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What Are Vasomotor Symptoms Of Menopause

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Vasomotor Symptoms: Hot Flashes & Night Sweats | Dr. Sara Gottfried

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Vasomotor Symptoms Of Menopause

Changes in the body during menopause are accompanied by a symptom such as hot flashes, which are faced by 80% of people. The nature of these vasomotor symptoms associated with menopause depends on the individual characteristics of the structure of the organism. The duration of flashes often doesnt exceed a few minutes. During attacks, a person feels a strong rush of heat to the hands, face and other parts of the body.

Doctors believe that the causes of vasomotor symptoms during menopause are unknown. But the absence of some hormones can have an impact. They believe it makes the hypothalamus, or the part of the brain that is responsible for regulating temperature, more sensitive to changes in a womans body temperature.

Cardiovascular Symptoms Of Menopause

Statistics show that cardiovascular disease in adulthood affects men. Women under 50 are significantly less prone to heart disease. However, with the onset of menopause, the number of heart diseases among women is increasing.

In this case, occur in the work process of all systems of the womans body changes. First of all, the bones, heart and blood vessels suffer. The increase of cardiovascular diseases at this stage is explained by a gradual decrease in the production of sex hormones and a violation of the processes.

One of the most important manifestations of cardiovascular disorders, aggravating the course of pathological menopause, are changes in the myocardium, developing independently of the formation of atherosclerosis of coronary vessels and arterial hypertension .

The main complaints of patients with pathological menopause are:

  • pain in the heart,
  • heartbeat ,
  • dyspnea.

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Vasomotor Symptoms In Menopause

Most women experiencing menopause are all too familiar with the hot flashes and night sweats that mark this transition. The medical term for hot flashes is vasomotor symptoms.

Hot flashes usually start suddenly, with a feeling of heat that begins around the upper chest and face, and then spreads. The feeling of heat, accompanied by heavy sweating and sometimes palpitations, lasts for around one to five minutes. After that, some women feel chills, shivering, and a feeling of anxiety.

While entirely normal, hot flashes can be disruptive for women who experience them. While some women average one hot flash a day, others have one every hour all day and night. In addition to being disconcerting and uncomfortable, hot flashes can disturb sleep when they occur at night.

Effects Of Associated Vms On Qol

Vasomotor Symptoms of Menopause

Perceived QOL is difficult to measure and there is no universal agreement on how it should be quantified. Objective measurements of health status may not capture the patient’s perception of overall life satisfaction. QOL can be defined as a reflection of an individual’s belief about functioning and achievement. HRQOL may be viewed as the individual’s perception regarding her physical, cognitive, and mental health as well as social situation . Assessments of overall QOL for menopausal women must include consideration of somatic symptoms , psychological symptoms , and life circumstances . Thus, overall QOL may include four major factors: occupational, health-related, sexual, and emotional . Consideration of HRQOL is also influenced by women’s increased risk of multiple chronic diseases associated with menopause, including osteopenia, osteoporosis and related fractures, and cardiovascular disease .

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Complementary And Alternative Medicine

A wide variety of complementary and alternative therapies have been used to relieve symptoms. Black cohosh, other herbal preparations, and over-the-counter products do not appear helpful. Also, some herbal preparations interact with other drugs. Soy protein, which can have estrogenic effects, has been studied with mixed results however, one soy product, S-equol, has been reported to relieve hot flushes.

Use of regular exercise, paced respirations , mindfulness, or relaxation techniques to reduce hot flushes have had mixed results, although exercise, yoga, and relaxation techniques may improve sleep and reduce stress. Acupuncture has also had mixed results.

Because not all complementary and alternative medicine therapies are efficacious and safe, clinicians should discuss the risks and benefits of these therapies to make sure that women are well-informed due to decreased ovarian function. Manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary… read more ).

