Prevalence and impact of vasomotor symptoms associated with menopause among women in Brazil: Subgroup analysis from an international cross-sectional survey.

OBJECTIVE: This study assessed the prevalence and impact of moderate and/or severe vasomotor symptoms and related treatment patterns in midlife women in Brazil. STUDY DESIGN: Brazilian women aged 40 to 65 years completed an online survey. The prevalence of moderate to severe vasomotor symptoms was assessed in postmenopausal women who completed a series of questionnaires to elicit responses regarding their treatment patterns and attitudes to treatments. MAIN OUTCOME MEASURES: Perimenopausal and postmenopausal women with moderate to severe vasomotor symptoms completed three standardized questionnaires (Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbances Short Form 8b) and answered open-ended questions. RESULTS: Of 1244 postmenopausal women who accessed the survey, 36.2 % had experienced moderate to severe vasomotor symptoms in the previous month. Moderate to severe vasomotor symptoms among 501 perimenopausal and postmenopausal women negatively affected overall quality of life (mean total score on the Menopause-Specific Quality of Life questionnaire was 3.6/8). On the Work Productivity and Activity Impairment questionnaire, women's scores for impairments in overall work and daily activities due to vasomotor symptoms were 50.3 % and 60.0 %, respectively. Overall mean (standard deviation) score on the Patient-Reported Outcomes Measurement Information System Sleep Disturbances Short Form 8b was 25.5 (5.8) on a scale of 8 to 40. Most women sought medical advice (65.5 %), but over half were not receiving treatment. Those who received treatment reported moderately favorable attitudes to hormone and nonhormone prescription medicines, but safety concerns remained. CONCLUSION: Brazilian women experienced a relatively high prevalence and burden of moderate to severe vasomotor symptoms.

Can cognitive behavioral therapy improve vasomotor symptoms and recurrent depression in postmenopausal women?

OBJECTIVE: The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in the treatment of vasomotor, sexual dysfunction, and recurrent depression in postmenopausal women. METHODS: This prospective, open study evaluated 112 postmenopausal women with vasomotor symptoms. Sexual dysfunction has cultural, social, biological, and emotional issues and divided into two groups: G1, without depression (n=65) and G2, with recurrent depression (n=47). The subjects underwent 12 sessions of in-person cognitive behavioral therapy and 12 sessions of home-based activity over a period of 6 months. They were evaluated at 3 months following the completion of therapy. Depression, memory, and attention-related functions, as well as climactic symptoms, were assessed using a questionnaire. RESULTS: In the depression questionnaire, the G1 group had a lower initial score than the G2 group (p<0.01). Following 6 months of therapy, both groups had similar improved scores. In the depression questionnaire, the women in group G1 had higher baseline values. In the assessment of vasomotor symptoms, the values in both groups were similar and showed an improvement in vasomotor symptoms after 24 weeks of treatment, but these effects disappeared after the follow-up of 48 weeks in the G2 group. Both groups improved the sexual dysfunction after 24 weeks. CONCLUSION: Cognitive behavioral therapy may be effective in reducing vasomotor symptoms and ameliorate the sexual dysfunction and recurrent depression in postmenopausal women after 24 weeks of treatment.

Severe menopausal symptoms linked to cognitive impairment: an exploratory study.

OBJECTIVE: To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women. METHODS: This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI). RESULTS: The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m 2 . On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI. CONCLUSION: Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.

Fezolinetant for the treatment of vasomotor symptoms associated with menopause: a meta-analysis.

This systematic review and meta-analysis investigated the efficacy and safety of fezolinetant for the treatment of moderate-to-severe vasomotor symptoms (VMS) associated with menopause. PubMed, Cochrane Library, Embase and Web of Science were searched for randomized controlled trials (RCTs) published from inception to June 2023, comparing fezolinetant to placebo in postmenopausal women suffering from moderate-to-severe VMS. The mean difference and risk ratio were calculated for continuous and binary outcomes, respectively. R software was used for the statistical analysis, and RoB-2 (Cochrane) to assess the risk of bias. We performed subgroup analysis based on different dosing regimens. Five RCTs comprising 3302 patients were included. Compared with placebo, at 12-week follow-up, fezolinetant significantly reduced the daily frequency of moderate-to-severe VMS (weighted mean difference [WMD] - 2.36; 95% confidence interval [CI] - 2.92, -1.81) and daily severity of moderate-to-severe VMS (WMD -0.22; 95% CI -0.31, -0.13). Also, fezolinetant significantly improved the quality of life (WMD -0.42; 95% CI -0.58, -0.26) and sleep disturbance (WMD -1.10; 95% CI -1.96, -0.24). There were no significant differences between groups in adverse events. These findings support the efficacy and safety of fezolinetant for the treatment of VMS related to menopause.

