"Menopause lasts 'up to 14 years'," the Daily Mail reports, with The Daily Telegraph reporting a similar figure – but according to The Guardian, it's "12 years".

All three headlines are prompted by a new US study, which does suggest that, at least in some women, symptoms such as hot flushes can persist for more than a decade.

Menopausal symptoms such as hot flushes and night sweats are collectively known as vasomotor symptoms (VMS), as they are all caused by constrictions and dilations to blood vessels. These can lead to a sudden increase in blood flow, which can then cause hot flushes and excessive sweating.

The study found that on average, women who had frequent VMS did so for more than seven years, with symptoms continuing for over four years after their last menstrual period.

It should be noted that the study focused on a specific group of menopausal women who reported frequent VMS (for six days or more in the previous two weeks). It is not clear if this group is representative of all women going through the menopause.

VMS can usually be successfully controlled using hormone replacement therapy (HRT). HRT does carry a very small risk of triggering hormonal cancers such as breast cancer, and, as we discussed earlier this month, ovarian cancer.

But these risks should be balanced against the benefits HRT can bring to quality of life. There are also self-help techniques you can use to cope better with VMS. Your GP can provide more information about treatment options.

Where did the story come from?

The study was carried out by researchers from several academic centres in the US, and was funded by the US National Institutes of Health, the Department of Health and Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women's Health.

One of the authors has financial ties with, and has acted in an advisory capacity to, a number of pharmaceutical companies.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA) Internal Medicine.

It is unclear why The Daily Telegraph and the Daily Mail reported that the menopause "lasts up to 14 years" and The Guardian decided "symptoms lasted up to 12 years", but all three headlines are potentially misleading.

The study found the average time frequent menopausal symptoms lasted was 7.4 years. Only a very small number of women had symptoms lasting more than a decade.

What kind of research was this?

This was an observational study looking at how long women going through the menopause experience hot flushes and night sweats. These are called vasomotor symptoms, and are caused by the decline in production of the female hormone oestrogen, which in turn can affect blood flow.

The authors also wanted to find out how long frequent symptoms persist after the final menstrual period and identify the risk factors for longer duration of symptoms.

They say vasomotor symptoms (VMS) can significantly affect quality of life and are experienced by up to 80% of menopausal women. These symptoms are also one of the chief menopause-related problems US women seek medical treatment for. Yet there are few robust estimates as to how long VMS lasts.

What did the research involve?

Between 1995 and 1997, researchers recruited 3,302 women for a large multi-ethnic, multiracial US study of the menopause.

The women had to be aged between 42 and 52 years, have an intact uterus and at least one ovary, report a menstrual cycle in the three months before they were screened, and not be pregnant or breastfeeding, or using oral contraceptives or HRT.

Of the initial 3,302 participants, 1,853 were excluded: 330 because they had surgery to remove their womb and ovaries, 583 because they began HRT, and 940 who did not report frequent VMS. The researchers analysed 1,449 women to find out how long they had menopausal symptoms overall.

Women were assessed at the start and followed up with annual visits for between 12.7 and 17.2 years. They were asked at each visit about their lifestyle, psychosocial factors, physical and psychological symptoms, and their medical, reproductive and menstrual history.

The women filled in a questionnaire at each visit about the frequency of hot flushes and night sweats in the previous two weeks.

These were recorded as occurring:

• not at all
• 1-5 days
• 6-8 days
• 9-13 days
• every day

Frequent VMS was defined as occurring at least six days in the previous two weeks.

From the women's self-report of their bleeding patterns during each preceding year, the researchers also assessed whether women were premenopausal, peri-menopausal (near the menopause), or postmenopausal.

Of the 1,449 women, 881 were assessed for how long VMS symptoms lasted after the final menstrual period. Researchers excluded 406 because their final menstrual period could not be dated, 132 who had no frequent symptoms after their final menstrual period, and 30 who began HRT before the first post-final menstrual period report of VMS.

The researchers looked at the total duration of frequent VMS, and the duration of frequent VMS after the final menstrual period. They also assessed the influence of potential confounders, such as:

• sociodemographic factors such as age, race, marital status and education
• lifestyle
• psychosocial factors such as attitude towards menopause, anxiety and stress

They analysed the duration of VMS using standard statistical methods.

What were the basic results?

