Evoked subjective and hypothalamic-pituitary-adrenal (HPA) axis stress responses and the impact of co-occurring sleep disturbances in midlife women with and without persistent vasomotor symptoms

Katherine Coleman, MS

Brigham and Women’s Hospital – Research Assistant
Coleman_Katherine poster

Scientific Abstract

Background: Hot flashes and night sweats (called vasomotor symptoms, VMS) are prevalent and distressing to many women during and after menopause. VMS are strongly linked with stress exposures, depression and insomnia. Women with VMS and with insomnia have been shown to have altered basal cortisol profiles similar to those observed in chronic stress conditions. We aimed to extend this work by examining relationships of VMS with response to an evoked stress paradigm, as well as the impact of concurrent insomnia.

Methods: 37 healthy peri- and postmenopausal women ages 45-65 with and without VMS and without current anxiety or depressive disorders were enrolled. Participants underwent the Montreal Imaging Stress Task (MIST), a social stress paradigm combining a computerized math task with social evaluative feedback. Changes in subjective, hemodynamic and salivary cortisol responses were measured pre- to post-task. Participants were categorized as having persistent VMS (10+ years; 27%), non-persistent VMS (<10 years; 46%) or no/minimal VMS (27%). Insomnia Severity Index  14 indicated presence of insomnia. Group differences in responses were analyzed using ANOVA.

Results: Women with persistent VMS showed a diminished stress response to the MIST as compared to women with no/minimal VMS, evidenced by smaller pre- to post-task changes in subjective stress ratings (score change 19 vs 31; p=0.055) and reduced salivary cortisol responses (0.01 vs 0.07 ug/dL change; p=0.05). Diminished cortisol response was most evident in women with comorbid VMS and insomnia compared to women with neither (0.0 vs 0.08 ug/dL change; p=0.016). Significant group differences in hemodynamic responses were not observed.

Conclusions: Our findings demonstrate that women with VMS, particularly when persistent or comorbid with insomnia, have blunted perceived and HPA-axis responses to evoked stress, consistent with anxiety disorders and PTSD, suggesting that VMS may represent a chronic stress condition.

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research Areas


Katherine L Coleman, MS, Jessica N Busler, PhD, Aleta S Wiley, MPH, Hadine Joffe, MD, MSc, Pamela B Mahon, PhD

Principal Investigator

Pamela Mahon, PhD

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