Definition And Epidemiology Of Vms

VMS, or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. VMS are episodes of profuse heat accompanied by sweating and flushing, experienced predominantly around the head, neck, chest, and upper back. VMS are experienced by the majority of women during the menopausal transition. In SWAN, 60-80% of women experience VMS at some point during the menopausal transition, with prevalence rates varying by racial/ethnic group. Research from SWAN indicates that the occurrence and frequency of VMS peak in the late perimenopause and early postmenopausal years, or the several years surrounding the final menstrual period. However, research from a range of studies has shown that a sizable minority of women report VMS earlier in midlife, before the onset of menstrual cycle changes, and well into their 60s and 70s, decades after the menopause transition., Given the prevalence and duration of VMS among midlife women, it is critical to understand the underlying biology of this symptom, the extent to which VMS may impair quality- of-life, and whether VMS may serve as a marker for other important health conditions.

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Variation In The Definitions Of Vasomotor

There was substantial heterogeneity in the definition of vasomotor-related outcomes. Three different definitions were used to measure the frequency of vasomotor symptoms. Most studies defined frequency as the number of hot flushes or night sweats, whereas 18 studies did not define how frequency was measured. The severity of vasomotor symptoms was defined in nine different ways and the intensity in seven different ways . The 68 studies reporting composite outcomes for vasomotor symptoms utilised 11 different ways of defining the composite score. The most commonly used approach measured the number of hot flushes and night sweats, and calculated a composite score weighted by severity rating. There was considerable overlap between composite score definitions.

Genitourinary Syndrome Of Menopause

Advances in Our Understanding of the Etiology/Mechanisms of Vasomotor Symptoms

Genitourinary syndrome of menopause refers to bothersome genital symptoms from changes in the vulva, vagina, and lower genital tract that are caused by diminished estrogen. This condition affects up to one-half of women during menopause.28 In 2014, a consensus conference endorsed the new term genitourinary syndrome of menopause to replace the terms vulvovaginal atrophy and atrophic vaginitis, partly because the older terminology does not encompass the extent of genital tract symptoms many women experience.29 Decreased estrogen can cause several changes to genital anatomy that lead to patient discomfort. Thinning of the vulvar mucosa may cause vulvar burning, irritation, or constriction of the introitus, resulting in entry dyspareunia. Narrowing of the vagina and decreased lubrication can cause painful intercourse or coital bleeding.30 Diminished estrogen may also lead to recurrent urinary tract infections and urinary urgency.29 Genitourinary syndrome of menopause is often progressive without treatment.28

Treatment Options for Genitourinary Syndrome of Menopause

Estrace vaginal cream 0.01%

Treatment Options for Genitourinary Syndrome of Menopause

Estrace vaginal cream 0.01%

This review updates previous articles on this topic by Hill and Hill,35 by Carroll,36 by Morelli and Naquin,37 and by Cutson and Meuleman.38

Read the full article.

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Hormonal Treatments For Vasomotor Symptoms

Menopausal hormone therapy is very effective for treating vasomotor symptoms that are moderate to very severe. Women who have had a hysterectomy can take estrogen alone. A woman who still has her uterus will be prescribed a combination of estrogen and progestin. Progestin is needed to reduce the risk of uterine cancer.

However, because MHT is associated with heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women, women are advised to use the smallest dose for the shortest amount of time possible .

Women of a certain age with a history of certain conditions, including breast cancer, coronary heart disease, blood clots, heart attack, and stroke should consider alternatives to hormone therapy. Women at high risk for these complications should also consider alternatives.

