Your mom might have called the menopause transition “the change of life”—and that’s actually a pretty good description. After decades of stocking up on tampons and most likely dealing with PMS and cramps on the regular, you’ll certainly experience your period shifting from its previously predictable pattern. Suddenly you could be dealing with skipped months, way more flow, mood swings, weight gain, and intense vasomotor symptoms (VMS)—better known as hot flashes and night sweats. VMS can have a major impact on your quality of life; in one study, over 93 percent of women with VMS reported sleep problems.
And up to 80 percent of women suffer from VMS during the transition to menopause. But on the positive side, women are becoming more open than ever about discussing VMS. Earlier this year, actress Naomi Watts told ELLE her own story of drenching night sweats, and why she founded a menopause wellness company to help other women. And the key to coping with VMS is, indeed, sharing information—but that can also be complicated, because frankly, researchers don’t know as much as they need to yet about the reasons they happen.
Why is this the case? Women of childbearing age were excluded from clinical trials for many years, meaning that there was a lack of data about VMS as women transitioned to menopause. Studies such as the Women’s Health Initiative are now investigating important aspects of menopause, according to the National Library of Medicine, but there is still much work to be done.
“The exact mechanism as to why VMS occurs is not totally understood,” says Dr. Rajita Patil, a Menopause Society certified practitioner and an assistant clinical professor of OB-GYN and director of the Comprehensive Menopause Program at the University of California, Los Angeles. “We do know that the structure inside your brain called the hypothalamus manages hormones in your body, including estrogen. During perimenopause into menopause, when your level of estrogen drops, there’s dysregulation—basically, your brain tells your body that you’re hot when you’re really not. So you react to even slight temperature changes and experience hot flashes and night sweats.” Research has shown that a reduction in two neurotransmitter hormones, norepinephrine and serotonin, also contributes to VMS.
But let’s take a closer look at what we do know about VMS. While there hasn’t been a ton of historical science on the subject (a search in the National Library of Medicine finds one study about menopause symptoms in 1945), there has been an uptick in studies more recently, and now there are approximately 1,500 published per year on the subject. Which means we finally have some information about dealing with the menopause transition, and advances in care are being made. Here’s what we know today, and how to use it to your best advantage.
VMS Is Not the Same for Every Woman
“We really don’t understand why some women have more severity of these symptoms, in terms of differences in the frequency of VMS, for example,” says Dr. Alyssa Brown, 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. But there are some established risk factors. For example, race and ethnicity can be a contributing factor: “Black and Hispanic women have more VMS,” notes Dr. Patil.
Other factors are all pretty familiar, since they’re also risk factors for many other conditions: a body-mass index higher than 25, a fasting glucose level over 100 mg/dL, high blood pressure, a sedentary lifestyle, and smoking all exacerbate VMS, according to a recent study of 406 Mexican women aged 45 to 60. These are all things that can be managed to some degree—for example, quitting smoking, especially before you’re 40 years old, could make a difference in how you experience menopause.
In an analysis that looked at the data of 21,600 women around 50 years of age, women who quit smoking before they saw their 40th birthday experienced VMS to around the same extent as women who had never smoked. But the smokers who were overweight were more likely to report hot flashes and night sweats than normal-weight smokers and those who’d never smoked.
VMS Can Put You at Risk for Future Health Problems
“The more severe your hot flashes are, the more direct the correlation is with your risk for cardiovascular issues like heart attack or stroke, as well as dementia and osteoporosis,” says Dr. Patil, noting a long-term study that found that those who experience frequent VMS are at increased risk—up to 77 percent—for a cardiovascular event. “How estrogen dilates blood vessels is something we really need to understand.”
In addition, estrogen helps keep LDL cholesterol (the bad kind) in check. So when women lose estrogen during the menopause transition, total cholesterol and LDL levels tend to rise, and HDL cholesterol levels decrease. And not only are the levels of good cholesterol diminished, but what remains is less protective of the heart in post-menopausal women. Talking to your doctor about ways to normalize your blood levels can help keep your ticker strong.
Experiencing VMS, especially in the form of night sweats, can also increase the stress on your heart all on its own, by hampering your quality of sleep. When you experience insomnia, that alone can cause irregular heart rhythms, also known as atrial fibrillation, and this can place menopausal women at increased risk for stroke, blood clots, and heart failure, according to research published in the Journal of the American Heart Association.
VMS Medication Can Really Help
A recent Mayo Clinic study found that only about one in four women with VMS actually receives any kind of treatment for it. But every woman should know that there are many drug therapies that can help alleviate symptoms, so they can explore the options that work best for them individually. Menopausal hormone therapy, non-hormonal medications, and selective serotonin reuptake/norepinephrine reuptake inhibitors are treatment options that may help you find relief; speak to your health-care provider to determine which might be best for you. Self-care measures like meditation and yoga can also be of some help.
The bottom line: Although we don’t yet know everything we need to about VMS, the information we already have can help improve your quality of life significantly.
