Hormone variability and hot flash experience: Results from the midlife women's health study.

OBJECTIVE: Hot flashes are believed to be related to hormonal changes. However, the relationship between hormonal fluctuations and hot flashes has not been studied. The objective of this study is to determine hormone measurement summaries that best explain the incidence of hot flashes in midlife women. STUDY DESIGN: In a cohort study of 798 midlife women over 1-7 years, women provided 4 weekly blood samples annually and completed a survey detailing life history, ongoing behaviors, and menopausal symptoms. Estradiol, progesterone, and testosterone were measured in all serum samples. Annual summary variables of each hormone were median, mean, maximum, minimum, variance, and range. The association of these values with hot flashes was assessed using multivariable logistic regression and Bayesian network analysis, controlling for smoking history and menopausal status. MAIN OUTCOME MEASURES: Hot flash incidence, severity, and frequency. RESULTS: For most outcomes, the best-fit model included progesterone variability; increased progesterone variance or range was correlated with decreased hot flash frequency (OR = 0.82, 95% CI = 0.74-0.91) and severity (OR = 0.82, 95% CI = 0.77-0.88). In the Bayesian network model, the maximum estradiol value was negatively correlated with many outcomes (OR for hot flashes = 0.68). Relationships between progesterone variability, maximum estradiol level, maximum progesterone level, and hot flashes indicate that the effects of progesterone variance on hot flash outcomes are likely mediated through progesterone's relationship with maximum estradiol level. CONCLUSIONS: Variability of progesterone, as opposed to mean values, should be used as an indicator of risk of hot flashes in midlife women.

Association between polycystic ovary syndrome and hot flash presentation during the midlife period.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-aged women; however, the impact of PCOS on menopausal symptoms remains poorly understood. This study aims to determine the influence of PCOS on hot flash presentation in midlife women. METHODS: Participants were recruited from the Midlife Women's Health Study involving 780 women aged 45 to 54 years. All women completed detailed questionnaires on hot flash symptoms. Between June 2014 and March 2015, participants were screened for history of PCOS based on the Rotterdam criteria. Fisher's exact tests and Wilcoxon rank-sum tests were used for analysis. Multivariate logistic regression was performed to identify factors associated with hot flashes at midlife. RESULTS: In all, 453 women (69%) consented to the telephone interview and 9.3% (n = 42) met diagnostic criteria for PCOS; 411 were included as controls. Mean age was 48.0 and body mass index was 27.3 for women with PCOS. The majority of participants were white (72%). There was no difference between PCOS and control women for levels of follicle-stimulating hormone, testosterone, progesterone, or estradiol. Multivariate logistic regression demonstrated that PCOS was not associated with increased odds of hot flash incidence. Smoking was the only variable associated with experiencing hot flashes (odds ratio 2.0, 95% confidence interval 1.05-3.98). CONCLUSIONS: A history of PCOS was not associated with increased hot flash symptoms during the midlife period. Additional research should continue to investigate the health and quality of life associated with a history of PCOS in the aging population.

The Midlife Women's Health Study - a study protocol of a longitudinal prospective study on predictors of menopausal hot flashes.

BACKGROUND: The Midlife Women's Health Study (MWHS) was developed to address some of the gaps in knowledge regarding risk factors for hot flashes among generally healthy midlife women during their menopausal transition. This manuscript describes the methods from the study and the main findings that were published to date, with a focus on predictors of hot flashes. This study was initially funded to test the hypothesis that obesity is associated with an increased risk of hot flashes through mechanisms that involve ovarian failure, altered sex steroid hormone levels, and selected genetic polymorphisms. METHODS/DESIGN: The MWHS was conducted between 2006 and 2015 as a prospective longitudinal population-based study of generally healthy midlife women (ages 45 to 54 years) during their natural menopausal transition. Women were eligible if they had intact uteri and both ovaries and reported having at least 3 menstrual periods in the last 12 months. Exclusion criteria included pregnancy, cancer, and use of hormonal/hormone-like supplements. Overall, 780 women were recruited into the study. The majority of study participants were followed for 4 to 7 years. At annual visits, women donated blood and urine samples, completed questionnaires, had a vaginal ultrasound, and had their anthropometric measurements taken. DISCUSSION: Several risk factors for menopausal hot flashes were identified or confirmed, including older age, perimenopausal status, current and former cigarette smoking, lower estradiol levels, lower progesterone levels, black race, and depressive symptoms. Factors that were associated with decreased odds of hot flashes included moderate alcohol consumption and more than 5 years of cessation of cigarette smoking. Body mass index was not associated with hot flashes. The MWHS has provided important information regarding hot flashes. The study methods are rigorous and can be easily adopted by research groups investigating naturally occurring menopausal hot flashes.