Transitioning From Contraception To Hormone Therapy

Transitioning from contraception to hormone therapy may be challenging because oral contraceptives have higher dosages than typical hormone therapy regimens. Also, measuring follicle-stimulating hormone levels after stopping oral contraceptives can be inaccurate during perimenopause.26 One small study found that a rise in follicle-stimulating hormone level without a change in estradiol levels two weeks after stopping oral contraceptives is evidence that it is safe to transition to hormone therapy.26 Others suggest discontinuation of contraception when women are in their mid-50s because spontaneous conception is rare at this age.27

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Impact Of Stress On Menopause Symptomatology

Vasomotor symptoms are the primary symptoms associated with menopause. Estimates of the incidence of hot flashes from population studies in the United States and worldwide have ranged from 24 to 93%. Studies of menopause in different cultures reveal wide cultural variation in symptom reporting. For example, hot flashes are uncommon in Mayan women, and Japanese and Indonesian women report far fewer hot flashes than women in Western societies. Because women across cultures differ in terms of their diet, physical activity, number of pregnancies, use of contraception, as well as attitudes toward menopause, it has been difficult to assess the reason for this variation. However, even within a culture, a high degree of variability of symptom reporting is found among women, suggesting considerable individual variation in symptom experience. What differentiates symptomatic from asymptomatic women is not well understood.

Thus, consistent with other research on stress and symptoms, there is some evidence that women experiencing stress for other reasons may have a tendency to notice or report greater menopausal symptoms. However, stress is only one of many factors that appear to impact menopausal symptoms.

G.R.J. Gordon, … S.J. Mulligan, in, 2009

The Immense Burden Of Menopausal Symptoms


Several recent articles suggest that the burden of menopausal symptoms is greater than generally perceived. About 80% of women experience vasomotor symptoms hot flashes and night sweats as they transition into the menopause phase. For most, the symptoms are manageable, but for a sizeable subset of midlife women, these symptoms can negatively affect sleep, mood, and quality of life. While clinical guidelines suggest that menopausal vasomotor symptoms typically last from 6 months to 2 years, new research suggests that for many women, the duration of symptoms is much longer.

Researchers recently analyzed data from 1449 perimenopausal women included in the Study of Womens Health Across the Nation , an observational study of women entering menopause. They observed that the median total duration of VMS was 7.4 years. The majority of the women included in this study experienced vasomotor symptoms for more than five years.

The studies were different in design one longitudinal and the other cross-sectional but the findings were similar and indicate that moderate to severe vasomotor symptoms are relatively common in midlife women and are not restricted to the perimenopause but may persist for many years beyond the last menstrual period. Also of note is the finding in the second study, where they assessed treatment, that only about 6.7% of the women were receiving treatment for their vasomotor symptoms.

Ruta Nonacs, MD PhD

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How Long Do They Last

Despite their pervasiveness, negative influence on quality of life, and association with adverse health indicators, we have lacked robust estimates of how long VMS last. In part this is because, until recently, few studies had sufficient follow-up of individual participants, and thus within-woman duration was inferred indirectly by comparing different women at varying stages of the menopause transition. Previous clinical guidelines suggested a typical duration of VMS between 6 months and 2 years. Recent findings, however, indicate that VMS last much longer. Any VMS i.e., regardless of frequency or severity have been found to last a total of 10.2 years on average, and average duration after the FMP is 4.9 years among those who continue to have symptoms. Average or median durations for frequent or moderate/severe VMS are somewhat shorter at 7.4 8.8 years in total, and 4.5 4.6 years after the FMP., VMS last longer in women whose symptoms begin earlier in the menopause transition. Frequent or moderate/severe VMS have a median duration of approximately 3.5 years in women whose symptoms begin postmenopause, compared with more than 11.5 years in women with an onset of VMS near the start of the menopause transition.,

What Are The Vasomotor Symptoms Of Menopause

Vasomotor is defined as being related tothe parts of the brain that regulate blood pressure. Many of the first symptomsof menopause are vasomotor ones. This is due to the hormonal changes that thebody is going through at the time. These symptoms often last anywhere from fiveto seven years. In some cases, they can last a lifetime.

When there is a sudden increase of bloodflow, uncomfortable heat and sweating often follow. During the day, many womenrefer to this experience as a hot flash. When it happens at night, it may becalled night sweats instead. Typically, the increase in blood flow happens tothe face, neck, and chest. For some women, this feeling is accompanied bychills, feeling flush, and great anxiety. In extreme cases, heart palpitationsmay occur as well.

