The Hot Flash Experience of Diabetic Women at Menopause

Sharon Dormire, PhD, RN, C, The University of Texas at Austin School of Nursing
John L. Ivy, PhD, The University of Texas at Austin Department of Kinesiology & Health Education, College of Education

Purpose: Menopausal hot flashes are experienced by 75 to 80% of women undergoing the natural course of menopause and 95-100% of women who have their ovaries surgically removed (Bachmann, 1999). Currently in the United States, there are 20,047,000 women of menopausal age (45-54) leading to an estimated 15,035,250 experiencing hot flashes (United States Census Bureau, 1999). An additional 22,507,000 women currently of ages 35-44 will experience menopause over the next ten to fifteen years (United States Census Bureau, 1999). As prevalent and significant to health care utilization as hot flashes are, however, the physiological mechanism of hot flashes is unknown. Furthermore, although it has long been known that there is an association between changing estrogen levels and menopausal hot flashes, and although it has been demonstrated that estrogen replacement can reasonably treat hot flashes for most women, how estrogen is associated with hot flash physiology is not yet known (Freedman, 2000).
The focus of this research is to examine the hypothesis that hot flashes are triggered as a result of an estrogen-related decline in glucose delivery to the brain. This hypothesis is supported both by animal studies and by a recently completed experimental study in a sample of postmenopausal women. In a logical extension of the hypothesis, it follows that menopause related changes in glucose delivery would be compounded in women with metabolic glucose delivery impairment associated with diabetes. Review of the literature reveals only three publications related to the menopause experience for the woman with diabetes. None of these three focus on description of symptoms of menopause experienced by the diabetic. Therefore, the objective of the proposed research project is to determine if the characteristics of hot flashes at menopause differ between women with diabetes and those of healthy women. The findings of this study have the potential to provide significant enrichment to the emerging model of the menopausal hot flash.

Research Aims: The objective of this pilot study is to determine if hot flashes experienced by diabetic women at menopause differ from those of healthy women.

Methods: To meet the goals of this study, 20 postmenopausal women between the ages of 40-55 will be recruited. All of the women recruited will be free of any chronic health problems (except Type II Diabetes), be normal to slightly over-weight women (body mass index 20-30), and experiencing hot flashes but not taking hormone therapy. Half of the women will be healthy and half will have Type II diabetes for at least 1 year before they started experiencing hot flashes. All participants in the study will be scheduled for a screening visit at the Laboratory Corporation of America to complete the following: informed consent; obtain height, weight, and vital sign measurements; laboratory blood work; a general questionnaire; and a hot flash history. Then, a research visit to the Exercise Physiology Laboratory of The University of Texas at Austin will be scheduled. During that visit hot flashes will be monitored through participant self-report and through skin conductance monitoring under conditions of fasting and feeding. In addition, a warming pad will be applied to the chest for 30 minutes of each hour as a hot flash stimulus. Blood glucose levels will be monitored every 15 minutes throughout the 3 hour data collection protocol. Findings from the proposed study will enrich the findings regarding changes in hot flash frequency as blood glucose changes in non-diabetic women by extending information to include a comparison with Type II diabetic women.