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Vasomotor symptoms (VMS) are the most common symptoms of menopause. Often referred to as hot flashes and night sweats (when occurring during sleep), vasomotor symptoms are episodes of feeling too warm or hot. These episodes occur suddenly, and symptoms can include flushed skin (especially in the upper body), sweating, and increased heartrate. Episodes can last for several minutes and are often followed by chills.
While menopause is a natural part of the aging process and VMS is an expected part of menopause, these symptoms can be disruptive to a person’s life, and can lower a person’s quality of life—for example, if episodes occur while a person is at work, or if night sweats interfere with sleep.
Anyone experiencing VMS should speak to a healthcare provider about their symptoms. While VMS typically resolves with time, there are therapies that can help manage VMS during menopause.
What are the treatment options for VMS?
Therapies that can ease and manage VMS can be divided into two broad categories—hormonal treatment and non-hormonal treatment.
Hormonal replacement therapy for VMS
Also called menopausal hormone therapy (MHT) or hormone replacement therapy (HRT), this approach involves taking medications that contain the female sex hormone estrogen, often combined with progestin (a synthetic version of the sex hormone progesterone):
- Hormone replacement therapies are available in different forms (oral medications, skin patches, injections), different formulations, and different dosage strengths.
- These medications reduce the severity and frequency of VMS. They also treat other menopausal symptoms and help prevent osteoporosis (bone loss, which is common during menopause).
- Hormone replacement therapy can also increase a person’s risk of heart disease, stroke, blood clots, and breast cancer. A full assessment of current health and medical history will be needed before beginning treatment.
Can you have estrogen-only HRT?
Estrogen-only therapies increase the risk of endometrial cancer but may be prescribed if a person does not have a uterus (for example, if the person being treated has had a hysterectomy).
Estrogen-progestin therapies do not carry this risk—though they do carry the risks mentioned above. One medication pairs estrogen with an estrogen agonist/antagonist. This combination helps reduce the risk of endometrial cancer.
Non-hormonal treatments for VMS
There are also a variety of non-hormone therapies used to treat VMS. Some are approved for the treatment of VMS, while others are prescribed “off-label.”
What medications are prescribed off-label for hot flashes?
Off-label prescribing means that an approved therapy is being used to treat a condition it is not approved for—this is a common practice, especially in conditions where there are a limited number of treatment options. Medications prescribed off-label in the treatment of VMS include certain drugs that are approved to treat depression, epileptic seizures, and high blood pressure.
What medications are approved for treating hot flashes?
There are two medications that are approved for the treatment of VMS. One is a type of antidepressant called an SSRI (selective serotonin reuptake inhibitor), a drug that increases the levels of serotonin.
The second is a type of drug called an NK3 receptor antagonist. This drug works by blocking the activity of specific neurotransmitters in the hypothalamus, the part of the brain that regulates body temperature. During menopause, changing hormone levels cause the hypothalamus to overreact to slight changes in temperature, which is how VMS occurs.
What is the best treatment for VMS?
VMS is a different experience for every person. There is no best treatment to help manage symptoms, only the treatment that is best for a particular person. Deciding on a treatment for VMS involves the careful consideration of potential risks and benefits, and your best source of information will be a healthcare provider.
Treatment may also involve lifestyle changes and avoiding things that trigger episodes of VMS. Common triggers can include hot or warm environments, spicy foods, caffeine, and alcohol. Lifestyle changes can include exercising more, making changes to what you eat, weight loss, reducing alcohol consumption, and quitting smoking (if you smoke).
