Comprehensive Guide to Understanding and Managing Vasomotor Symptoms of Menopause

Vasomotor symptoms are the physiological changes occurring due to fluctuations in the body’s blood vessel activity, commonly experienced during menopause. These symptoms are primarily triggered by changes in hormonal levels, especially a decrease in estrogen, due to the transitioning of the fertile phase to the non-reproductive phase.

The symptoms include hot flashes, night sweats, heart palpitations, and changes in blood pressure. According to the North American Menopause Society, up to 75% of females in the United States experience hot flashes around menopause. ⁽¹⁾ Menopause in the United States begins at the age of 45-58 years of age, with the average age being 52 years. ⁽²⁾

Vasomotor symptoms may vary in frequency and intensity among individuals. These symptoms are a natural part of the menopause transition, but they have a significant impact on the quality of life of a female.

Having an understanding of the menopause symptoms is important for several reasons:

• Menopause symptoms impact the quality of life of a female. Knowing about the symptoms can help a female seek appropriate management strategies which can be helpful in improving her wellbeing.
• Sleep disturbance can lead to an increase in stress and fatigue. Being aware of it, a female can seek prompt medical advice.
• It can be helpful in improving the psychological well-being of a female.
• A female can discuss the concerns with a healthcare provider and explore treatment options and choose a suitable approach for the management of symptoms.
• If family members, friends, and colleagues have an understanding of the menopause symptoms, they can be more understanding and empathetic and offer necessary support during the transition phase.
• Knowledge of treatment can help a female to make well-informed decisions about their health and explore options that align with her preference and medical history.
• The knowledge can help debunk myths and promote open conversation about this natural phase of a woman’s life.

The vasomotor symptoms of menopause hold significant importance due to several reasons:

• Vasomotor symptoms are most commonly experienced by females during menopause. This highlights the need for understanding and managing these symptoms effectively.
• These symptoms can have a profound impact on a female’s quality of life.
• The vasomotor symptoms may continue for a longer period of time after menopause. The prolonged duration of these symptoms underscores the importance of finding effective strategies to manage them.
• Vasomotor symptoms can cause discomfort, emotional distress, and psychological changes.
• These symptoms interfere with daily activities and make it difficult for a female to maintain their usual routines and lifestyle.

Recognizing the significance of vasomotor symptoms of menopause helps a female seek medical advice and explore treatment options.

Menopause is a biological process that marks the end of a female’s reproductive years. It is a point when a female has not had a menstrual period for 12 consecutive months, indicating the permanent cessation of menstruation.

The process of menopause can be divided into 3 stages:

• Perimenopause: It is a transition phase leading to menopause. The ovaries gradually start producing less estrogen and make the menstrual cycle irregular. The hormonal fluctuation leads to hot flashes, night sweats, mood swings, vaginal dryness, and changes in menstrual flow. The length of perimenopause may vary for each woman and may last for a few months to several years.
• Menopause: It confirms menopause officially after 12 consecutive months without a menstrual period. The ovaries at this point stop releasing eggs and the production of estrogen and progesterone declines significantly. It is a natural part of aging and marks the end of the women’s ability to conceive naturally.
• Post menopause: It is the time after menopause and starts once menopause is confirmed and continues throughout the rest of a female’s life. The hormone level in this stage stabilizes to a lower level. The female, at this point, is at an increased risk of health conditions such as osteoporosis and heart disease.

Estrogen is a primary female sex hormone primarily produced by the ovaries and in small amounts by adrenal glands and fat tissues. As menopause approaches, estrogen production decreases and leads to several changes in the menstrual cycle and eventually cessation of menstruation during menopause. The decreased levels of estrogen lead to hot flashes, night sweats, mood swings, and changes in skin and hair. Estrogen helps maintain bone density and a decline in it may increase the risk of osteoporosis leading to weak and brittle bones.

Progesterone is an important female sex hormone and works in conjunction with estrogen to regulate the menstrual cycle and support pregnancy. It prepares the uterus for a potential pregnancy. Its decline during menopause leads to changes in and eventual cessation of menstruation. In post-menopause, lack of progesterone combines with reduced estrogen levels, can contribute to uterine changes and increased risk of endometrial hyperplasia in some women.

