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 are now investigating important aspects of menopause, 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. While there hasn’t been a ton of historical science on the subject, 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.
“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. 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 like a high body mass index, high blood sugar levels, high blood pressure, sedentary lifestyle, and smoking can also exacerbate VMS.
“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. Estrogen dilates blood vessels and helps keep LDL cholesterol levels in check. So when women lose estrogen during menopause, cholesterol levels can rise and HDL levels decrease. 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.
A recent 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 and self-care measures that can help alleviate symptoms. Menopausal hormone therapy, non-hormonal medications, selective serotonin reuptake inhibitors, and norepinephrine reuptake inhibitors are treatment options that may help you find relief. Speaking to a healthcare provider is the best way to determine which options are best for you.
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.
