Vasomotor Symptoms in Menopause

Hot flashes and night sweats are common

Most women experiencing menopause are all too familiar with the hot flashes and night sweats that mark this transition. These are what are referred to as vasomotor symptoms. You may feel a sudden feeling of warmth that starts in the face and upper body. It can also lead to excessive perspiration.

This article discusses what hot flashes feel like and how common they are. It also discusses available treatments, including both hormonal and non-hormonal.

Businesswoman sitting in front of fan cooling off
Sean De Burca / Getty Images

Vasomotor Symptoms

Hot flashes usually start suddenly, with a feeling of heat that begins around the upper chest and face, and then spreads. The feeling of heat can be accompanied by heavy sweating and sometimes palpitations or feeling unusual changes in your heartbeat.

It usually lasts for around one to five minutes. After that, some women feel chills, shivering, and a feeling of anxiety.

While entirely normal, hot flashes can be disruptive for women who experience them. While some women average one hot flash a day, others have one every hour all day and night. In addition to being disconcerting and uncomfortable, hot flashes can disturb sleep when they occur at night. 

How Common Are Hot Flashes?

Up to 80% of women in menopause experience hot flashes. They may occur when your periods start getting irregular, or during perimenopause (the menopause transition period). They are most common around the time when menopause starts, or when your periods end.

Although it was once thought that hot flashes stopped within a few years, there's growing research that they can last far longer than previously believed.

According to the North American Menopause Society, for most women, hot flashes last for five to seven years. For others, they can last for 10 to 15 years. Some women may even experience hot flashes for more than 20 years.

Causes of Vasomotor Symptoms

During the menopause transition, levels of the hormone estrogen begin to drop. The loss of estrogen disrupts the body's ability to regulate heat properly. This causes a sweating response at lower-than-normal core body temperatures.

The feeling of heat during a hot flash is caused by the sudden opening of the blood vessels close to the skin. This is followed by increased blood flow. Sweating lowers the core body temperature and then may lead to shivering to increase the temperature back to normal.

Hormonal Treatments

Menopausal hormone therapy (MHT) is very effective for treating vasomotor symptoms that are moderate to very severe.

Women who have had a hysterectomy (removal of the uterus) can take estrogen alone. A woman who still has her uterus will be prescribed a combination of estrogen and progestin. Progestin is needed to reduce the risk of uterine cancer.

However, MHT is associated with heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women. Therefore, healthcare providers are advised to prescribe women the smallest dose for the shortest time possible (no longer than five years).

Women going through menopause who have a history of certain conditions should consider alternatives to hormone therapy. These include breast cancer, coronary heart disease, blood clots, heart attack, and stroke. Women at high risk for these complications should also consider alternatives.

Non-Hormonal Treatments

Women who can't use hormones, or who choose not to, do have many other alternatives. The North American Menopause Society recommends a variety of different non-hormonal treatments including:

  • Cognitive-behavioral therapy: A type of therapy that modifies thought patterns and unwanted behaviors and that may also help with physical symptoms
  • Clinical hypnosis: Therapy that uses a trance-like state to help bring about relaxation and symptom relief
  • Paroxetine salts: Used to treat depression and the only non-hormonal treatment approved to treat vasomotor symptoms by the U.S. Food and Drug Administration
  • Clonidine: A medication used to treat high blood pressure that may also improve hot flashes

Of course, the best treatment for you is what works for you. If you have mild hot flashes, you may find relief from at-home strategies such as:

  • Lowering the room temperature
  • Using fans
  • Dressing in layers that can be easily shed
  • Avoiding triggers like spicy foods

Summary

Most women going through menopause experience hot flashes or vasomotor symptoms. It happens when estrogen levels drop in your body and affect your ability to regulate heat properly.

Your healthcare provider may recommend hormonal or non-hormonal treatments. Hormonal treatments are usually effective for hot flashes. However, they can raise the risk of heart attacks, breast cancer, blood clots, and stroke in some women.

Non-hormonal treatments can include medications and therapy. It may also include at-home strategies like using fans and avoiding spicy food.

A Word From Verywell

Hot flashes, or vasomotor symptoms, can be frustrating and uncomfortable to experience. Know that you're not alone and that they're common for most women going through menopause. Also, keep in mind that they won't last and will eventually fade away.

Talk with your healthcare provider and let them know what you're experiencing. They can help you find a treatment (or at-home remedy) that's safe and effective for you.

Frequently Asked Questions

  • What are vasomotor symptoms?

    The term vasomotor relates to the constriction or dilation of blood vessels. Vasomotor symptoms in menopause include hot flashes, flushing, and night sweats. 

  • What causes vasomotor instability?

    Vasomotor instability is common during menopause. The exact cause is not quite understood. Vasomotor stability is regulated by the hypothalamus. A drop in estrogen associated with menopause alters the level of neurotransmitters in the brain. It is believed this leads to vasomotor instability and hot flashes that accompany it.

  • How long does a hot flash last?

    An individual hot flash typically lasts less than five minutes. Once it passes, some women experience chills, shivering, or anxiety that can linger for a bit.

  • What is the difference between night sweats and hot flashes?

    When a hot flash occurs while you are awake, you can take measures to cool down. But when you have night sweats, a hot flash in your sleep, you do not feel it coming on and are unable to take action. As a result, you sweat and often soak your pajamas. This can leave you with chills.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bansal R, Aggarwal N. Menopausal hot flashes: A concise reviewJ Midlife Health. 2019;10(1):6–13. doi:10.4103/jmh.JMH_7_19

  2. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155-1172. doi:10.1097/GME.0000000000000546

  3. Sood R, Faubion SS, Kuhle CL, Thielen JM, Shuster LT. Prescribing menopausal hormone therapy: an evidence-based approachInt J Womens Health. 2014;6:47–57. doi:10.2147/IJWH.S38342

By Kate Bracy, RN, NP
Kate Bracy, RN, MS, NP, is a registered nurse and certified nurse practitioner who specializes in women's health and family planning.