Effect of a lavender essential oil and sleep hygiene protocol on insomnia in postmenopausal women: A pilot randomized clinical trial.

INTRODUCTION: Insomnia and vasomotor symptoms are frequently experienced during the menopausal transition and in postmenopause, worsening sleep maintenance and quality of life. Our study evaluated the use of lavender essential oil and sleep hygiene guidance on quality of life, sleep patterns and self-reported hot flashes in postmenopausal women with insomnia diagnosis. METHODS: This study is part of a larger experimental, double-blind, randomized controlled trial. We included 35 postmenopausal women with a diagnosis of insomnia who were distributed in two groups: A Placebo group (sunflower oil) and an Aroma group (Lavandula angustifolia essential oil); both inhaled the oils before bedtime for 29 days. The groups received sleep hygiene guidelines and weekly follow-up. Validated questionnaires were used to assess the effect of the intervention, and a sleep diary was used to assess sleep onset latency (SOL), total sleep time (TST), and sleep efficiency (SE) daily. Participants who complained of vasomotor symptoms at baseline kept a daily record of their frequency and intensity. RESULTS: All participants benefited in almost all domains of quality of life and in the self-assessed TST and SE. The Aroma group achieved a significant improvement in their overall quality of life score over time. No differences were observed in respect of the hot flashes record and daytime sleepiness. CONCLUSIONS: The aromatherapy intervention was effective in improving the overall quality of life in the Aroma group. Moreover, the sleep diary and sleep hygiene instructions helped all participants to, respectively, self-assess and improve their sleep patterns.

Prevalence and impact of vasomotor symptoms due to menopause among women in Brazil, Canada, Mexico, and Nordic Europe: a cross-sectional survey.

OBJECTIVE: This study investigated the prevalence and impact of moderate to severe vasomotor symptoms (VMS), related treatment patterns, and experiences in women. METHODS: The primary objective was to assess the prevalence of moderate to severe menopause-related VMS among postmenopausal women aged 40 to 65 years in Brazil, Canada, Mexico, and four Nordic European countries (Denmark, Finland, Norway, and Sweden) using an online survey. Secondary objectives assessed impact of VMS among perimenopausal and postmenopausal women with moderate to severe VMS using the Menopause-Specific Quality of Life questionnaire, Work Productivity and Activity Impairment questionnaire, Patient-Reported Outcomes Measurement Information System sleep disturbances assessment, and questions regarding treatment patterns and attitudes toward symptoms and available treatments. RESULTS: Among 12,268 postmenopausal women, the prevalence of moderate to severe VMS was about 15.6% and was highest in Brazil (36.2%) and lowest in Nordic Europe (11.6%). Secondary analyses, conducted among 2,176 perimenopausal and postmenopausal women, showed that VMS affected quality of life across all domains measured and impaired work activities by as much as 30%. Greater symptom severity negatively affected sleep. Many women sought medical advice, but most (1,238 [56.9%]) were not receiving treatment for their VMS. The majority (>70%) considered menopause to be a natural part of aging. Those treated with prescription hormone therapy and nonhormone medications reported some safety/efficacy concerns. CONCLUSIONS: Among women from seven countries, moderate to severe menopause-related VMS were widespread, varied by region, and largely impaired quality of life, productivity, and/or sleep.

Prevalence of menopausal symptoms and severity related factors among mid-aged Paraguayan women as measured with the 10-item Cervantes Scale.

