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During the menopausal transition, many women experience sleep disturbances, changes in mood and cognitive performance, migraine, and Vasomotor Symptoms (VMS), also known as hot flushes and night sweats. They also undergo physical changes, which can continue long into postmenopause, including changes in body shape, osteoporosis, increased risk of cardiovascular events, ageing of hair and skin, and vulvovaginal atrophy.1
Vasomotor Symptoms are the most commonly reported symptoms of the menopausal transition. Up to 80% of women are affected by VMS during the menopausal transition.2
VMS arise from heightened neuronal activity in the hypothalamus. This leads to hypertrophy of KNDy neurons and altered activity in the temperature control centre. The resulting VMS include the uncomfortable feeling of heat and sweating, which can disrupt women’s daily lives.1-5
The burden of VMS
Have you ever talked to your doctor about menopause?
Did you know that there are multiple symptoms (including changes to your body) due to menopause?
Are hot flushes and night sweats causing you to sweat through your clothes?
Are night sweats disrupting your sleep?
Are hot flushes impacting your social life, causing you to feel self-conscious or causing you to reconsider plans?
Are hot flushes discouraging you from exercising?
Are hot flushes impacting you at work? Have they affected your career outlook?
Have hot flushes impacted your sex life and intimacy with your partner?
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See a hot flush in action within the temperature control centre of the hypothalamus
Menopause is defined as the permanent cessation of menstrual periods. However, the symptoms of menopause can begin before the cessation of menses and extend over several years.1
Perimenopause, the transition from the reproductive period to the first year postmenopause, is associated with increasing symptom burden. This is due to the neurochemical changes in the central nervous system, which are associated with Vasomotor Symptoms (VMS), sleep disorders, and depression.1
Other symptoms can include changes in body shape related to cardiometabolic changes, musculoskeletal alterations, skin and urogenital atrophy, sexual dysfunction, osteoporosis, and sarcopenia.1
The symptoms of menopause not only have a significant effect on quality of life, they also have been associated with the onset of chronic conditions—serving as predictors of future health risks.1
The most bothersome symptoms of menopause—and the most common reason women seek medical care during the menopausal transition—are hot flushes and night sweats, also know as Vasomotor Symptoms.2 Hot flushes are characterised by a sudden intense sensation of heat in the upper body, particularly the face, neck, and chest. Episodes of VMS typically last 1 to 5 minutes, and can be accompanied by perspiration, chills, anxiety, and heart palpitations. However, individual experiences of VMS vary.3
Oestrogen declines during menopause. Among the effects of this decline are vaginal atrophy, ageing of skin, osteoporosis, and VMS.1.4.6
In the case of VMS, we now know that during menopause, less oestrogen reaches the oestrogen receptors of kisspeptin/neurokinin B/dynorphin (KNDy) neurons, which are located in the temperature control centre of the hypothalamus. The reduction in oestrogen alters the activity of the KNDy neurons, and that altered activity is one of the causes of VMS.4,6
VMS are physiological symptoms associated with menopause.3
In the temperature control centre in the hypothalamus:
Studies have shown that the frequency and severity of VMS may be used as a predictor of chronic diseases in the future, such as cognitive impairment, cardiovascular disease, and osteoporosis.10
Even though hormone therapy (HT) has long been the standard of care, diminished oestrogen is not the only cause of VMS.4,5
[Current treatment classes for hot flushes and night sweats include HT and SSRI.] Other treatment strategies include over-the-counter remedies like supplements and herbs. Each of these options has varying levels of efficacy and safety.2
Up to 80% of women are affected by VMS during the menopausal transition.3 VMS last for a median duration of 7.4 years, and women living with VMS reported a negative impact on sleep (82%), mood (69%), concentration (69%), energy (63%), sexual activity (41%), work (46%), social activities (44%), and leisure activities (48%).11,12
Not all women realise that VMS are a medical condition worthy of discussion; therefore, many go undiagnosed or untreated.13,14 Having a productive dialogue is crucial in helping women impacted by VMS. Studies show that women want to have open and honest conversations about menopause symptoms and treatment options with their doctor.13
This is Video Features
Waking up in the middle of the night due to VMS, feeling hot with a damp pillowcase, is classified as what severity of VMS?
Severe. A severe VMS episode is defined as the sensation of heat with sweating causing cessation of activity (such as sleeping). A moderate VMS episode is defined as the sensation of heat with sweating while maintaining the ability to continue activity. A mild VMS episode is defined as the sensation of heat without sweating.2
Approximately what percentage of women experience Vasomotor Symptoms (VMS), also known as hot flushes and night sweats, during the menopausal transition?
Up to 80% of women experience VMS during the menopausal transition.2
Sleep disturbances due to VMS are one of the most bothersome aspects of the menopausal transition.
True. 40% to 60% of women report sleep disturbances during the menopausal transition, including nighttime awakenings.3
On average, how many times per week do women experience VMS?
30+. In a UK study, postmenopausal women who experience VMS reported an average of 33.5 hot flushes and night sweats per week.4
VMS can impact:
All of these. Women living with VMS reported a negative impact on sleep (82%), mood (69%), concentration (69%), energy (63%), sexual activity (41%), work (46%), social activities (44%), and leisure activities (48%).5
How likely are severe VMS to cause a negative impact on overall quality of life compared to mild or moderate symptoms?
3.6x. Women with severe VMS were 3.58 times as likely to be negatively impacted as those with mild or moderate symptoms.5
VMS may be indicators of future chronic conditions.
True. Studies have shown that the frequency and severity of VMS can be used as a predictor of chronic disease in the future, such as cognitive impairment, cardiovascular disease, and osteoporosis.6
Hot flushes always diminish after age 55.
False. A study of postmenopausal women in 5 European countries (France, Germany, Italy, Spain, and the UK) was equally stratified by 3 age groups: 45 to 54, 55 to 64, and ≥65. Among women with symptoms of menopause, the current incidence of hot flushes generally diminished with age. However, in France, the 55 to 64 age group reported a higher prevalence of hot flushes than the younger (45 to 54) age group. Across the countries, hot flushes remained prevalent after age 64, especially in Germany (56%) and France (57%).7
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