title: Plasma sex steroid hormones and risk of developing type 2 diabetes in women: a prospective study Menopausal hot flashes and insulin resistance Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women's Health Across the Nation Accuracy of Subjective Hot Flush Reports Compared With Continuous Sternal Skin Conductance Monitoring
abstract: Aims /hypothesis Prospect i ve data directly investigating the role of endogenous sex hormones in diabetes risk have been scant , particularly in women . We aim ed to examine comprehensively plasma sex hormones in connection with risk of developing type 2 diabetes  in postmenopausal women . Methods We conducted a prospect i ve , nested case – control study of  plasma oestradiol , testosterone and dehydroepi and rosterone sulfate  and risk of type 2 diabetes in a cohort of women health professionals with a mean age of 60.3 and 12.2 years since menopause . Among women not using hormone therapy and free of baseline cardiovascular disease , cancer and diabetes , 359 incident cases of type 2 diabetes were matched with 359 controls during an average follow-up of 10 years . Results Oestradiol and testosterone were each strongly and positively associated with risk of type 2 diabetes . After adjustment for BMI , family history , lifestyle and reproductive variables , the multivariable relative risks ( 95 % CI ) comparing the highest vs lowest quintile were 12.6 ( 2.83–56.3 ) for total oestradiol ( p = 0.002 for trend ) , 13.1 ( 4.18–40.8 ) for free oestradiol ( p < 0.001 for trend ) , 4.15 ( 1.21–14.2 ) for total testosterone ( p = 0.019 for trend ) and 14.8 ( 4.44–49.2 ) for free testosterone ( p < 0.001 for trend ) . These associations remained robust after adjusting and accounting for other metabolic syndrome components and baseline HbA1c levels . Conclusions /interpretationIn postmenopausal women , higher plasma levels of oestradiol and testosterone were strongly and prospect ively related to increased risk of developing type 2 diabetes . These prospect i ve data indicate that endogenous levels of sex hormones may play important roles in the pathogenesis of type 2 diabetes . Clinical Trials.gov ID no. : NCT00000479 Objective Recent data have indicated that menopausal hot flashes may be a determinant for cardiovascular health . Therefore , we studied the impact of hot flashes on insulin resistance , one of the most powerful markers of cardiovascular health , in recently postmenopausal women . Methods We studied 143 recently postmenopausal ( amenorrhea 6 - 36 mo ) healthy and normal-weight women without previous hormone therapy use . The women prospect ively recorded the number and severity of hot flashes for 2 weeks , and a vali date d total symptom score , the hot flash weekly weighted score , was calculated for each woman . Insulin resistance was assessed from  fasting blood levels of glucose and insulin with the homeostasis model assessment . Results In 12 women , the assessment of insulin ( n = 11 ) or glucose ( n = 1 ) failed , and they were excluded from further analysis . Thus , hot flashes were absent in 19 , mild in 32 , moderate in 27 , and severe in 53 women . The levels of glucose or insulin , or HOMA showed no differences between these groups , nor was insulin resistance related to the number or severity of hot flashes or to the levels of C-reactive protein or sex hormone – binding globulin . Overall , insulin resistance showed a positive association with body mass index ( mean difference , 0.058 ; 95 % CI , 0.015 - 0.102 ; P = 0.009 ) and a negative association with level of estradiol ( mean difference , −0.002 ; 95 % CI , −0.003 to −0.001 ; P = 0.009 ) . Conclusions Insulin resistance may not be involved in hot flash – related changes in cardiovascular health . However , because of the small sample size , these findings need to be interpreted with caution Objective : The aim of this study was to examine changes in health-related quality of life ( HRQL ) during the menopausal transition , controlling for chronological aging , symptoms , and other covariates . Methods : This was a prospect i ve , longitudinal study of women aged 42 to 52 years at baseline recruited at seven US sites ( N = 3,302 ) in the multiethnic Study of Women 's Health Across the Nation . Women eligible for the cohort had an intact uterus , had at least one ovary , were not currently using exogenous hormones , were either premenopausal or early perimenopausal , and were self-identified as one of the study 's design ated racial/ethnic groups . Data from the baseline interview and six annual follow-up visits are reported . HRQL was assessed with five subscales from the Medical Outcomes Study Short-Form Health Survey , with reduced functioning defined as being in the lowest 25 % on a subscale . Covariates included symptoms , medical conditions , sociodemographics variables , physical activity , and psychological factors . Results : With adjustment for baseline age , chronological aging , and relevant covariates , the odds of reduced role-physical functioning were significantly greater at late perimenopause ( odds ratio , 1.46 ; 95 % CI , 1.08 - 1.99 ) and postmenopause ( odds ratio , 1.49 ; 95 % CI , 1.09 - 2.04 ) compared with premenopause . Menopause status was unrelated to bodily pain , vitality , role-emotional , or social functioning .  Hormone therapy users were more likely to report reduced functioning . Other variables significantly related to HRQL across all domains included vasomotor symptoms , urine leakage , poor sleep , arthritis , depressed mood , perceived stress , and stressful life events . Conclusions : The menopausal transition showed little impact on HRQL when adjusted for symptoms , medical conditions , and stress OBJECTIVE : To compare 2 subjective and 1 objective method for assessing hot flush frequency : prospect i ve paper hot flush diaries , prospect i ve electronic event markers , and the Biolog ambulatory sternal skin conductance monitor . METHODS : Fifty-five breast cancer survivors provided two 24-hour periods of data , 1 week apart , at baseline before being r and omized for an intervention study . Women completed a prospect i ve paper hot flush diary and pressed an event marker to subjectively record each hot flush they experienced while wearing a sternal skin conductance monitor . RESULTS : Sensitivity was uniformly low ( < 50 % ) for both subjective methods at each week . The estimated probability that a woman would record a true monitor-verified hot flush subjectively by diary or event marker was between 36 % and 50 % of the time if she was awake and between 22 % and 42 % of the time if she was asleep . Underreporting of diary hot flushes consequently result ed in more than 50 % missing severity and bother ratings . Specificity was high ( 96–98 % ) for both the diary and event marker , for both weeks , and for both waking and sleeping times . The positive predictive value was low ( 34–52 % ) , and negative predictive value was high ( 94–97 % ) . This indicates that , rather than overreporting hot flushes when they did not exist , women tended to underreport hot flushes when they did exist . CONCLUSION : Use of prospect i ve paper hot flush diaries and electronic event markers may seriously underestimate hot flush frequency and result in missed intensity and bother ratings . LEVEL OF EVIDENCE :
target: Because of the heterogeneity and the limited number of studies , there is no sufficient evidence on the potential role of vasomotor symptoms in metabolic health .
  However , both high- quality cohort studies , with large study population s and adjustment for multiple confounding variables showed positive associations between vasomotor symptoms and insulin resistance and type 2 diabetes mellitus .
  These findings suggest that there is an association between vasomotor symptoms and metabolic health outcomes .
background: The objective of this study was to systematic ally review studies describing the association between vasomotor symptoms and metabolic syndrome , type 2 diabetes and insulin resistance in peri- and postmenopausal women .