The researchers found that in women with frequent hot flushes and night sweats:

• the average duration of symptoms was 7.4 years
• among 881 women who experienced an observable final menstrual period, the average duration of symptoms afterwards was 4.5 years
• women who were premenopausal or early peri-menopausal when they first reported frequent VMS experienced these symptoms for the longest time overall (on average, for more than 11.8 years) and after the final menstrual period (on average for 9.4 years)
• women who were postmenopausal at the onset of symptoms had the shortest total duration of symptoms (on average, 3.4 years)
• compared with women of other racial or ethnic groups, African-American women reported the longest total duration of symptoms (on average, 10.1 years)
• women of a younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety when they first reported symptoms were more likely to experience symptoms for a longer time period

How did the researchers interpret the results?

The researchers say frequent vasomotor symptoms (VMS) lasted more than seven years during the menopausal transition for more than half of the women, and persisted for 4.5 years after the final menstrual period.

Longer-lasting VMS was associated with being premenopausal and having greater "negative affective factors" in women when they first experienced symptoms.

Healthcare professionals should advise women to expect that frequent symptoms of hot flushes and night sweats could last more than seven years, and they may last longer for African-American women.

Conclusion

This is an interesting study with a long follow-up period. It suggests the length of time women have hot flushes for may be underestimated.

However, it was carried out on US women and the results may not be generalisable to other populations.

That aside, unlike many other studies of its type, it did make an effort to include a range of ethnicities, including Chinese, Hispanic and African-American women.

The study relied on women self-reporting their symptoms only once each year, which may affect its reliability.

It also only looked at women who reported getting frequent vasomotor symptoms (at least six days in the previous two weeks). As a group, this sample may not be representative of menopausal women overall and may be more vulnerable to a longer duration of symptoms.

It is interesting that women who reported more anxiety about menopause also reported a greater duration of VMS.

The menopause is a perfectly natural event, and there are many ways women can learn to cope with its effects.

If symptoms are making you miserable, it’s worth talking to your GP. HRT is often effective, but if you are unable or unwilling to take it, alternatives to HRT are available.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Menopause lasts 'up to 14 years': Study says doctors should advise women that symptoms may occur for longer than they previously thought. Daily Mail, February 17 2015

Menopause symptoms can last up to 12 years, study reveals. The Guardian, February 18 2015

Menopause symptoms like hot flushes can last 14 years. The Daily Telegraph, February 17 2015

Links To Science

Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine. Published online February 16 2015

"Tai chi can help older patients with disabling conditions," The Guardian reports after an analysis of old data found the martial art may help relieve some symptoms of four age-related diseases: cancer, heart failure, osteoarthritis and chronic obstructive pulmonary disease (COPD).

Notable significant effects were seen, with improvements in walking for those who had heart failure, improved strength of the big quadriceps muscles for those with heart failure and COPD, and pain and stiffness for people with osteoarthritis. There were also trends for effects on depression and quality of life for those with heart failure and COPD.

However, this review can't prove tai chi will definitely have a positive effect for people who have these conditions. The trials were highly variable in their study population, the type of tai chi practised, the type of comparison intervention, and the outcomes examined. Despite the large collective number of studies, most of the individual results were based on only one or a few studies. 

Nevertheless, remaining active and exercising within your limits is positive in all stages of life, even for those who have a chronic disease. If you find tai chi enjoyable and it boosts your physical or mental wellbeing, that can only be a good thing.

If tai chi is not your cup of oolong, you could always try the Strength and Flex exercise plan. 

Where did the story come from?

The study was carried out by researchers from the University of British Columbia and the University of Toronto, and was funded by the University of British Columbia and the British Columbia Lung Association.

It was published in the peer-reviewed British Journal of Sports Medicine.

The UK media provide a generally accurate picture of the evidence. However, it would have been helpful to note that this study was limited by the highly variable studies the researchers looked at, which makes it difficult to form any definite conclusions.   

What kind of research was this?

This systematic review aimed to identify trials looking at the effectiveness of tai chi for four common chronic conditions: cancer, heart failure, COPD and osteoarthritis. The results of the identified trials were then pooled in a meta-analysis to give an overall effect.

Tai chi involves gentle flowing movements to improve strength, posture and balance, and has become an increasingly popular form of exercise, particularly among the middle-aged and elderly.

It has also been tried as a complementary healthcare approach for many different conditions, with some studies suggesting it has both physical and psychosocial benefits.

This review aimed to gather the evidence surrounding the martial art to get an overall conclusive summary of its effects. However, the results of a systematic review are only ever as good as the studies included, so there may be inherent limitations in the quality of the various studies and the methods used.   

What did the research involve?

The researchers searched four literature databases up to the end of December 2014 for randomised controlled trials published in English that compared tai chi with any other control group in people with four chronic conditions: cancer, heart failure, COPD and osteoarthritis. The studies were assessed for quality, and the outcomes were pooled for different disease-specific symptoms and outcomes.