Risk Factors for Extended Duration and Timing of Peak Severity of Hot Flashes.

OBJECTIVE: To identify risk factors associated with the duration of hot flashes and the time of peak hot flash severity in mid-life women. METHODS: A cohort of 647 women reporting hot flashes were followed for 1-7 years, with survey data and hormone measurements. Survival analysis determined the association of risk factors with the duration of hot flashes. Linear regression determined the association of risk factors with the time of peak severity. Final models were determined through stepwise model selection. RESULTS: Average hot flash duration was 2.5 years (range: 1-33), with peak severity on average at 2.96 years (range: 1-20). Duration of hot flashes was associated with race, education, menopause status, smoking history, BMI, alcohol consumption, leisure activity levels, and levels of estradiol and progesterone. In the final model, only race, alcohol consumption, leisure activity, and menopause were retained. White women had significantly shorter hot flash durations than non-white women. Women consuming at least 12 alcoholic drinks in the previous year had a significantly shorter duration of hot flashes with a smaller effect of hot flash duration on increasing in time to peak severity compared to those who consumed less than 12 alcoholic drinks in that year. Higher serum progesterone levels were associated with later peak severity if the duration of the hot flashes was less than 2 years and an earlier peak severity otherwise. CONCLUSIONS: These results suggest that some behaviors (such as moderate alcohol consumption) are associated with shorter durations of hot flashes, and that progesterone was associated with the dynamics of hot flash severity.

Phthalate metabolite levels and menopausal hot flashes in midlife women.

During the menopausal transition, a woman's reproductive capacity declines, her hormone milieu changes, and her risk of hot flashes increases. Exposure to phthalates, which can be found in personal care products, can also result in altered reproductive function. Here, we investigated the associations between phthalate metabolite levels and midlife hot flashes. Eligible women (45-54 years of age) provided detailed information on hot flashes history and donated urine samples (n=195). Urinary phthalate metabolite levels were measured by HPLC-MS/MS. A higher total sum of phthalate metabolites commonly found in personal care products was associated with an increased risk of ever experiencing hot flashes (odds ratio (OR)=1.45; 95% confidence interval (CI)=1.07-1.96), hot flashes in the past 30days (OR=1.43; 95%CI=1.04-1.96), and more frequent hot flashes (OR=1.47; 95%CI=1.06-2.05). These data suggest that some phthalate exposures from personal care products are associated with menopausal hot flashes in women.

The Associations Between Body Mass Index, Smoking, and Alcohol Intake with Ovarian Volume in Midlife Women.

BACKGROUND: Despite the fact that ovarian volume is a marker of reproductive aging, there is little understanding of factors related to ovarian volume among aging women. The objective of this analysis was to examine the associations between body mass index (BMI), cigarette smoking, and alcohol intake with ovarian volume among midlife women. MATERIALS AND METHODS: Data were analyzed from 771 women (45-54 years of age at baseline) enrolled in the Midlife Women's Health Study, a cohort study that was initiated in 2006. At annual clinic visits, height and weight were measured, a transvaginal ultrasound was performed to measure ovarian volume, blood was drawn to measure hormone concentrations, and a comprehensive questionnaire was administered. Generalized linear models and repeated measures mixed models were conducted to examine the associations between BMI, cigarette smoking, and alcohol intake with ovarian volume, adjusting for age and race. RESULTS: Age was significantly and negatively associated with ovarian volume. However, BMI, smoking, and alcohol use were not associated with ovarian volume either when stratified by menopausal status or when adjusting for age and race. Estradiol, but not progesterone or testosterone, was significantly and positively associated with ovarian volume overall and among both white and black participants (p < 0.05). CONCLUSIONS: This study provides insight into the associations between BMI, smoking, and alcohol use with ovarian volume among midlife women. The findings are somewhat consistent with the published literature and, thus, indicate that these factors may not be clinically important in terms of ovarian volume during the menopausal transition.

Ectopic pregnancy after in vitro fertilization: differences between fresh and frozen-thawed cycles.

