Vasomotor Symptoms in Menopause

Hot flashes and night sweats are common

Most people experiencing menopause are all too familiar with the hot flashes and night sweats that mark this transition to a last period. These are vasomotor symptoms, which means they're related to nerves that regulate blood flow and affect the narrowing and widening of blood vessels.

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 people feel chills, shivering, and a feeling of anxiety.

While entirely normal, hot flashes can be disruptive for those who experience them. While some individuals 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 Vasomotor Symptoms?

Up to 80% of women experience vasomotor symptoms—hot flashes, night sweats—during menopause and a majority rate them as moderate to severe.

Vasomotor symptoms 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

The cause of vasomotor symptoms is not fully understood, but it likely has many factors contributing to it.

During the menopause transition, levels of the hormone estrogen begin to drop. It's generally believed that the loss of estrogen affects the hypothalamus, which is a part of the brain that regulates the body’s temperature, disrupting the body's ability to regulate heat properly.

If the hypothalamus mistakenly senses that you're too warm, it sets off processes to try to cool you down. 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.

Research has found that neither hormone levels nor bleeding changes entirely explained vasomotor symptoms or their frequency, which suggests that other factors, including lifestyle factors, may also play a role.

Risk Factors

Besides menopause itself, there are some risk factors for hot flashes and night sweats.

Smoking or exposure to it is the main lifestyle factor that increases your risk of hot flashes and night sweats.

Being overweight is linked with an increased risk of vasomotor symptoms in early menopause. However, it's also linked to a lower risk in late menopause.

Conditions and treatments that may increase your risk, include:

  • Anxiety or depression prior to menopause
  • Using hormonal (estrogen or androgen) therapy
  • Medically induced menopause from having a hysterectomy (surgical removal of the uterus)

Triggers

If you experience hot flashes, there are some triggers that may make them worse.

The following may trigger or intensify your symptoms and you may want to limit or avoid them:

  • Alcohol
  • Spicy food
  • Caffeine

Heat is also a trigger. You may want to dress in layers that can be easily removed if a hot flash hits.

When to See a Healthcare Provider

If vasomotor symptoms are bothering you and interfering with your quality of life, talk to your healthcare provider.

They can help you explore your treatment options and also help determine if your symptoms are related to menopause or may be due to another condition with similar symptoms, such as:

  • Hyperthyroidism (overactive thyroid)
  • Anxiety
  • Infections
  • Vasculitis (involves inflammation of blood vessels)
  • Nervous system disorders
  • Diabetes
  • Autoimmune conditions, such as rheumatoid arthritis or lupus
  • Cancer

Treatments

Patterns for hot flashes are unique to each person and can range from minor and easily tolerated to severe and debilitating.

Hot flashes usually fade away over time, and they don't need to be treated unless you find them bothersome and disruptive. Treatments do not actually cure vasomotor symptoms but can offer some relief.

There are lifestyle changes and coping strategies through therapy that may be helpful or your healthcare provider may recommend prescription hormonal therapy or other medications.

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: A selective serotonin-reuptake inhibitors (SSRI) medication 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, especially at night
  • 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 (sometimes called flushing) and night sweats (hot flashes at night). 

  • 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.

  • Are herbal treatments for hot flashes safe?

    No dietary supplements or herbal therapies have been found to be effective for hot flashes, according to the North American Menopause Society. Supplements also aren't regulated by the FDA, so monitoring for purity and safety are inconsistent. Discuss any herbal treatments you're considering with your healthcare provider.

10 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.
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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.