What We Know—and Don’t Know—About Menopause and VMS
Did cavewomen ask their caveman husbands to fan them when they woke up from night sweats? Were Victorian-era women able to get out of their corsets by the time a hot flash passed? How did menopausal women cool down before having their very own refrigerators to stand in front of?
Society has come a long way since the first women experienced hot flashes, the tell-tale signs of the menopause transition. And yet, there’s still so much that remains unexplained about vasomotor symptoms (VMS), the term medical professionals use to describe hot flashes, night sweats, and heart palpitations. Here are four things we do know about VMS, as well as four things scientists are still trying to figure out.
What we know: The vast majority of women experience VMS during the menopause transition
More than 80% of women report having hot flashes during the menopause transition, including perimenopause (the four to eight years leading up to menopause) and continuing for about 4.5 years following the last menstrual period. Hot flashes can range in intensity from mild to severe, with many women reporting they feel an intense heat rising from the chest, neck, and face, often accompanied by sweating.
“There’s a large spectrum of severity,” says Felice Gersh, M.D., author of Menopause: 50 Things You Need to Know. “Some women describe their hot flashes as a heatwave, and they just want to reach for a fan. For others, it can be a total body experience where they’ll be sweating profusely from every part of their body.”
What we don’t know: What exactly causes VMS
VMS is triggered by the hypothalamus, a gland in your brain that you can think of as your own personal thermostat. Prior to menopause, estrogen helps regulate your body’s thermostat by keeping another hormone called neurokinin in check. As estrogen levels ebb and flow during the menopause transition, neurokinin goes unchecked, leading to wild swings in body temperature. Although scientists have determined many of the underlying mechanisms of VMS, they have yet to pinpoint exactly why the symptoms occur.
What we know: VMS affects racial groups differently
Thanks to the Study of Women’s Health Across the Nation (SWAN), in which researchers have been following a group of over 3,000 women for nearly 30 years, we now have a better understanding of how varied VMS is among both individual women and racial groups. And the differences can be stark. Consider:
White participants in SWAN experienced VMS for an average of six-and-a-half years, whereas Black women experienced VMS for 10 years
Averages for Hispanic women in the study fell between the Black and white groups
Chinese and Japanese women reported the least severe hot flashes of all the racial groups analyzed.
Native American women experienced VMS at rates similar to Black women in terms of how long VMS lasted and the severity of symptoms, according to findings of a separate study.
Some of these disparities can be explained by each group’s incidence of certain VMS risk factors, such as smoking and obesity. For instance, 24% of Black women in the SWAN study reported being smokers as compared to 17% of white women. But even after adjusting for these factors, Black women were still 50% more likely to experience VMS than white women.
What we don’t know: Why these differences among races exist
“In the past, studies have tended to lump all vasomotor symptoms together without looking at these different subgroups, so we really don’t know [why these variations exist] yet,” says Siobán D. Harlow, Ph.D., SWAN study investigator and professor emeritus of epidemiology and global public health in Michigan. “Future research really needs to try to understand what risk factors and what underlying physiology is contributing to these differences.”
What we know: VMS is more than simply bothersome
Hot flashes are more than just an annoyance—they can have seriously negative effects on your physical and mental health, particularly if they’re affecting your sleep. Women in the SWAN study who had more frequent VMS were twice as likely to experience sleep disturbances as compared with women who had less frequent VMS. And we know inadequate sleep can increase an individual’s risk for cardiovascular disease, a weakened immune system, chronic pain, depression, and more.
Even independently of the sleep implications, VMS appears to increase a woman’s risk for having a heart attack later in life. SWAN researchers concluded that more frequent VMS correlated with a higher risk of heart attack. Women who reported having hot flashes six or more days per week were 50% more likely to have a heart attack than women who reported having hot flashes one to five days a week.
What we don’t know: All the ways VMS affects a woman’s long-term health
It’s too soon to tell exactly how VMS affects heart health, but research continues to explore the relationship. “Is it just an association, meaning that they occur together, or is there a causal relationship?” asks Sherri-Ann Burnett-Bowie, M.D., an assistant professor of medicine in Massachusetts and one of the principal investigators for the SWAN study. “Is there something about vasomotor symptoms that leads to an increase in cardiovascular disease? We just don’t know yet.”
Scientists are also exploring how VMS may affect a woman’s chances of developing insulin resistance, liver disease, and other chronic health problems.
What we know: There are several very good VMS treatments available
Even though so many women experience hot flashes and night sweats, only a small number seek treatment, which is a shame because there are many effective therapies available, says Dr. Burnett-Bowie. Women today have more treatment options than ever before, including several prescription drugs on the market that have proven to be highly successful at treating VMS.
Other science-backed VMS remedies include following a Mediterranean diet and eating specific foods, including fruit. Exercise, and more specifically resistance training, may also have a positive effect on VMS, according to a 2019 Swedish study. And, of course, quitting smoking is a must.
What we don’t know: Whether or not certain alternative therapies are effective
If your aunt swears by black cohosh or red clover to ease hot flashes, take her recommendation with a grain of salt. Some women report getting relief from alternative therapies, but the scientific research isn’t there to support it, according to the North American Menopause Society—and some of these natural remedies can produce unpleasant side effects.
Your best bet is to seek out a menopause-certified provider who can take into account your full medical history and help you find the therapy that’s right for you. You can search for one in your area at menopause.org.
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