Frequently asked questions

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

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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:

  • Neurokinin B (NKB) and oestrogen modulate KNDy neurons in a delicate balance, contributing to body temperature regulation. KNDy neurons are stimulated by NKB and inhibited by oestrogen6-8
  • Through the menopausal transition, oestrogen declines, disrupting the balance with NKB6,7,9
  • Unopposed, NKB signalling causes heightened KNDy neuronal activity, which leads to hypertrophy of KNDy neurons and altered activity in the temperature control centre6,7,9
  • As a result, the temperature control centre triggers heat dissipation effectors that cascade into hot flushes and night sweats—VMS6,9

Watch a hot flush in action

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

 

[SSRI=selective serotonin reuptake inhibitor.]

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

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H1 -Light: What is menopause?

H2 - Light italic - What are the most common symptoms of menopause?

H3 - Semibold - What’s the role of oestrogen in VMS?

H4 - Semibold italic - What causes VMS?

H5 - bold - Can VMS be an indicator of other health implications?
H5 - Bold italic - What are the current VMS treatment options?
H6- Regular - What is the impact of VMS on women's lives?

Light - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Light italic - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Semibold - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Semibold italic - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Bold  - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Bold italic - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Regular - For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone

Particular Wording:

For too long, explanations of Vasomotor Symptoms associated with menopause (VMS), commonly known as hot flashes and night sweats, have been limited to declining estrogen alone.


References:

  1. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause – global prevalence, physiology and implications. Nat Rev Endocrinol 2018;14(4):199-215.
  2. Kaunitz AM, Manson JE. Management of menopausal symptoms. Obstet Gynecol 2015;126(4):859-76.
  3. Thurston RC. Vasomotor symptoms. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A Clinician's Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society, 2019:43-55.
  4. Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol 2007;196(2):97-106.
  5. Modi M, Dhillo WS. Neurokinin 3 receptor antagonism: a novel treatment for menopausal hot flushes. Neuroendocrinology 2019;109(3):242-8.
  6. Padilla SL, Johnson CW, Barker FD, Patterson MA, Palmiter RD. A neural circuit underlying the generation of hot flushes. Cell Rep 2018;24(2):271-7.
  7. Krajewski-Hall SJ, Blackmore EM, McMinn JR, Rance NE. Estradiol alters body temperature regulation in the female mouse. Temperature 2018;5(1):56-69.
  8. Wakabayashi Y, Nakada T, Murata K, et al. Neurokinin B and dynorphin A in kisspeptin neurons of the arcuate nucleus participate in generation of periodic oscillation of neural activity driving pulsatile gonadotropin-releasing hormone secretion in the goat. J Neurosci 2010;30(8):3124-32.
  9. Krajewski-Hall SJ, Dos Santos FM, McMullen NT, Blackmore EM, Rance NE. Glutamatergic neurokinin 3 receptor neurons in the median preoptic nucleus modulate heat-defense pathways in female mice. Endocrinology 2019;160(4):803-16.
  10. Biglia N, Cagnacci A, Gambacciani M, Lello S, Maffei S, Nappi RE. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric 2017;20(4):306-12.
  11. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015;175(4):531-9.
  12. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas 2009;62(2):153-9.
  13. Parish SJ, Nappi RE, Kingsberg S. Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment. Menopause 2018;25(8):937-49.
  14. Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes 2005;3:47.
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Get read FAQs about menopause and VMS due to menopause
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Get read FAQs about menopause and VMS due to menopause
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Get read FAQs about menopause and VMS due to menopause



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

Image is not good
FAQs(title) | KnowVMS
Get read FAQs about menopause and VMS due to menopause
Image is not good
FAQs(title) | KnowVMS
Get read FAQs about menopause and VMS due to menopause
Image is not good
FAQs(title) | KnowVMS
Get read FAQs about menopause and VMS due to menopause

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:

  • Neurokinin B (NKB) and oestrogen modulate KNDy neurons in a delicate balance, contributing to body temperature regulation. KNDy neurons are stimulated by NKB and inhibited by oestrogen6-8
  • Through the menopausal transition, oestrogen declines, disrupting the balance with NKB6,7,9
  • Unopposed, NKB signalling causes heightened KNDy neuronal activity, which leads to hypertrophy of KNDy neurons and altered activity in the temperature control centre6,7,9
  • As a result, the temperature control centre triggers heat dissipation effectors that cascade into hot flushes and night sweats—VMS6,9

Watch a hot flush in action

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

 

[SSRI=selective serotonin reuptake inhibitor.]

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

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