Objective: To determine the prevalence of menopausal symptoms and factors related to severity in mid-aged women.Methods: Cross-sectional study in which 216 urban-living women from Asunción-Paraguay (40-60 years) were surveyed with the 10 item Cervantes Scale (CS-10) and a general questionnaire (personal and partner data).Results: Median (interquartile range [IQR]) age of the sample was 48 [9] years, 48.1% were postmenopausal, 8.8% used menopausal hormone therapy, 39.4% psychotropic drugs, 43.5% had hypertension, 6.5% diabetes, 51.9% abdominal obesity, and 89.3% had a partner (n = 193). A history of sexual abuse was present in 2.8%. Median total CS-10 score was 8.5 [9.75]. Overall, 93.3% (180/193) of women having a partner were sexually active, with a median coital frequency of 8 times per month. According to the CS-10, the three most prevalent menopausal symptoms were: aching in muscles and/or joints (70.8%), anxiety and nervousness (70.8%) and hot flashes/night sweats (54.2%). Factors associated with higher CS-10 scores were: female age and educational level, marital status, menopausal status, and marital sexual aspects. Partner educational level was inversely correlated (rho Spearman coefficient) with CS-10 total scores. However, multiple linear regression analysis found that higher total CS-10 scores (more severe menopausal symptoms) negatively correlated to coital frequency and positively correlated with peri- and postmenopausal status, parity, sedentary lifestyle and a history of sexual abuse.Conclusion: Menopausal symptoms in this mid-aged urban female Paraguayan sample were related to hormonal, sexual and other female aspects.

Non-oncological gynecological diagnoses in a women's health care service during the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2.

OBJECTIVE: Analyze clinical factors and non-oncological gynecological diagnoses before and during the initial months of the COVID-19 pandemic. METHOD: Crosssectional study at an Outpatient Gynecology Clinic in Brazil involving medical consultations performed during the pre-pandemic and pandemic periods. The number of visits, prevalence of non-oncological gynecological diagnoses, and clinical-demographic data were analyzed. Parametric continuous variables were evaluated by Student's t-test and ANOVA tests, non-parametric variables were evaluated by the Mann-Whitney and Wilcoxon tests, and categorical or binary variables were evaluated by chi-square and Fisher's exact tests. Univariate logistic regression tests were performed, and variables with p ≤ 0.20 were subjected to multivariate logistic regression. Statistical significance was set at p < 0.05. RESULTS: There were 1,236 records during the pre-pandemic period and 530 during the pandemic, reflecting a significant reduction (57.88%; p = 0.001) in medical consultations. The outpatient prevalence of women older than 50 y (OR 0.85; 95%CI 0.68-1.05) reduced, and the outpatient prevalence of postmenopausal women with hot flashes (OR 1.34; 95%CI 1.09-1.65; p = 0.005) and alcohol consumption habits (OR 2.76; 95%CI 1.15-6.59; p = 0.023) increased. There was a 6% proportional increase in noninflammatory disorders of the female genital tract (p = 0.030) and a 72.4% decrease in general physical examinations, contraception, and procreation (p = 0.001). Multivariate analysis showed that there was an increased prevalence of abnormal uterine bleeding (OR, 1.7; 95% CI 1.34-2.16; p = 0.001) and endometriosis (OR 1.65; 95% CI 1.13-2.42; p = 0.01). CONCLUSION: Medical consultations for benign gynecological diseases during the pandemic prevented non-inflammatory disorders of the female genital tract, with an emphasis on abnormal uterine bleeding and endometriosis. There was an increased prevalence of women under 50 years of age, women with symptoms of hot flashes, and alcohol consumption habits and a reduction in the prevalence of general physical examinations, contraception, and procreation.

Menopause in people with cystic fibrosis.

This study aimed to describe the menopause experience of people with cystic fibrosis (CF). We conducted a computer-based cross-sectional survey of women with CF 25 years or older at 10 US CF centers exploring a range of sexual and reproductive health concerns, including menopause. We used descriptive statistics to analyze results. Of 460 participants, 5 (3%) were perimenopausal and 34 (7%) were postmenopausal. Of participants perimenopausal or menopausal (n = 39), 97% reported the following menopausal symptoms occurring at least once a week: most commonly early wake-up (83%); stiffness/soreness in joints, neck, or shoulders (65%); and night sweats (65%). Among menopausal participants, the median self-reported age at menopause was 48.5 years (interquartile range, 5.5 y). Thirty percent experienced worsened CF symptoms during menopause, and 42% experienced worsening CF symptoms after menopause. Twenty-four percent of menopausal participants were on estrogen therapy and 15% on estrogen and progesterone therapy. Three-fourths of participants using hormone therapy reported no change in their CF symptoms. One percent of the 460 survey participants reported discussing menopause with their CF provider, despite 19% wanting to discuss this topic with their CF team. This is the first study to describe menopause symptoms of people with CF. People with CF experience a variety of menopausal symptoms and often report a worsening of their CF symptoms after menopause, suggesting an interplay between female sex hormones and CF. Larger studies are needed comparing the sexual and reproductive health experiences and care needs of people with CF in the menopause transition to the general population.

