Women’s Health
Per- and Polyfluoroalkyl Substances and Vasomotor Symptoms among Midlife Women: A Cross-sectional Analysis in the Study of Women’s Health Across the Nation Jiaxin Wu* Jiaxin Wu Wenzhiyuan Zhang Xin Wang Carrie A Karvonen-Gutierrez Zhenke Wu Bhramar Mukherjee Siobán D. Harlow Ellen B. Gold John F Randolph Sung Kyun Park
Vasomotor symptoms (VMS), ie, hot flashes and night sweats, are reported by most women during the menopause transition. Per- and polyfluoroalkyl substances (PFAS) have been associated with disrupted sex hormone levels and earlier menopause, but associations between PFAS and VMS are unexplored. This study aimed to assess associations between PFAS and prevalent VMS in midlife women.
We included 1,285 women aged 45-56 years from the Study of Women’s Health Across the Nation (SWAN) at Visit 3 in 1999-2000. VMS was defined as any VMS reported in the previous two weeks. Serum concentrations of seven PFAS with high detection rates (>96%) were included: linear perfluorooctanoate (n-PFOA), linear perfluoroctane sulfonate (n-PFOS), sum of branched isomers of PFOS (Sm-PFOS), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS), 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA), and 2-(N-methyl-perfluorooctane sulfonamido) acetate (EtFOSAA). Total PFOS were computed as the sum of n-PFOA and Sm-PFOS. Logistic regressions computed odd ratios (ORs) and 95% confidence intervals (95% CIs) for associations at this visit. PFAS mixture effects were evaluated using quantile g-computation.
After adjusting for age, race/ethnicity, site, education, body mass index, physical activity, smoking, environmental tobacco smoke exposure, menopausal status, prior anxiety, and symptom sensitivity score at Visit 1, ORs (95% CIs) for each doubling of PFAS exposure were 1.20 (1.03, 1.40) for n_PFOA, 1.20 (1.04, 1.39) for n_PFOS, 1.11 (0.98, 1.26) for Sm_PFOS, 1.19 (1.03, 1.38) for total PFOS, 1.20 (1.04, 1.38) for PFNA, 1.12 (1.003, 1.25) for PFHxS, 1.16 (1.02, 1.32) for MeFOSAA, and 1.05 (0.95, 1.15) for EtFOSAA. A mixture of 7 PFAS had an OR of 1.38 (1.08, 1.75) for each tertile increase.
These study results suggest that some PFAS and their mixtures may increase the odds of VMS in midlife women. Further longitudinal studies are needed to examine if PFAS exposure predicts incident VMS.
