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

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