Effects of nutritional interventions on the severity of depressive and anxiety symptoms of women in the menopausal transition and menopause: a systematic review, meta-analysis, and meta-regression.

IMPORTANCE: Depression and anxiety may significantly affect women during the menopausal transition. In addition to traditional treatment strategies such as hormone therapy, antidepressants, and psychotherapy, nutritional interventions have been increasingly studied, but there is no consensus about their role in this patient population. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effect of nutritional interventions on the severity of depressive (DS) and anxiety (AS) symptoms in women during the menopausal transition or menopausal years. EVIDENCE REVIEW: Electronic search using databases PubMed, Cochrane, and Embase to identify articles indexed until January 31, 2021, focusing on randomized placebo-controlled trials documenting the effect of diet, food supplements, and nutraceuticals on DS and AS. FINDINGS: Thirty-two studies were included (DS, n = 15; AS, n = 1; DS and AS combined, n = 16). We found two studies that demonstrated data combined with other interventions: one with lifestyle interventions (vitamin D plus lifestyle-based weight-loss program) and another with exercise (omega 3 plus exercise). The pooled effect size favored the intervention group over placebo for both DS and AS (DS: standardized mean difference, -0.35 [95% confidence interval, -0.68 to -0.03; P = 0.0351]; AS: standardized mean difference, -0.74 [95% CI, -1.37 to -0.11; P = 0.0229]). There was significant heterogeneity in the pooled results, which can be attributed to differences in assessment tools for depression and anxiety as well as the variety of nutritional interventions studied. The subgroup analysis showed a statistically significant effect of menopausal status (perimenopausal or menopausal) but not the type or duration of nutritional intervention. Older age was the only significant predictor of the effect size of nutritional interventions in the meta-regression. CONCLUSIONS AND RELEVANCE: Nutritional interventions are promising tools for the management of mood/anxiety symptoms in women during the menopausal transition and in postmenopausal years. Because of significant heterogeneity and risk of bias among studies, the actual effect of different approaches is still unclear.

Eficacia y seguridad de una alternativa a la terapia hormonal de la menopausia: extracto purificado de polen / Efficacy and safety of an alternative to menopausal hormone therapy: purified cytoplasm of pollen

Los síntomas vasomotores (SVM) se encuentran entre los síntomas más comunes de la transición a la menopausia. Más del 70% de las mujeres de mediana edad informan SVM en algún momento durante la transición a la menopausia, y para un tercio de las mujeres los SVM son muy frecuentes o graves. Muchas mujeres recurren a terapias naturales para tratar los SVM. Esta revisión se centra en una de esas opciones naturales: el extracto purificado de polen (Serelys®). Se realizó una búsqueda e identificación de artículos publicados hasta octubre de 2022 recopilados de sistemas de búsqueda electrónicos, como Google Scholar, MEDLINE, PubMed y Scopus. Las palabras de búsqueda fueron “Vasomotor symptoms”, “menopause” AND “pollen”. Los estudios preclínicos señalan un mecanismo de acción en su implicación sobre el sistema serotoninérgico, así como su unión a los receptores de dopamina. Los estudios clínicos demuestran la seguridad y el efecto positivo sobre los SVM.

Vasomotor symptoms (VMS) are among the most common symptoms of the menopausal transition. More than 70% of middle-aged women report VMS at some point during the menopausal transition, and for a third of women, VMS is very common or severe. Many women turn to natural therapies to treat VMS. This review focuses on one such natural option, purified pollen extract (Serelys®). The information available until October 2022 was collected via the library and electronic search systems such as Google Scholar, MEDLINE, PubMed, and Scopus. The search words were: “Vasomotor symptoms”, “menopause” AND “pollen”. Preclinical studies point to a mechanism of action in its involvement in the serotonergic system, as well as its binding to dopamine receptors. Clinical studies demonstrate the safety and positive effect on VMS.