OBJECTIVE: To evaluate whether the uterine environment is associated with the risk of ectopic implantation by comparing outcomes of fresh and frozen-thawed embryo transfers. DESIGN: Retrospective historical cohort. SETTING: Not applicable. PATIENT(S): We used the Society for Assisted Reproductive Technologies (SART) database to identify pregnancies that resulted from fresh and frozen blastocyst transfers from 2008 to 2011. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We determined the proportion of ectopic (EP) versus intrauterine-only pregnancies resulting from fresh or frozen embryo transfers in autologous and donor-oocyte cycles. Generalized estimation equation regression models were used to adjust for maternal and treatment characteristics. RESULT(S): Among 103,070 cycles that resulted in a clinical pregnancy, 1.38% were ectopic. The odds of EP were 65% lower in women who had a frozen compared with a fresh transfer in autologous cycles. Donor-oocyte transfers had lower odds of EP compared with autologous cycles, with no difference between fresh and frozen donor transfers. Women who had both a fresh and a frozen transfer with autologous oocytes had a higher risk of EP in their fresh cycles compared with their frozen cycles. CONCLUSION(S): Embryo transfers in cycles without ovarian hyperstimulation, such as frozen or donor cycles, were associated with lower rates of EP compared with fresh autologous cycles, suggesting that a difference in the tubal-uterine environment contributes to abnormal implantation after IVF.

Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study.

OBJECTIVE: The aim of this study was to examine the associations of demographic characteristics, health behaviors, and hormone concentrations with the experience of any, current, more severe, and more frequent midlife hot flashes. METHODS: Baseline data from 732 women aged 45 to 54 years who were enrolled in the Midlife Women's Health Study were analyzed. A clinic visit was conducted to collect blood samples for hormone assays and to measure ovarian volume using transvaginal ultrasound. A self-administered questionnaire ascertained information on demographic factors, health habits, and hot flash history. Multivariable logistic regression was conducted to examine associations between potential risk factors and hot flash outcomes. RESULTS: Approximately 45% of participants reported experiencing midlife hot flashes. In covariate-adjusted models, older age, perimenopause status, current and past cigarette smoking, and depressive symptoms were significantly associated with increased odds of all of the hot flash outcomes. In addition, history of oral contraceptive use was associated with increased odds of any hot flashes. In contrast, higher current alcohol intake was significantly associated with decreased odds of any, current, and more severe hot flashes. Higher estradiol and progesterone concentrations were significantly associated with decreased odds of all hot flash outcomes. CONCLUSIONS: Although the temporality of such associations is not known because of the cross-sectional nature of the data, these observed relationships can help to identify women at risk for hot flashes.

Change in body mass index, weight, and hot flashes: a longitudinal analysis from the midlife women's health study.

BACKGROUND: The goals of this study were to examine the associations between body mass index (BMI), as well as BMI change and weight change, with midlife hot flashes. METHODS: Data were analyzed from an ongoing 5-year cohort study of 631 midlife women (ages 45-54 years) recruited from Baltimore, Maryland, and its surrounding counties. Height and weight were measured at clinic visits conducted annually. Questionnaires administered at each clinic visit collected detailed data on hot flashes, including the severity and frequency, and other covariates. Data were analyzed using logistic regression and generalized estimated equation models, adjusting for potential confounders. RESULTS: Among women enrolled in the study, 45.2% reported hot flashes and 32.0% were categorized as being obese (BMI ≥30 kg/m(2)) at baseline. At baseline, BMI was not significantly associated with ever experiencing hot flashes (BMI ≥30 versus <25 kg/m(2): odds ratio [OR] 0.92; 95% confidence interval [CI]: 0.58, 1.15) or any of the other hot flashes outcomes (recent, frequent, or severe). In addition, no statistically significant associations between BMI, BMI change, or weight change, and the hot flash outcomes were observed in the longitudinal models (for example, any hot flashes: BMI ≥30 versus <25 kg/m(2): OR 0.81; 95% CI: 0.56, 1.17). CONCLUSION: BMI, BMI change, and weight change during midlife were not related to hot flashes in this study. The data suggest that other factors, such as smoking habits, are more important in determining hot flashes risk during midlife.

Genetic polymorphisms in the aryl hydrocarbon receptor-signaling pathway and sleep disturbances in middle-aged women.

