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. The medical term for hot flashes is vasomotor symptoms.

Businesswoman sitting in front of fan cooling off
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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, accompanied by heavy sweating and sometimes palpitations, 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. 

Hot Flashes in Menopause

Up to 80 percent of women in menopause experience hot flashes. They are more common late in the menopause transition, just before the woman enters into early post-menopause.

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, but 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, causing 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, 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 for Vasomotor Symptoms

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, because MHT is associated with heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women, women are advised to use the smallest dose for the shortest amount of time possible (no longer than five years).

Women of a certain age with a history of certain conditions, including breast cancer, coronary heart disease, blood clots, heart attack, and stroke should consider alternatives to hormone therapy. Women at high risk for these complications should also consider alternatives.

Non-Hormonal Treatments for Hot Flashes

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:

  • Cognitive-behavioral therapy
  • Clinical hypnosis 
  • Paroxetine salt
  • Selective serotonin reuptake/norepinephrine reuptake inhibitors, also known as SSRI
  • Clonidine

Of course, the best treatment for you is what works for you. Many women with mild hot flashes say they find relief from strategies such as lowering the room temperature, using fans, dressing in layers that can be easily shed, and avoiding triggers like spicy foods.

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3 Sources
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  2. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155-72. 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