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What Are the Vasomotor Symptoms of Menopause

Medically reviewed by Shilpa Amin, M.D., CAQ, FAAFP — By Rachel Nall, MSN, CRNA on October 12, 2022At about 40 years old, levels of estrogen and progesterone start to fall in women, and perimenopause — the transition to menopause — begins. As this transition progresses, women may experience vasomotor symptoms (VMS). VMS occurs due to the constriction or dilation of blood vessels. They include hot flashes, night sweats, heart palpitations, and changes in blood pressure. The most likely reason why these symptoms can occur during menopause is that hormonal fluctuations affect the mechanisms that control blood pressure and temperature control. According to the North American Menopause Society, up to 75% of women in the United States experience hot flashes around menopause. Hot flashes usually occur over a period lasting from 6 months to 2 years, but you can experience them for up to 10 years. In the U.S., menopause usually begins between the ages of 45 and 58 years. The average age for menopause is 52 years. Most people enter menopause 12 months after their last period. Hot flashes and other symptoms can start during perimenopause, while menstruation is still occurring, or they may begin after your periods end. Not everyone has these symptoms and they can vary in severity among individuals. You may start menopause earlier in life. In some cases, this may happen naturally, but in others, it may be due to surgery, a health condition, or certain types of medical treatment.

Symptoms

Hot flashes are a common VMS of menopause. Menopause isn’t a health condition. It’s a normal transition that most women will go through during their life. But the hormonal changes that it involves can lead to specific symptoms. Hormones play a role in how the cardiovascular system works. As their levels change, they can affect the circulatory system. They can also interfere with how the nervous system controls body temperature. Hot flashes are the main VMS. During a hot flash, you may feel a sudden sensation of heat that affects your chest, neck, and face. The skin in these areas may become red. Alongside hot flashes, you may experience:sweating, including night sweatssleep disturbancesanxietyheart palpitations These symptoms tend to affect people for about a year. But 17% of women may continue to experience them for several years. If menopause starts as a result of treatment, such as chemotherapy, you may find that the associated symptoms stop, and menstruation begins again once the treatment finishes. But this isn’t true for everyone.

Causes

The causes of hot flashes are likely to be neurovascular, which means that they happen when changes occur in the part of the nervous system that affects circulation. Experts believe that hot flashes result from changes in the part of the brain that regulates body temperature. Sudden drops in estrogen levels may trigger them, but it’s unclear exactly what role this hormone plays. Some evidence shows that taking supplementary estrogen helps relieve symptoms, but scientists haven’t found a correlation between circulating hormone levels and the severity of symptoms. Possible triggers for hot flashes include:eating spicy foodsdrinking coffee or alcoholwearing clothing that’s too warm for the environmenthaving a high temperaturesmokingstresssome medical treatments and drugssome health conditions, such as diabetes, tuberculosis, or an overactive thyroid But they can also occur without any apparent trigger. Some types of cancer treatment can also lead to hot flashes, regardless of your age or sex.

Risk factors

VMS is common during menopause, but not everyone experiences it. Factors that may increase your risk include smoking and obesity. Hot flashes may occur over a longer period in Black and Hispanic women than in white or Asian Americans, according to the National Institute on Aging.

Complications

Hot flashes and sweating aren’t usually harmful, but they can lead to discomfort, and you may feel embarrassed by the visibility of the symptoms. In some cases, hot flashes may not relate to menopause but may stem from problems with the nervous or vascular system. These hot flashes may be a sign of changes that could lead to other conditions, such as cardiovascular disease or dementia. You should see your doctor if:hot flashes interfere with your daily lifeyou have other symptoms, such as diarrhea, fatigue, unexplained weight loss, or a general feeling of being unwellyou’re at risk of another health condition, such as diabetes or thyroid problems Seeing a doctor can help you get treatment to improve your comfort levels and reduce anxiety. Doctors may also identify other underlying causes of VMS, should these be present.

Treatment

Your doctor may recommend medication to help you manage hot flashes.

Hormone therapy

Hormone therapy aims to balance hormone levels in the body. It can help relieve hot flashes and other symptoms, but it’s not suitable for everyone, as it can lead to side effects. Your doctor may not recommend hormone therapy if you have a history or high risk of certain conditions, including cardiovascular disease, stroke, breast cancer, uterine cancer, and liver disease.

Antidepressant drugs

Antidepressants, such as paroxetine (Paxil), may help. Healthcare professionals will usually prescribe a lower dosage for menopause symptoms than for depression. Possible adverse effects include headaches, nausea, and drowsiness. You may have mild symptoms during menopause and won’t need to use medications. You should discuss with your doctor the benefits and drawbacks of using medications.

Lifestyle remedies

Some lifestyle practices may help you manage hot flashes during menopause. These include:avoiding known triggers, such as spicy foods, alcohol, and caffeinequitting smoking, if applicable, or avoiding secondhand smokedressing in layers so that it’s easy to remove a layer if a hot flash occurscarrying a water bottle containing ice water to sip if a hot flash startskeeping a portable fan nearbykeeping the bedroom cool at nightavoiding exercise immediately before bedtimepracticing deep breathing and relaxation exercisesfollowing a healthful diet and getting regular exercisereaching or maintaining a moderate weight Researchers who conducted a 2012 study that looked at 17,473 women, suggested that women who lost 10% or more of their body weight through dietary changes experienced a reduction in or end to VMS during menopause. Some people use alternative treatments, such as black cohosh, dehydroepiandrosterone (DHEA), or soy isoflavones for hot flashes. But, according to the National Institute on Aging, there isn’t any evidence that these will help, and their long-term effects are unclear. You should speak with a doctor before using any herbal treatments, supplements, or other types of medication for menopause.

Outlook

VMS, especially hot flashes, are a common feature of menopause. Not everyone experiences them, and they can affect people differently. If you find that VMS affects your daily life significantly, you should speak with a doctor, who may recommend treatments or lifestyle changes that can help. Last medically reviewed on October 12, 2022

How we vetted this article

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nia.nih.gov/health/hot-flashes-what-can-i-doHot flushes: Menopause. (2018).
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womenshealth.gov/menopause/menopause-basicsMenopause FAQs: Hot flashes. (n.d.).
menopause.org/for-women/menopause-faqs-hot-flashesMiller VM, et al. (2018). What's in a name: are menopausal "hot flashes" a symptom of menopause or a manifestation of neurovascular dysregulation?
ncbi.nlm.nih.gov/pmc/articles/PMC5970009/Saccomani S, et al. (2017). Does obesity increase the risk of hot flashes among midlife women? A population-based study.
ncbi.nlm.nih.gov/pubmed/28562488Smith RL, et al. (2015). Does quitting smoking decrease the risk of midlife hot flashes? A longitudinal analysis.
ncbi.nlm.nih.gov/pmc/articles/PMC4546860/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 12, 2022 By Rachel Nall, MSN, CRNA Edited By Britt Gambino Medically Reviewed By Shilpa Amin, MD, CAQ, FAAFP Copy Edited By Naomi Farr Share this articleMedically reviewed by Shilpa Amin, M.D., CAQ, FAAFP — By Rachel Nall, MSN, CRNA on October 12, 2022

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