Regional and geographical differences may explain variability in menopausal symptom occurrence due to development of climate-specific thermoneutral zones leading to population-specific hot flash frequencies. Limited information available regarding menopausal symptoms in underserved women living in extreme heat.

Understanding the perception of menopausal symptoms in underserved women living in extreme heat regions to identify if heat impacts perception of menopausal symptoms was the objective of this study. Women in free, low-income, and homeless clinics in Phoenix were surveyed during summer and winter months using a self-administered, written questionnaire including demographic, climate and menopause related questions, including the Green Climacteric Scale (GCS).

A total of 139 predominantly Hispanic (56 %), uninsured (53 %), menopausal (56 %), mid-aged (mean 49.9, SD 10.3) women were surveyed— 36% were homeless or in shelters. Most women were not on menopausal hormone therapy (98 %). Twenty-two percent reported hot flashes and 26% night sweats. Twenty-five percent of women reported previously becoming ill from heat. More women thought season influenced menopausal symptoms during summer than winter (41 % vs. 14 %, p = 0.0009). However, majority of women did not think temperature outside influenced their menopausal symptoms and that did not differ by season (73 % in winter vs. 60% in summer, p=0.1094). No statistically significant differences seen for vasomotor symptoms between winter and summer months.

Regional and geographical differences may be key in understanding the variability in menopausal symptoms. Regardless of season, the menopausal, underserved and homeless women living in Arizona reported few vasomotor symptoms. In the summer, they were more likely to report that the season influenced their menopausal symptoms rather than temperature suggesting an influence of the season on symptom perception.

There is a lot of variation in health outcomes when it comes to individual states in America. Some states, such as Hawaii, have the life expectancy equivalent to that of developed countries, whereas states like Mississippi have the life expectancy equivalent to that of third world countries. This raised the questions of which states are doing well in health and why, and if their health has to do with their performance in the primary, secondary, tertiary, and/or quaternary prevention levels. The purpose of this research was to investigate if there is a correlation between performance in any of the prevention levels and the overall health status of a state, and if there is, which prevention level would be most beneficial for states to prioritize. The hypothesis of this research was: states that prioritized primary and secondary levels of prevention would have better health than states that prioritized tertiary and quaternary levels of prevention, since basic health measures contribute more to health outcomes than advanced medicine. To investigate this question, indicators were chosen to derive the ranking of each state in health and each of the four prevention levels. Six states were then chosen to represent the high, average, and low health statuses respectively. The six states were ranked for all indicators, and the data was analyzed and compared to determine a potential relationship between the prevention level rankings and the overarching health ranking. It was found that there is a correlation between performance in the primary and secondary prevention levels and a state’s overall health status, whereas there was no such correlation for the tertiary and quaternary levels. A model for health was proposed for states looking to improve their health status, which was to invest in primary prevention, followed by secondary, tertiary, then quaternary prevention and only moving to the next prevention level once the previous level reached a satisfactory threshold.