Vasomotor Symptoms of Menopause: Facts At-a-Glance for Primary Care
Hot flashes and night sweats are just 2 of the myriad symptoms associated with menopause. Click through a quick refresher on the transition and effective treatments.
VMS Prevalence and Duration: VMS are extremely common, affecting up to 80% of women during the menopause transition.
VMS Symptoms and Patterns: VMS include sudden, intense feelings of heat, usually over the face, neck, and chest, sometimes with sweating, flushing, and palpitations as well as night sweats.
Pathophysiology of VMS: VMS are linked to thermoregulatory instability in the hypothalamus, where estrogen withdrawal reduces the thermoneutral zone, increasing sensitivity to even minor changes in core body temperature.
Risk Factors for VMS: Vary among women but are more likely if they have early menopause, high BMI, smoke tobacco, and are of African American descent.
Health Impact of VMS: Frequent/more severe VMS may be linked to elevated risk for cardiovascular disease, lower bone density over time, and mental health challenges.
Treatment for VMS: Hormone therapy remains the gold standard but nonhormonal therapies are becoming more important options. Cognitive behavioral therapy and mind-body approaches may help reduce symptom-related stress.
Nonhormonal Treatment for VMS: Fezolinetant, a selective neurokinin 3 receptor antagonist (FDA approved) and elinzanetant, a dual neurokinin-1, -3 receptor antagonist (FDA review pending), and SSRIs/SNRIs (eg, venlafaxine, paroxetine) are options.
Supportive Treatments for VMS: Non-pharmacologic options, including lifestyle modifications (eg, weight management, smoking cessation, stress reduction) can support symptom management but do not replace medical treatments for moderate-to-severe VMS.
Vasomotor symptoms (VMS), including hot flashes and night sweats, are the most common and distressing symptoms associated with the menopausal transition. They affect approximately 60% to 80% of women during perimenopause and the endocrinologic change may persist for a decade or longer in some individuals. These symptoms are not only uncomfortable but also linked to significant health and psychosocial consequences. Beyond their immediate discomfort, VMS are associated with sleep disturbance, increased risk of depressive symptoms, heightened cardiovascular risk, and while still being investigated, perceived cognitive decline in midlife.
The short slide show above is by no means comprehensive but rather meant as an at-a-glance reminder of the characteristics of the transition and some of the clinical approaches to reducing symptoms.
Sources
Rapkin AJ. Vasomotor symptoms of menopause: physiologic condition and central nervous system approaches to treatment. AJOG. 2007;196(2):97-106. https://www.ajog.org/article/S0002-9378(06)02476-8/fulltext
Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: a review. JAMA. 2023;329(5):405-420. doi:10.1001/jama.2022.24140
The American College of Obstetricians and Gynecologists. Management of menopausal symptoms. Practice Bulletin 141. January 2014. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2014/01/management-of-menopausal-symptoms
The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. doi:10.1097/GME.0000000000002028
Magraith K, Jang C. Management of menopause. Aust Prescr. 2023;46(3):48–53. doi: 10.18773/austprescr.2023.014