PSMD9 is linked to T2D age of onset, years of isolated and combined insulin therapy, irregular menses, and hot flashes.

OBJECTIVE: PSMD9 is a ubiquitous protein present at high concentrations in eukaryotic cells. It contributes to the degradation of intracellular proteins in the immune system. It is part of the 26S proteasome complex, and its regulatory role on proteasomal activity as well as its effect on genetic transcription have been recognized. PSMD9 has been related with insulin secretion, and it regulates the ligand-dependent retinoid-target genes transcription. Importantly, PSMD9 rs74421874 (IVS3+nt460-G>A), rs3825172 (IVS3+nt437-C>T), and rs14259 SNPs have been previously linked to type 2 diabetes (T2D), maturity-onset diabetes of the young 3 (MODY3), overweight status and waist circumference, hypertension, hypercholesterolemia, cardiovascular disease, microvascular disease (retinopathy, neuropathy, and nephropathy), carpal tunnel syndrome, depression, anxiety, insomnia, and sleep hours. MATERIALS AND METHODS: In this study, we analyzed the above-mentioned PSMD9 rs74421874 (IVS3+nt460-G>A), rs3825172 (IVS3+nt437-C>T), and rs14259 SNPs for linkage to the T2D quantitative traits of T2D age of onset, duration in years of combined oral hypoglycemic agents and insulin therapy and only insulin therapy, stress, and the birth weight of the subjects' children; and with the T2D qualitative phenotypes of irregular menses, couple infertility, and menopausal hot flashes. RESULTS: We found that PSMD9 was linked to irregular menses of reproductive age, menopausal hot flashes, T2D age of onset, years of combined oral and insulin therapy and of insulin therapy; we also found that it shows only a tendency towards linkage to stress, birthweight, and couple infertility. CONCLUSIONS: This is the first time that this gene is implicated with irregular menses of reproductive age (a trait of polycystic ovarian syndrome), hot flashes, T2D onset age, and duration years of combined oral and insulin therapy and only insulin therapies.

Nutritional Risk Factors Associated with Vasomotor Symptoms in Women Aged 40-65 Years.

Vasomotor symptoms (VMS) are the most common symptoms among menopausal women; these include hot flashes and night sweats, and palpitations often occur along with hot flashes. Some studies in Mexico reported that around 50% of women presented with VMS mainly in the menopausal transition. It has been proven that VMS are not only triggered by an estrogen deficiency, but also by nutritional risk factors. Evidence of an association between nutritional risk factors and VMS is limited in Mexican women. The aim of this study is to identify nutritional risk factors associated with VMS in women aged 40−65 years. This is a comparative cross-sectional study, undertaken in a retrospective way. A sample group (n = 406 women) was divided into four stages according to STRAW+10 (Stages of Reproductive Aging Workshop): late reproductive, menopausal transition, early postmenopause, and late postmenopause. Hot flashes were present mainly in the early postmenopause stage (38.1%, p ≤ 0.001). Two or more VMS were reported in 23.2% of women in the menopausal transition stage and 29.3% in the early postmenopause stage (p < 0.001). The presence of VMS was associated with different nutritional risk factors (weight, fasting glucose levels, cardiorespiratory fitness, and tobacco use) in women living in the northeast of Mexico.

Profile of Brazilian climacteric women: results from the Brazilian Menopause Study.

OBJECTIVE: This study aims to understand the epidemiological characteristics of Brazilian menopausal women, and their view on menopause hormone therapy (MHT). METHODS: A national cross-sectional study with 1500 women between 45 and 65 years old was carried out through questionnaires. RESULTS: The overall median age of participants was 52 [47-56] years, and 55 [52-59] years for the postmenopausal subgroup. Menstrual irregularity started at median age 46 [44-49] years. Median menopause age was 48 [45-51] years with no differences between socioeconomic classes. The prevalence of any climacteric symptoms was 87.9% and hot flashes started at median age 47 [45-50] years. Among women in menopause/menopausal transition, 52.1% received any medical prescription, and MHT was recommended for 22.3%. Among those who started MHT, 45.4% were still using the treatment and the median duration of use was 8 months, but different among socioeconomic classes (24 months for class A against 3 months for class D/E). CONCLUSIONS: In this first Brazilian national population-based study on menopause and MHT, it was observed that, in spite of being symptomatic when entering menopause around 48 years of age, only a small part of Brazilian women started MHT and the median duration of treatment was less than 1 year, but the duration was higher for higher socioeconomic class.

