Why You Need to Know About VMS

Thought you were done with those waves of heat that leave you sweating once you hit your “one year without a period in sight” anniversary, aka menopause? Sadly, for many women, there’s no such luck. Even after you enter menopause, you may continue to experience vasomotor symptoms (VMS): hot flashes around your face, neck, chest and upper back, plus night sweats, which can wake you up repeatedly and prevent you from getting decent sleep.

Up to 80 percent of women experience VMS as they transition into menopause, usually for six months to two years, according to data from Massachusetts General Hospital. Yet VMS can last a lot longer. “Vasomotor symptoms may, and often do, continue after your final menstrual period,” says Tara K. Iyer, MD, MSCP, lead physician at Brigham and Women’s Hospital’s Menopause and Midlife Clinic and an instructor in medicine at Harvard Medical School. “I’ve had patients experience VMS for one to two years [after menopause], and a handful continue to have hot flashes into their 80s, or even their 90s.”

What’s the cause of VMS in the first place? “The precise physiological mechanism of vasomotor symptoms is not completely understood, but it involves a complex interplay of hormones, multiple neurotransmitters, and the body’s thermoregulatory system,” Iyer says.

A recent review of the scientific research explains that the drop in estrogen associated with menopause causes alterations to the area of your brain that regulates your body temperature, known as the hypothalamic thermoregulatory neutral zone. This falls in line with a long-held theory that hot flashes happen initially due to less ovarian estrogen. This, coupled with a simultaneous reduction of the neurotransmitter hormones norepinephrine and serotonin, can cause vasodilation in your fingers and toes, which can raise your skin temperature, blood pressure, and heart rate temporarily. (Sounds like a hot flash, doesn’t it?)

“VMS frequency and intensity often decrease over time, and they typically don’t persist indefinitely,” says Iyer. But if you’re one of the number of women for whom that’s not the case, here’s why hot flashes and night sweats may still be happening to you—and what you can do to ease the discomfort.

You haven’t been in menopause long enough.

You might have to tough out your symptoms just a little bit longer, if you only recently stopped having periods. The Study of Women’s Health Across the Nation (SWAN) examined the duration of women’s experiences once they were in menopause. “The women in this study continued to have VMS after their final menstrual period for a median of 4.5 years,” says Iyer. Accepting that your body needs a little more time to adjust to this major transition can, in itself, go a long way toward making you feel more in control.

You may have factors contributing to VMS that you can’t change.

The duration of VMS can be affected by factors like race and ethnicity. For example, research presented at the 2022 North American Menopause Society’s annual meeting found that Black women are more likely to experience severe hot flashes and night sweats. Talking with your doctor about treatment options is a great way to get relief.

Additionally, if you’re going through an unavoidably stressful period in your life, due to divorce, grief, or financial issues, you may be dealing with mood changes, anxiety, or sleep problems due to those. All of these psychological pressures worsen VMS, according to a research review. Or you may have gained weight during perimenopause that you’re struggling to lose, a natural and common issue for many women. Obesity can trigger VMS due to inflammation during perimenopause, according to a paper investigating VMS. There can be an upside here, though: As some women enter menopause, this situation can reverse, and as inflammation in your system decreases, additional weight will no longer exacerbate VMS.

But even if you can’t change why you have VMS, you can take steps to get physical and emotional relief. Weight loss through diet and exercise, mindfulness practices like meditation and yoga, and talking with a therapist can all be very helpful.

You’re a smoker.

Now here’s a factor that you can do something about. In an analysis that looked at 21,600 women around 50 years of age, smokers who were overweight were more likely to report hot flashes and night sweats. When those smokers lost weight, the incidence of VMS diminished, though not to the same levels of women who had never smoked. And women who quit smoking before they saw their 40th birthday experienced VMS symptoms to around the same extent as women who had never smoked.

You aren’t on HRT.

Research presented at the 25th European Congress of Endocrinology found that women who have severe hot flashes after they reach menopause are more likely to develop both high blood pressure and metabolic syndrome, which can increase their risk of stroke, heart disease, and type 2 diabetes. To reduce these risks, the researchers advocate that these women begin hormone replacement therapy (HRT) shortly after they have their last period. “The gold standard of care for relief of hot flashes and night sweats is HRT, which is typically a very safe, effective choice in healthy women under the age of 60 years old, or within 10 years of menopause without a reason it shouldn’t be used,” says Iyer, who notes that this is not a safe option for every woman.

“We know HRT eliminates symptoms, but it’s not a one-size-fits-all solution,” says Alyssa Brown, MD, an assistant professor of obstetrics and gynecology and associate program director of the OB-GYN residency program at the University of South Florida Morsani College of Medicine, in Tampa. “There are potential health issues to consider.” These risks can include breast cancer, blood clots, and, ironically, stroke and heart disease. “Whether HRT is going to work for you is very individualized, and needs to be discussed with your doctor,” Brown says.

But HRT isn’t the only treatment option to consider. “For women who can’t safely have HRT, or don’t wish to take hormone therapy, non-hormone medications may prove useful to reduce hot flashes and night sweats,” says Iyer.

You don’t know all your options for relief.

Seeing not only your primary-care physician and gynecologist, but also a menopause specialist, can make a huge difference in handling VMS. The specialist will be able to provide you with a full management plan based on your medical history, your current symptoms, and the goals you have for treatment. Again, the approach they take will be geared toward what you as an individual need—targeted care is always the best solution for VMS.

“It’s okay to speak up and ask what you’re worried about—write down your questions, planning one or two things you want to discuss during your visit, and know that your provider is there to help you,” Brown says. “When you start planning your life around your symptoms, it’s a quality-of-life issue.”