(PS10-82) Anxious Arousal as a Moderator of the Link Between Diurnal Cortisol Slope and Hot Flashes in Menopausal Women

Background: The menopausal transition is accompanied by various psychological and physical symptoms. Up to 80% of women report experiencing vasomotor symptoms of hot flashes and/or night sweats (Bryant et al., 2012). Hot flashes and cortisol, a stress biomarker (Pollard, 1995), are potentially interconnected through the HPA axis (Casper & Yen, 1985). Following a diurnal rhythm, cortisol levels typically rise in the morning (Cortisol Awakening Response, CAR) and decline throughout the day (Diurnal Cortisol Slope, DCS; Clow et al., 2004). However, there is evidence of irregular cortisol patterns among women with hot flashes (Sauer et al., 2020; Reed et al., 2016), and the relationship between cortisol patterns and hot flashes might be more salient in individuals with higher anxiety. Specifically, our lab has found that anxious arousal, compared to and controlling for general distress and anhedonic depression symptoms, are particularly related to hot flashes (Behar et al., under review). The current study tested the potential moderating effect of anxious arousal on the association between CAR and/or DCS and hot flashes, with general distress and anhedonic depression as comparisons.  

Methods: This study applies secondary analysis to data from the Midlife Development in the United States (MIDUS) 2, 3, and Refresher 1 Daily Diary and Biomarker projects, including the Milwaukee African American oversample projects. Participants were 130 women aged 42 to 60 who reported experiencing at least one day of hot flashes. In Daily Diary projects, across four days, participants’ salivatory cortisol levels were collected via in-home kits; participants were also asked to self-report their hot flash severity via phone interview. In Biomarker projects, participants completed the Mood and Anxiety Symptom Questionnaire (MASQ), which included the subscales of general distress, anxious arousal, and anhedonic depression.

Results:  There was a significant interaction effect (p= .042) between DCS and anxious arousal in predicting hot flash severity, such that women who reported higher anxious arousal evidenced a stronger positive relationship between DCS and hot flashes. The interaction between CAR and anxious arousal was not significant (p> .05). As comparisons, the interaction between DCS and general distress and between DCS and anhedonic depression were both not significant (ps > .05).

Conclusion: Women with higher anxious arousal had a stronger relationship between diurnal cortisol slope and hot flash severity. A flatter (hence more positive) diurnal cortisol slope suggests a reduced ability of cortisol levels to return to baseline after the morning peak. Considering the similarity in physiological symptoms between anxiety and hot flashes, it is not surprising that anxious arousal could potentially strengthen the link between cortisol dysregulation and hot flash symptoms.