low levels of treatment in this population may reflect a tendency to underestimate the impact of vasomotor symptoms, to label these problems as annoying but not severe enough to merit treatment. Or perhaps, given the concerns related to long-term use of hormone replacement therapy, women may be reluctant to pursue treatment and may be unaware that non-hormonal treatments may also effective for managing their symptoms.
Another way to look at the impact of menopausal symptoms is by measuring their financial burden. Looking at health insurance claims from 60 self-insured Fortune 500 companies in the United States between 1999 and 2011 , researchers examined healthcare resource utilization, work productivity loss (disability + medically related absenteeism), and associated costs in women with and without menopausal symptoms.
Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. During the 12-month follow-up, they found that women with untreated VMS (n = 252,273; mean age, 56 y) had significantly higher healthcare resource utilization than women in the control, symptom-free cohort: 82% higher for all-cause outpatient visits and 121% higher for VMS-related outpatient visits. In terms of indirect costs, women with VMS had 57% more work productivity loss days than controls. The extra healthcare services added on average $1,336 per person per year compared to women without symptoms, and the indirect economic loss due to missed work was an extra $770 per woman per year.
While this study looked at work absenteeism, another study looked at presenteeism (the act of attending work while sick) among peri- and post-menopausal women. Among employed women experiencing VMS, women with severe and moderate symptoms had presenteeism rates of 24.28% and 14.3%, versus 4.33% in women with mild symptoms. This finding suggests that there may be additional losses in work productivity which are difficult to quantitate.
So if we do the math, that’s $2,116 per woman per year in additional direct and indirect costs. Approximately 2 million American women become perimenopausal each year over the next decade. If we estimate that about 20% of those women will have moderate to severe vasomotor symptoms, untreated VMS will cost about $800 million per year. This is a problem we cannot afford to ignore.
In an accompanying editorial, Dr. JoAnn Pinkerton states, “It is imperative that women’s healthcare providers must recognize that hot flashes are more than just a nuisance. Although it is true that hot flashes themselves are not life-threatening, they are disruptive to women, their lives, their families, and the workplace… The burden of persistent VMS rests not only on the women themselves and on their careers but also on their employers and families and on healthcare and workplace costs. Women deserve to be asked about the frequency and severity of their hot flashes and night sweats, with healthcare providers understanding that disruptive VMS need to be addressed with therapy.”
Ruta Nonacs, MD PhD
Avis NE, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015.
Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause. 2015 Feb 20.
Pinkerton JV. Money talks: Untreated hot flashes cost women, the workplace, and society. Menopause 2015 Mar; 22:254.
Sarrel P, Portman D, Lefebvre P, Lafeuille MH, et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause. 2015 Mar;22(3):260-6.