33 studies met the inclusion criteria, but several reported data in two or more publications, giving a total of 24 individual trials. There were five studies available each for cancer, heart failure and COPD, and nine for osteoarthritis. The results of all the osteoarthritis studies, and four of the studies for each of the other conditions, were pooled in the meta-analysis.

The trials were of average quality, with most having a score of five out of 10 on the quality scale used (the PEDro scale). The sample size of the trials included ranged from 11 to 206. The average age of the participants varied, but they tended to be in their 60s and 70s. 

What were the basic results?

The studies examined different physical and psychological outcomes. The main effects were as follows.

Physical symptoms

• Walking – tai chi gave significant improvements on the six-minute walk test in people with heart failure and COPD. One study each for cancer and osteoarthritis found no effects on walking.
• Muscle strength – one COPD and one heart failure study found significant improvement in knee extensor strength, but there was no effect in the osteoarthritis studies.
• Getting up and moving – the osteoarthritis studies found tai chi improved the timed get up and go test result, as well as sit to stand times. One heart failure study found no effect.
• Chronic disease symptoms – tai chi significantly improved pain, stiffness and physical function in osteoarthritis. In COPD, there was a trend towards tai chi improving shortness of breath compared with control, but this was non-significant. No two cancer studies reported the same outcome. There was a trend for reduced fatigue in one study, but this had an extremely small sample size.
• Other physiological effects – heart failure studies found no effect on blood pressure or respiratory function.

Psychological outcomes

• Quality of life – tai chi had significant effects on osteoarthritis, but there were no significant effects in COPD, cancer or heart failure studies.
• Depression – tai chi was associated with significant improvements in depression symptoms in heart failure studies, but there were non-significant trends in osteoarthritis and COPD studies. In cancer, it was the control intervention (stress management) that improved symptoms rather than tai chi.  

How did the researchers interpret the results?

The researchers concluded that, "The results demonstrated a favourable effect or tendency of tai chi to improve physical performance, and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, heart failure and osteoarthritis." 

Conclusion

This review searched the literature to summarise the effects of tai chi on four common chronic conditions. It identified a large number of trials collectively examining many different physical and psychological outcomes in a predominantly middle-aged to elderly population. 

The notable significant effects seemed to be for improvements in walking for those with heart failure, knee extensor strength for those with heart failure and COPD, and pain and stiffness for those with osteoarthritis. There were also trends for effects on depression and quality of life for people with heart failure and COPD.

The researchers concluded that tai chi could be performed by individuals for many different chronic conditions. However, this review can't demonstrate that tai chi will definitely have a positive effect if it's tried out by someone who has one of these chronic conditions.

Overall, the systematic review is a high-quality study design. However, the evidence is only as good as the studies included. The 24 individual studies in this review were widely different, and most results are based on one to a few studies.

Variations across the studies included:

• The type of tai chi, the overall duration of the intervention, and the frequency and duration of individual sessions.  
• The type of disease and severity, even within the same chronic disease category – for example, most cancer studies were in breast cancer, but even these varied in their stages, while another was just in "unknown cancer survivors".
• Osteoarthritis varied between spine, hip and knee, and the severity of pain and disability.
• The comparison groups varied – for example, some were just usual care or waiting list, others self-help education, some spiritual or psychological-related, and others varied physical activities such as walking, aerobics or stretching programmes. 
• As demonstrated by the results, the outcomes examined varied widely, and individual outcomes were only examined by one to four studies per condition.
• Sample sizes varied, and some were extremely small – for example, only 11 people in one study. Sometimes within these small studies, the dropout rate from the trial was also high – for instance, 10 people dropping out from a starting size of just 31 participants.

This makes it very difficult to say whether a certain type of tai chi will help individuals with chronic conditions.

Nevertheless, the benefits of exercising within our limits are well known – even when a person has a chronic disease. If you find tai chi enjoyable, this can only be a good thing.

The Tai Chi Union for Great Britain website has information about classes available in your area. 

Links To The Headlines

Tai chi can help older patients with disabling conditions – study. The Guardian, September 17 2015

Tai Chi 'could be prescribed' for illnesses. BBC News, September 18 2015

Tai Chi could help older people with cancer, heart disease and osteoarthritis. Daily Mirror, September 18 2015

Links To Science

Chen Y, Hunt MA, Campbell KL, et al. The effect of Tai Chi on four chronic conditions—cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses. British Journal of Sports Medicine. Published online September 17 2015