OBJECTIVE: We aimed to determine if selected genetic polymorphisms in the aryl hydrocarbon receptor (AHR)-signaling pathway and circadian locomotor output cycles kaput (CLOCK) are associated with insomnia and early awakening in middle-aged women. METHODS: Women aged 45 to 54years (n=639) were recruited into a middle-aged health study and agreed to complete questionnaires and donate blood samples. Questionnaires were used to assess sleep outcomes. Blood samples were processed for genotyping for the selected polymorphisms: AHR (rs2066853), AHR repressor (AHRR) (rs2292596), aryl hydrocarbon nuclear translocator (ARNT) (rs2228099), and CLOCK (rs1801260). Data were analyzed using multivariable logistic regression. RESULTS: Women heterozygous for the AHRR alleles (GC) had decreased odds of insomnia compared to women homozygous for the AHRR_C allele (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.49-0.96). Women with at least one of the AHRR_G or CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.64; 95% CI, 0.43-0.96). Additionally, women homozygous for the AHRR_G and CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.56; 95% CI, 0.35-0.89). None of the selected single nucleotide polymorphisms (SNPs) or combinations of SNPs were significantly associated with early awakening. CONCLUSIONS: Selected genetic polymorphisms in the AHR-signaling pathway (i.e., AHRR) and CLOCK may play a role in decreasing the risk for experiencing insomnia during the menopausal transition.

Effect of luteal-phase support on endometrial microRNA expression following controlled ovarian stimulation.

BACKGROUND: Studies suggested that microRNAs influence cellular activities in the uterus including cell differentiation and embryo implantation. In assisted reproduction cycles, luteal phase support, given to improve endometrial characteristics and to facilitate the implantation process, has been a standard practice. The effect of different types of luteal phase support using steroid hormones in relation to endometrial miRNA profiles during the peri-implantation period has not seen described. This study was designed to evaluate the expression of miRNAs during the luteal phase following controlled ovarian stimulation for IVF and the influence of different luteal phase support protocols on miRNA profiles. METHODS: The study was approved by the Johns Hopkins Hospital Institutional Review Board. Endometrial biopsies were obtained on the day of oocyte retrieval from 9 oocyte donors (group I). An additional endometrial biopsy was obtained 3-5 days later (Group II) after the donors were randomized into three groups. Group IIa had no luteal-phase support, group IIb had luteal support with micronized progesterone (P), and Group IIc had luteal support with progesterone plus 17-beta-estradiol (P + E). Total RNA was isolated and microarray analysis was performed using an Illumina miRNA expression panel. RESULTS: A total of 526 miRNAs were identified. Out of those, 216 miRNAs were differentially regulated (p < 0.05) between the comparison groups. As compared to the day of retrieval, 19, 11 and 6 miRNAs were differentially regulated more than 2 fold in the groups of no support, in the P support only, and in the P + E support respectively, 3-5 days after retrieval. During the peri-implantation period (3-5 days after retrieval) the expression of 33 and 6 miRNAs increased, while the expression of 3 and 0 miRNAs decreased, in the P alone and in the P + E group respectively as compared to the no steroid supplementation group. CONCLUSION: Luteal support following COS has a profound influence on miRNA profiles. Up or down regulation of miRNAs after P or P + E support suggest a role(s) of luteal support in the peri-implantation uterus in IVF cycles through the regulation of associated target genes.

Genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway as potential risk factors of menopausal hot flashes.

OBJECTIVE: We sought to determine if genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway are associated with menopausal hot flashes via hormone levels. STUDY DESIGN: Women (n = 639) aged 45-54 years completed a study survey and provided blood for genetic and hormone analyses. The associations were analyzed using multivariable logistic regression and generalized linear models. RESULTS: Women carrying CYP1B1 (rs1800440) GG genotype had 3-fold greater odds of experiencing hot flashes for ≥1 year compared to the AA genotype (adjusted odds ratio [OR], 3.05; 95% confidence interval [CI], 1.12-8.25). Adding serum estradiol concentrations to the confounder-adjusted model resulted in a nonsignificant association (adjusted OR, 2.59; 95% CI, 0.91-7.18). Carriers of both CYP1B1 (rs1800440) G and CYP1B1 (rs1058636) G alleles had higher odds of experiencing hot flashes for ≥1 year compared to women homozygous for the major alleles (adjusted OR, 1.77; 95% CI, 1.06-2.96), even after adjustment for serum estradiol. CONCLUSION: CYP1B1 is associated with menopausal hot flashes via pathways that may involve changes in serum estradiol concentration.

A genetic polymorphism in the CYP19A1 gene and the risk of hypertension among midlife women.