How long an episode lasts varies from womanto woman. In most cases, it is less than five minutes. This is long enough tocause major disruption, however, especially when the episodes are waking awoman up at night. The vasomotor symptoms of menopause are typically the mostsevere in the first year or two of menopause.

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Icipant Selection And Recruitment

In-person interviews were conducted with women 4064years of age who were experiencing 35 moderate to severe hot flashes and/or night sweats per week. Moderate VMS were defined as sensations of heat with sweating without disruption of activity severe VMS were defined as sensations of heat with sweating prompting cessation of normal activity. To be eligible, women also had to have either undergone removal of both ovaries 6weeks prior to screening or had no menstruation for 12months prior to screening due to menopause or treatment for breast cancer . Exclusion criteria included pregnancy cessation of menses due to contraceptive use, pregnancy/breastfeeding, and/or treatment for a medical condition other than breast cancer and current malignancy, with the exception of breast cancer currently treated with maintenance hormonal therapy.

Selective Estrogen Receptor Modulators

Clinician readiness for new therapies for vasomotor symptoms

The SERMs tamoxifen and raloxifene have been used primarily for their antiestrogenic properties and not to relieve menopausal symptoms. However, ospemifene, a SERM, can be used to treat dyspareunia due to vaginal atrophy if women cannot use estrogen or a vaginal drug or if they prefer to use an oral drug other than estrogen dose is 60 mg orally once a day due to decreased ovarian function. Manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary… read more ). In women who have recently been taking hormone therapy, hot flushes may temporarily increase, but in most women, hot flushes resolve after about 6 weeks.

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Future Studies Will Need To Disentangle The Complex Relationships Between Vasomotor Symptoms Cvd Risk And Ht Use

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A menopausal woman often tells her doctor that she is suffering fromvasomotor symptoms, but it is far less often that her doctor wonders whetherthese symptoms represent anything more than a quality of life issue.

Yet emerging evidence raises questions about whether vasomotor symptomsare more than just a nuisance. Some have hypothesized that the peripheralvasomotor instability typical of hot flashes may herald underlyingabnormalities in systemic vascular function. Since hot flashes occur in thevast majority of women during the menopausal transition, there has beenincreasing interest in elucidating whether or not the presence of vasomotorsymptoms may have health implications beyond their impact on a womansquality of life.

Emily D. Szmuilowicz, MD

A growing body of literature suggests that cardiovascular disease riskfactors may differ in women with vs. without vasomotor symptoms. On the onehand, some traditional CVD risk factors may predispose women to vasomotorsymptoms.

Emily D. Szmuilowicz, MD, is an Instructor of Clinical Medicine atNorthwestern University and a member of the Endocrine Today Editorial Board.

Avasomotor Episodes And Other Brain Dysfunction At The Start Of The Climacteric

Vasomotor episodes , usually referred to as hot flushes or hot flashes, are the most common symptom reported by climacteric women and are the primary cause for seeking medical advice during this period. The rate of reporting of VMEs is not constant throughout the world for example, 50% to 85% of women in North America and Europe report VMEs at the time of cessation of ovarian function. The basis for this discrepancy is not understood, but evolutionary and cultural aspects appear to play important roles . The regular and dose-related diminution of VMEs in symptomatic women described elsewhere in this book attest to the role of estrogen in the occurrence of VMEs.

Thermoregulatory centers in the hypothalamus are largely responsible for the control of vasomotor tone and VMEs . This is discussed in detail elsewhere in this book.

VMEs are only one of many estrogen-dependent signs and symptoms of brain dysfunction that are prominent during the climacteric. Interestingly, these manifestations are generally not conceived as brain symptoms. Rather, they are usually lumped in the category of menopausal symptoms, thereby losing their significance as harbingers of brain dysfunction and perhaps permanent brain disease. This is a massively underdocumented area in need of much research.

A. Defresne, V. Bonhomme, in, 2017

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