Lifestyle factors: are they related to vasomotor symptoms and do they modify the effectiveness or side effects of hormone therapy?

This article reviews and summarizes published literature in order to address the following questions: (1) Are lifestyle factors (alcohol use, cigarette exposure, and physical activity) and body mass index (BMI) related to the occurrence of vasomotor symptoms in perimenopausal and postmenopausal women? (2) Do lifestyle factors or BMI modify the effectiveness or side effects of menopausal hormone therapy (HT)? Information was culled from a nonstructured review of English-language literature. Low levels of alcohol consumption (≤1 drink per day for women) do not have a measurable effect on occurrence of vasomotor symptoms; whether greater amounts of alcohol intake would promote vasomotor symptoms cannot be addressed by available literature. Most published studies report that active cigarette smoking is positively associated with vasomotor symptoms. However, a large study found that passive (but not active) smoking (i.e., secondhand smoke exposure) was related to vasomotor symptoms. Studies to date do not support a relation between physical activity and vasomotor symptoms. However, rates of vasomotor symptom reporting were low in these studies, potentially limiting the ability to detect an effect of physical activity. Greater BMI is a risk factor for more vasomotor symptom reporting. The scarcity of data that directly address whether lifestyle factors or BMI modify the effects of HT precludes a substantive response to this question at present. Available literature suggests that smoking and greater body weight are risk factors for vasomotor symptoms; women with vasomotor symptoms who smoke may benefit from smoking cessation, and women who are heavier than ideal body weight may benefit from weight reduction. Whether certain behaviors or BMI raise or lower the risks or benefits of HT remains largely unknown and should be the focus of future research.