OBJECTIVE: To test whether a synonymous single nucleotide polymorphism (A→G; rs700518) in the CYP19A1 gene, which encodes the enzyme aromatase, is associated with an increased risk for hypertension of midlife women. METHODS: In a cross-sectional study, 639 midlife women were recruited. Eligible women had their blood pressure, weight and height measured, and donated a blood sample for hormone and genetic analyses. The participants also completed a detailed study survey. Women were grouped according to their genotype, blood pressure measurements, and medical history. The data were analyzed using logistic and linear regression models. The study had 80% power to detect small differences in mean systolic blood pressure (SBP; 4.5 mmHg) and diastolic blood pressure (DBP; 3 mmHg). RESULTS: The selected polymorphism was significantly associated with hypertension and SBP in unadjusted analyses. Interestingly, women with hypertension were more likely to be homozygous for the A allele (AA) compared to women who were not categorized as having hypertension. Further, the mean SBP was significantly higher for women who were homozygous for the A allele when compared to women carrying the other genotypes (AG or GG). The unadjusted association between DBP values and genotype was of borderline statistical significance (p=0.07). However, after adjustment for potential confounders (age, race, body mass index (BMI), smoking and physical activity), the associations between genotype and hypertension/blood pressure were attenuated and not statistically significant. CONCLUSION: The rs700518 polymorphism in the CYP19A1 is not associated with hypertension in our sample of midlife women. Other factors, including race and BMI, appear to play a greater role.

Somatic symptoms among cosmetologists compared to women in other occupations.

BACKGROUND: Although the literature pertaining to the cosmetology occupation and specific health effects, such as asthma, dermatitis, and reproductive function, has grown substantially, little information is available about whether cosmetologists are at increased risk of other symptoms compared to women working in other occupations. Thus, the purpose of this study was to determine if cosmetologists of reproductive age are at increased risk of self-reported symptoms compared to women of the same age working in other occupations. METHODS: Data were analyzed from 450 cosmetologists and 511 women in other occupations, aged 21-55 years, in the Baltimore metropolitan region who responded to a mailed survey that ascertained detailed data on symptoms as well as usual work tasks. RESULTS: The data showed that cosmetologists were at increased risk of memory and sleep disturbances, muscle weakness, throat irritation, and hot flashes compared to women of the same age working in other occupations after adjustment for confounders, including cigarette smoking. Among the cosmetologists, handling cleaning supplies; hair bleaching; use of straighteners, texturizers, or permanent chemicals; and several nail care work tasks were associated with one or more of the queried symptoms. CONCLUSIONS: Findings from this study suggest that, compared to noncosmetologists, cosmetologists are at increased risk for a number of symptoms reported to be associated with decreased quality of life. These symptoms may also reflect chronic exposure to chemicals that have been shown to be related to more severe long-term health outcomes.

Adverse health outcomes among cosmetologists and noncosmetologists in the Reproductive Outcomes of Salon Employees (ROSE) study.

The purpose of this study was to examine adverse health outcomes, including those related to cardiovascular and skin health as well as respiratory functions, among cosmetologists aged 21 to 55 yr and to compare data to women of the same age working in other occupations. Self-reported data were analyzed from 450 cosmetologists and 511 women in other occupations who participated in the Reproductive Outcomes of Salon Employees (ROSE) study in Maryland. Odds ratios (OR) and 95% confidence intervals (95% CI) were computed using logistic regression to examine the associations between cosmetologist occupation and each adverse health outcome adjusted for age, education, and smoking status. Cosmetologists were at significantly increased risk of depression compared to noncosmetologists after adjustment for age, education, and smoking status (OR 1.49; 95% CI 1.10, 2.00). There were no statistically significant associations between cosmetology occupation and the other adverse health outcomes, including those related to allergies and skin disorders, in both the unadjusted and adjusted analyses. Cosmetologists may be exposed to chemicals in the salon that lead to depression. Future study needs to be conducted to examine specific chemical exposures in the salon. This will help to provide information required for the development of best occupational safety practices among salon workers.

Health outcomes of children born to cosmetologists compared to children of women in other occupations.

The purpose of the study was to examine the health of children born to cosmetologists compared to the health of children of women working in other occupations. Cross-sectional data were analyzed from 319 cosmetologists and 366 women in other occupations aged 21 to 55 years who reported at least one live birth. Repeated-measures modeling was used to account for lack of independence among multiple pregnancies per participant. The results showed that cosmetologist occupation was associated with having a child with a learning disorder; however, the strength of this association was attenuated and the odds ratio was not statistically significant after confounder adjustment. Cosmetologist occupation was not associated with other adverse health outcomes among the children born to women in such an occupation, including urinary/kidney health problems. The findings indicate that cosmetologists are not at increased risk of having a child with medical problems compared to women in other occupations.

