Understanding Vasomotor Symptoms of Menopause and How to Manage Them

It can happen when you’re relaxing at home, presenting during an important meeting, or walking down the street. Suddenly, out of nowhere, you get an abrupt feeling of intense heat in your upper body. Your face may flush red, and you may notice that your skin moistens (or even drips) with sweat, almost instantaneously. If you’re in perimenopause or menopause, you’ve likely just experienced a common vasomotor symptom (VMS), known as a hot flash.

Hot flashes, along with night sweats, are the hallmark vasomotor symptoms often associated with the menopause transition. They can range in intensity from “I think someone may have turned up the thermostat,” to “When did I fall into an erupting volcano?”

Vasomotor symptoms can affect 60%-80% of women during this transitional time.¹ Understanding what’s causing these symptoms to occur, and learning how to treat them, may help you deal with their intensity, and get you back to feeling more like yourself again. 

What are the Vasomotor Symptoms of Menopause?

Vasomotor symptoms result from the abrupt dilation or constriction of blood vessels.² In addition to hot flashes and night sweats, these symptoms can include heart palpitations and changes in blood pressure.³ Women who have frequent hot flashes during menopause may be more likely to experience hypertension, as well.⁴ Problems with insomnia, and heightened feelings of anxiety, can also occur.⁵

Vasomotor symptoms tend to range in intensity and duration. Recent data indicates that severe or frequent VMS experienced during menopause may last for up to 7-9 years, however milder symptoms may persist for an even longer period of time.⁶ Some women do also report having hot flashes and night sweats for shorter durations – less than 5 years.⁷ It’s important to note that your age when you enter perimenopause, which is the transitional period leading up to menopause, seems to play a role in how long your vasomotor symptoms may last.⁸ 

What Causes Vasomotor Symptoms in Menopause?

As common as these symptoms are, their underlying physiological causes are not completely understood.⁹ Declining reproductive hormone levels, more specifically estrogen and progesterone, are thought to play a strong role.

Estrogen levels start to fluctuate during perimenopause and then steeply decline during postmenopause. There are estrogen receptors throughout the body, including in the central nervous system (CNS), which is comprised primarily of the spinal cord and brain. Among its many functions, estrogen supports the regulation of neural circuits in our CNS that control temperature.¹⁰

It may be helpful to think of this area in the hypothalamus of our brains, as our “internal thermostat”. It’s thought that declining estrogen levels cause changes in the central nervous system which impact both body temperature and circulation¹¹, effectively throwing our balanced thermostat, out of whack.

Can You Prevent Vasomotor Symptoms of Menopause?

Menopause is a natural part of aging that is inevitable. You may, however, be able to reduce the occurrence of these disruptive vasomotor symptoms during perimenopause and menopause by noticing and eliminating some of the triggers that seem to influence them or make them more severe.¹²

Triggers vary, but may include:¹³ 

• Smoking cigarettes or being around secondhand smoke
• Eating hot, spicy foods (think chili peppers or curry)
• Drinking alcoholic or caffeinated beverages
• Experiencing increased levels of stress and anxiety
• Being outside in the heat, or indoors in hot environments, like saunas or steam rooms
• Wearing tight, restrictive clothing

How to Treat the Vasomotor Symptoms of Menopause

If you’re struggling with any type of menopausal symptom, including VMS, talking to a medical professional is a great place for you to start when exploring your treatment options.

VMS during menopause don’t usually require specific testing to determine a diagnosis. In most instances, a healthcare provider will be able to diagnose and recommend treatment based on a description of symptoms, coupled with information about your age, individual medical history,  and menstrual cycle activity. If additional testing is needed, you may undergo a physical or gynecological exam as well as blood tests including those to measure hormone levels.¹⁴ Occasionally thyroid issues, infection or cancer can contribute to VMS, so be sure to check in with your healthcare provider if you’re concerned about any new symptoms.¹⁵

Over-the-Counter Treatment Options for VMS

Non-prescription vasomotor symptom treatments may range from lifestyle changes, such as incorporating light layers and moisture wicking clothing options into your wardrobe, to investing in a good personal fan, increasing your hydration, cutting back on or eliminating smoking, and trying certain dietary changes, including supplements.

