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Hot flashes, a regular symptom of menopause, while usually lasting only a few years, can continue for up to 14 years and are likely to last longer the earlier they begin, a study published on Monday in the Journal of the American Medical Association, or JAMA, Internal Medicine has found, according to a report by the New York Times.

In what is called the largest study to date, researchers looked at a group of 1,449 ethnically and geographically diverse women who had frequent hot flashes. Women in the group had symptoms of menopause for a median of 7.4 years. Half of the women had symptoms for less time, but another half still suffered for up to 14 years.

Black and Hispanic women in the study were found to have hot flashes longer than white or Asian women. Black women had the longest-lasting symptoms, lasting a median of 10.1 years, which was twice the median for Asian women. Non-Hispanic white women had symptoms for a median of 6.5 years; Hispanic women, 8.9 years.

Researchers haven’t identified the reasons for the racial differences.

“It could be genetic, diet, reproductive factors, how many children women have,” said Wake Forest Baptist Medical Center professor Nancy Avis, the study’s lead author, according to the Times.

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However, the researchers did find that women who had persistent symptoms were less educated, had higher perceived stress and were more likely to suffer from depression and anxiety. Additionally, researchers discovered that the earlier the symptoms started, the more likely they were to last. That is to say, women who got hot flashes before their periods ended were more likely to have persistent symptoms than those whose hot flashes began only when menstruation stopped.

As research also shows, a lot of women are prone to having hot flashes before their periods stop. One in eight women reportedly began getting hot flashes while they were still having regular periods. Only one-fifth started having symptoms after menopause.

“If you don’t have hot flashes until you’ve stopped menses, then you won’t have them as long,” Avis said. “If you start later, it’s a shorter total duration and it’s shorter from the last period on.”

Read more at the New York Times.