Menstrual cycle abnormalities among cosmetologists: the Reproductive Outcomes in Salon Employees (ROSE) study.

This study was conducted to examine whether cosmetologists of reproductive age are at increased risk of menstrual cycle abnormalities compared to women of the same age working in other occupations. Participants in the study (450 cosmetologists and 511 noncosmetologists) were recruited through mass mailing of questionnaires. To be included in the study, respondents to the survey had to be between 21 and 55 years of age and not have had a hysterectomy/oophorectomy. The main outcome measures included irregular menstrual cycle length and pain during menstrual period. The results showed no statistically significant associations between being a cosmetologist and having menstrual cycle abnormalities. The observed estimates did not differ when including and excluding women who had ever used oral contraceptives. Thus, the findings of the study suggest that cosmetologists are not at increased risk of menstrual cycle abnormalities. Further studies using detailed salon exposure and work task data in relation to menstrual cycle outcomes should be conducted.

Serum leptin levels, hormone levels, and hot flashes in midlife women.

OBJECTIVE: To examine the associations between serum leptin levels, sex steroid hormone levels, and hot flashes in normal weight and obese midlife women. DESIGN: Cross-sectional study. SETTING: University clinic. PATIENT(S): 201 Caucasian, nonsmoking women aged 45 to 54 years with a body mass index of <25 kg/m2 or >or=30 kg/m2. INTERVENTION(S): Questionnaire, fasting blood samples. MAIN OUTCOME MEASURE(S): Serum leptin and sex steroid hormone levels. RESULT(S): Correlation and regression models were performed to examine associations between leptin levels, hormone levels, and hot flashes. Leptin levels were associated with BMI, with "ever experiencing hot flashes" (questionnaire), with hot flashes within the last 30 days, and with duration of hot flashes (>1 year, P=.03). Leptin was positively correlated with testosterone, free testosterone index, and free estrogen index and inversely associated with levels of sex hormone-binding globulin. In women with a body mass index>or=30 kg/m2, leptin levels no longer correlated with testosterone levels. CONCLUSION(S): Serum leptin levels are associated with the occurrence and duration of hot flashes in midlife women; however, no correlation was found between leptin and serum estradiol.

Hot flashes and blood pressure in midlife women.

OBJECTIVES: Recent epidemiological studies suggest that hot flashes may have a detrimental impact on the cardiovascular system. The purpose of this study was to examine the associations between hot flashes and blood pressure among women aged 45-54 years who had never used hormone therapy. STUDY DESIGN: Data were analyzed from 603 women who participated in the Midlife Health Study, a cross-sectional study conducted in the Baltimore Metropolitan region. MAIN OUTCOME MEASURES: All participants came to the clinic where systolic and diastolic blood pressures were measured, height and weight were assessed, and a questionnaire was administered that ascertained detailed data on history of hot flashes and participant demographics and health habits. RESULTS: The data showed that 56.9% of the participants reported ever experiencing hot flashes. In the age-adjusted analyses, both systolic and diastolic blood pressures were significantly and positively associated with hot flashes. However, the estimates were markedly attenuated and not statistically significant after adjustment for age, race, smoking status, current alcohol use, body mass index, and use of an anti-hypertensive agent or a cholesterol-lowering medication. Similar results were observed for moderate or severe hot flashes, hot flashes experienced for one or more years, and hot flashes experienced within the previous 30 days. CONCLUSIONS: These findings indicate that hot flashes are not significantly associated with blood pressure during midlife.

Infertility among cosmetologists.

Although chemicals used in hair salons have been linked to infertility in animal models, little is known about whether exposures in hair salons are associated with infertility in women. Thus, a survey-based study was performed to investigate infertility in 448 cosmetologists and 508 non-cosmetologists working in Baltimore, Maryland and its surrounding counties. Infertility was assessed with questions addressing time-to-pregnancy (TTP) length (>or=12 months), consulting a medical professional about fertility problems, and taking medication to become or maintain a pregnancy. Occupational exposure was assessed by job tasks and customers served per week. There were no statistically significant associations between working as a cosmetologist and the odds of TTP>or=12 months, consulting a medical professional about infertility, or taking medication to either become or maintain a pregnancy. The data suggest that cosmetologists are not at increased risk for infertility compared to women of the same age working in other occupations.