Vasomotor symptoms are the group of physiological changes resulting from fluctuation in blood vessel activity. The common symptoms include:

• Hot flashes, a sudden sensation of heat affecting the chest, neck, and face
• Night sweats
• Cold flashes
• Formication: Formication is the sensation of insects crawling across or underneath your skin. The name comes from the Latin word ‘formica,’ meaning ant. This condition is usually associated with menopause but can also occur in many other health conditions like Parkinson’s disease, fibromyalgia, or as a withdrawal symptom from substances like alcohol or opioids.
• Heart palpitations
• Anxiety
• Sleep disturbances

These symptoms are experienced by a female for about a year. However, many females continue experiencing them for several years. ⁽³⁾

If menopause starts as a side effect of any treatment such as chemotherapy, the symptoms may subside and menstruation may begin once the treatment finishes.

The primary mechanism is related to hormonal changes and involves the hypothalamus, neurotransmitter, and blood vessels.

• Hypothalamus and Thermoregulation: Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. This process is one aspect of homeostasis: a dynamic state of stability between an animal’s internal environment and its external environment. Hypothalamus is a region in the brain that plays a crucial role in regulating body temperature and maintaining internal balance. The functioning of the hypothalamus is disrupted by the declining levels of estrogen and progesterone. Estrogen influences the hypothalamus temperature-regulating centers, causing it to misinterpret body temperature and trigger responses that result in vasomotor symptoms.

• Neurotransmitter and Vasodilation/Vasoconstriction: Neurotransmitters are the chemicals in the brain that transmit signals between nerve cells. Changes in hormone levels during menopause affect the balance of the neurotransmitters, particularly serotonin and norepinephrine. Serotonin is involved in mood regulation and body temperature control. Decreased serotonin levels dilate the blood vessels and lead to hot flashes. Fluctuation in norepinephrine levels causes sudden vasodilation and the sensation of hot flashes.

  Vasodilation is the widening of blood vessels. It’s a process that occurs naturally in your body in response to triggers such as low oxygen levels, or stimulants such as caffeine. Vasodilation causes increased blood flow in the vessels and decreased blood pressure.

  Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles, and veins. It regulates blood flow and can help increase blood pressure in response to cold, stress, or the hormone epinephrine (adrenaline).

• Role of Hormonal Fluctuation: Estrogen regulates body temperature and its fluctuation can disrupt the body’s ability to maintain thermal equilibrium. This leads to vasodilation, sweating, and a sensation of heat during hot flashes.
• Potential Genetic and Environmental Factors: Genetic and environmental factors also affect the development of vasomotor symptoms. Females with a genetic predisposition experience more intense and frequent hot flashes. Also, external factors such as stress, smoking, caffeine, and certain medications intensify the occurrence of symptoms. ⁽⁴⁾

Management and treatment options for vasomotor symptoms of menopause are based on individual preference, medical history, and symptom severity. Common approaches to manage and alleviate symptoms include: ⁽⁵⁾

• Hormone Therapy: It aims to balance hormone levels in the body. It can be helpful in relieving hot flashes and other symptoms. Hormone therapy does not suit everyone as it can lead to side effects. It is not recommended for people with a history of or high risk of cardiovascular disease, stroke, breast cancer, uterine cancer, and liver disease.
• Antidepressants Drugs: A low dosage of antidepressants is given to females with depression. The adverse effect of these medication includes headache, nausea, and drowsiness.
• Lifestyle Remedies: Certain lifestyle interventions can be helpful in alleviating symptoms of menopause. These include:

• Avoiding triggers such as spicy food, alcohol, and caffeine
• Quitting smoking
• Carrying water bottle containing ice water
• Keeping a portable fan nearby
• Practicing deep breathing and relaxation exercise
• Reaching and maintaining moderate weight

A study showed that females who made dietary changes and lost 10% of body weight experienced a reduction in or end of vasomotor symptoms during menopause. ⁽⁶⁾

Some people also use alternative treatments to alleviate the symptoms. It is advisable to speak with a doctor before using any herbal intervention or supplement or any other type of medication for menopause.

Vasomotor symptoms especially hot flashes are common features of menopause. People experience it differently. If someone is experiencing vasomotor symptoms that are affecting their daily life significantly should make sure to speak with a doctor and follow recommended treatment or lifestyle changes.

Also Read:

• Side Effects of Menopause|Supplements, Herbs That Help Deal With Menopause Symptoms
• 11 Natural Ways to Reduce Menopause Symptoms
• 11 Natural Remedies for Perimenopause Symptoms