In many instances, you may be able to reduce hot flashes and find relief from VMS by using a combination of these non-prescription options and over-the-counter supplements.

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Prescription Options for Managing Vasomotor Symptoms of Menopause

If the above options aren’t working to address your VMS, and you’re struggling to manage your symptoms, several prescription options are also available.

Fezolinetant, a new, hormone-free medication that goes by the name of Veozah^TM, was recently approved by the FDA to reduce the occurrence of moderate-to-severe vasomotor symptoms of menopause. It’s important to note that this medication may not be right for everyone, including those with liver or kidney disease. People taking CYP1A2 inhibitors for conditions like obsessive-compulsive disorder should also not take this medication.¹⁶

Many menopausal women can safely take prescription hormone therapy (HRT) as another option to relieve hot flashes.¹⁷ However, like any medication, HRT is not suitable for everyone. Be sure to speak with your healthcare provider about potential risks, such as blood clots in the legs or lungs or breast cancer.¹⁸ It's always important to discuss your treatment options with your provider first, as they know your medical history best.                                        

Additionally, according to The Menopause Society’s hormone therapy position statement from 2022, patients undergoing hormone therapy for the management of VMS, should be assessed individually and on an occasional basis. The Menopause Society also advises that those on hormone therapy should be evaluated periodically to determine the need for continued use of HRT or similar therapies, based on the severity of the patient’s menopause symptoms, any underlying medical conditions, as well as potential risks and/or side effects with use.¹⁹

Other prescription options include certain antidepressants, including SNRIs and SSRIs, as well as specific anti-seizure medications, such as gabapentin, which has been shown to reduce the severity of these symptoms. Oxybutynin is another option.²⁰ Again, be sure to speak with your provider to determine what’s best for you.

If VMS experienced during menopause are impacting your quality of life, talk to your healthcare provider. There are many effective options available, so you don’t have to suffer with vasomotor symptoms in silence. No matter what treatment you decide is best for you, relief is out there.

Resources

1. https://www.sciencedirect.com/science/article/abs/pii/S0889854511000702?via%3Dihub
2. https://www.medicalnewstoday.com/articles/317801
3. https://www.medicalnewstoday.com/articles/317801
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175429/#:~:text=More%20frequent%20baseline%20VMS%20was%20associated%20with%20higher%20BP.
5. https://www.healthline.com/health/menopause/vasomotor-symptoms-of-menopause#symptoms
6. https://www.ahajournals.org/doi/10.1161/JAHA.120.017416
7. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996#:~:text=Main%20Outcomes%20and%20Measures%20Total,FMP%20persistence%20was%204.5%20years.
8. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996#:~:text=Main%20Outcomes%20and%20Measures%20Total,FMP%20persistence%20was%204.5%20years.
9. https://www.sciencedirect.com/science/article/abs/pii/S0889854511000702?via%3Dihub
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237993/
11. https://www.medicalnewstoday.com/articles/317801#symptoms
12. https://www.webmd.com/menopause/menopause-hot-flashes#:~:text=There's%20nothing%20you%20can%20do,Stress
13. https://www.webmd.com/menopause/menopause-hot-flashes#:~:text=There's%20nothing%20you%20can%20do,Stress
14. https://www.everydayhealth.com/menopause/vasomotor-symptoms/guide/#:~:text=Healthcare%20professionals%20can%20usually%20recognize,to%20help%20establish%20the%20diagnosis.
15. https://www.medicalnewstoday.com/articles/hot-flash-causes#causes-of-hot-flashes
16. https://www.veozah.com/ 
17. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/the-experts-do-agree-about-hormone-therapy
18. https://www.fda.gov/consumers/free-publications-women/menopause-medicines-help-you
19. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/the-experts-do-agree-about-hormone-therapy
20. https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795