Menopause is more than Hot Flashes: What is Missing in Homeopathic Research? A Narrative Review.

BACKGROUND: Menopausal complaints are frequently treated with homeopathy in daily practice worldwide. Recently, vasomotor symptoms have been understood to have implications as predictors of other important and long-term outcomes, causing increased risk of mortality and/or disability. METHODS: A comprehensive search of the literature was conducted to investigate whether homeopathic treatments for menopausal women with vasomotor symptoms have a positive effect on other important health outcomes associated with menopause, such as cardiovascular disease, neurocognitive impairment, metabolic and mood disorders, or osteoporosis. RESULTS: Though observational studies have shown encouraging results in reducing the severity and frequency of hot flashes in women treated with homeopathy, few randomized controlled trials have shown positive results. In most of the studies using homeopathy, the primary outcome is reduction in the frequency and severity of hot flashes, and other menopausal complaints are assessed secondarily as a part of the symptoms evaluated in the menopausal scales. Quality of life improves with homeopathic treatments for hot flashes, but there is scarce evidence of the effect of homeopathy on other health outcomes associated with menopause. Limited evidence exists in the case of menopausal women treated with individualized homeopathy for depression and metabolic disorders. CONCLUSION: A more comprehensive approach for treating menopause in routine homeopathic practice constitutes a valuable opportunity to increase knowledge and high-quality research in this field. Future homeopathic research for menopause should be focused on well-designed, double-blind, placebo-controlled, randomized trials as well as on pragmatic trials to show whether homeopathic treatments for vasomotor symptoms can also improve outcomes that are well-known to increase the risk of mortality and/or disability.

Hot flashes, insomnia, and the reproductive stages: a cross-sectional observation of women from the EPISONO study.

STUDY OBJECTIVES: To investigate the association of hot flashes and insomnia in women in premenopause and postmenopause. METHODS: The study was performed using data from the São Paulo Epidemiological Sleep Study. Women in premenopause were classified as having regular menstrual cycles, being anovulatory, or using hormonal contraceptives. Women in menopause were classified as being in perimenopause, early postmenopause, or late postmenopause. Women reporting frequent insomnia symptoms and relevant daytime complaints were classified as having insomnia disorder. Polysomnography alterations suggestive of insomnia were also identified. RESULTS: The frequency of hot flashes was 42% among women in postmenopause (mainly in early postmenopause) and 9% among women in premenopause (mainly anovulatory; P < .01). Approximately 18.7% had insomnia disorder, 48% had isolated insomnia symptoms, and 32.4% had polysomnography alterations. Comparing women in menopause with those in premenopause, the diagnosis of insomnia was similar (premenopause: 18.9% vs menopause: 17.5%), but women in menopause had more frequent isolated insomnia symptoms (premenopause: 43.9% vs menopause: 55.9%; P = .02) and polysomnography correlates of insomnia (premenopause: 26.5% vs menopause: 42.6%; P < .01). Hot flashes were more frequent among women with insomnia disorders (25.5%) and with isolated insomnia symptoms (23.0%) when compared with good sleepers (12.6%) in the entire sample (P = .01). Among women in late menopause, the prevalence of hot flashes was higher in both women with insomnia disorders (42.1%) and with isolated insomnia symptoms (37.5%) when compared with women who were good sleepers (14.3%; P = .05). CONCLUSIONS: Hot flashes are associated with insomnia and polysomnography alterations suggestive of insomnia. The prevalence of hot flashes among women with insomnia disorder is especially high among women in late postmenopause. CITATION: Hachul H, Castro LS, Bezerra AG, et al. Hot flashes, insomnia, and the reproductive stages: a cross-sectional observation of women from the EPISONO study. J Clin Sleep Med. 2021;17(11):2257-2267.