The most classic symptoms of low estrogen are hot flashes and night sweats, collectively known as vasomotor symptoms. Vasomotor symptoms are an extreme thermoregulatory response associated with profuse sweating, flushing, and increased heart rate. Vasomotor symptoms can last for seconds to minutes, and frequency varies throughout the day and night. I was taught in medical school and residency that vasomotor symptoms are a nuisance to be treated only if severe, but new data presented at the North American Menopause Society suggest otherwise.
How Many Women Suffer from Vasomotor Symptoms?
Eighty percent of women experience vasomotor symptoms during perimenopause or menopause.1 They occur early in 39 percent, and late in 67 percent. Other women experience them in the years leading up to perimenopause—many of my patients have night sweats a few days to a week before their period. I experienced hot flashes when I was postpartum at age 38, and may women find that the postpartum period is a preview of coming attractions in perimenopause and menopause. Vasomotor symptoms are associated with sleep disturbance, depressed mood, and overall decline in physical, social, and emotional quality.2 We all knew that already.
Hot Flashes and Night Sweats Are Not Just a Nuisance That Should Be Medicated Away
Now we realize that vasomotor symptoms are associated with other important indicators, including cardiovascular disease (CVD) risk, such as an adverse CVD risk factor profile, greater subclinical CVD and, in emerging work, CVD events.3 In the Study of Women’s Health Across the Nation (SWAN), frequent hot flashes were associated with higher tissue plasminogen activator antigen and higher factor VIIc in multivariable models. Findings persisted after adjusting for estradiol levels.4
Importantly, not all races suffer equally. Black women experience the longest duration of vasomotor symptoms at 10.1 year, followed by Latinx women at 6.5 years. The shortest duration is seen in Chinese and Japanese women.5
Learn more in this short 2-minute video that I shot for you on vasomotor symptoms.
What You Need to Know about Vasomotor Symptoms
- Vasomotor symptoms later in menopause may be associated with the greatest risk of cardiovascular disease.6
- Risk factors for vasomotor symptoms include higher body mass index, smoking, depression, alcohol, and race. You can modify your risk of the first four risk factors with lifestyle approaches like evidence-based weight loss, smoking cessation, treatment for mood, and decreasing or eliminating alcohol consumption.
- Untreated vasomotor instability impairs endothelial function—and may be associated increased risk of chronic disease such as hypertension, osteoporosis and osteoporotic fracture, CVD, depression, and cognitive decline.7
- We used to think that vasomotor symptoms were a consequence of a narrowed thermoregulatory zone in the hypothalamus, but the latest research suggests that changes in insulin, glucose, cortisol, serotonin, specific neuronal pathways involving kisspeptin, neurokinin B, and dysnorphin (KNDy), autonomic and endothelial function may be involved.8 In other words, the cause is still unclear but having stress and glucose problems may make vasomotor symptoms worse.
- One of my favorite treatments for vasomotor symptoms is in my book, The Hormone Cure, page 181. Paced breathing with a five-second inhale, ten-second hold, and five-second exhale has been shown to decrease hot flashes by more than forty percent. Other cool tips for hot flashes are featured on the same page.
The Crucial Window of the Perimenopause to Menopause Transition
I agree with Wen Shen M.D., Clinical Assistant Professor at Johns Hopkins University, who reported this week at the North American Menopause Society meeting that the perimenopause and menopause transition is a crucial window of opportunity to identify and prevent chronic disease. She shared that globally, 1.2 billion women will be in menopause in 2030, and the rate of increase is 47 million per year. We need more funding and research on the experience of women through the transition and how we can reduce risk with precision medicine.
One of the most effective treatments for vasomotor symptoms is bioidentical hormone therapy, at the lowest dose and for the shortest duration. If you want to learn more about whether hormone therapy is right for you, or you want to become a precision medicine patient and learn science-based ways to navigate perimenopause and menopause, go to SaraGottfriedMD.com/patient to register for the grand reopening of my practice to new patients.
- Delamater L, Santoro N. Clin Obstet Gynecol. 2018 Sep;61(3):419-432.
- Kravitz HM, et al. Menopause. 2003 Jan-Feb;10(1):19-28; Bromberger JT, et al. J Affect Disord. 2007 Nov;103(1-3):267-72; Avis NE, et al. Menopause. 2009 Sep-Oct;16(5):860-9.
- Thurston RC. Climacteric. 2018 Apr;21(2):96-100.
- Thurston RC, et al. Menopause. 2011 Oct;18(10):1044-51
- Avis NE, et al. Obstet Gynecol Clin North Am. 2018 Dec;45(4):629-640.
- Szmuilowicz ED, et al. Menopause. 2011 Jun;18(6):603-10; van den Berg MJ, et al. BJOG. 2015 Aug;122(9):1252-8.
- Biglia N, et al. Climacteric. 2017 Aug;20(4):306-312.
- Eichling PS, Sahni J. J Clin Sleep Med. 2005 Jul 15;1(3):291-300. PMID: 17566192.
Freedman RR. J Steroid Biochem Mol Biol. 2014 Jul;142:115-20.
Chedraui P, Pérez-López FR. Climacteric. 2019 Apr;22(2):127-132