Difference between vasomotor and other symptoms of menopause

By Monazza Ahmad, B.Pharm, MSc

Menopause is undeniably the most confusing phase of a woman’s life. The irregular menstrual cycle and unpredictable biological changes and emotional state can negatively affect her social, work, and daily life.
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Seeking help for these symptoms could feel awkward since many times women don’t know how to communicate these concerns and whether it would be empathetically understood or not. At times, the complex medical terms associated with menopause can make it tough to follow the course of treatment plan.

Let’s discuss the major signs and symptoms of menopause and the terminologies associated with it that may help you understand your situation as well as convey your concerns to your provider.

What are vasomotor symptoms (VMS)?
The word “vaso” is originated from the Latin1 meaning vessel, and “motor” relates to movement. So vasomotor symptoms are the movement of blood vessels characterized by their constriction and dilation that causes temporary irregular blood pressure that in turn alters the body temperature, making us feel hot or sweat.2

This temperature alteration results in hot flashes and night sweats that are the most common indication of perimenopause and menopause.3,4
Other chronic and progressive symptoms are characterized by vaginal dryness, painful intercourse, and reduced lubrication. It is seen in both premenopausal and postmenopausal phases.5

Why do I feel like I’m the only one suffering from these symptoms?
During menopausal transition, the vasomotor symptoms impact about 80% of the women in the US and differ widely from region to region.6,7
Even though a variety of symptoms is common during menopause, some are not much reported due to their mild and nonspecific nature. Up to 84% of postmenopausal women tend to just deal with the menopausal discomfort rather than seeking medical attention.5,8

How long do these symptoms last?
Don’t worry if you have been experiencing vasomotor symptoms for more than a few years. For many women, it can last over a decade or two, with 4-20 hot flashes daily being common during menopause.9

A new long-term study of women from various races and ethnicities suggests that hot flashes and night sweats can take up to 11 years to resolve for some women. Interestingly, the study further discovered that hot flashes lasted longer, for 9-10 years, if started before the menstrual period ended, while their duration was much shorter, with 3.5 years if women had their first hot flash after the periods ended.10

Some menopausal symptoms can get worse with age as opposed to the other menopausal symptoms that improve with time.

How do these symptoms impact women’s quality of life?
Hot flashes, night sweats, vaginal dryness, low libido, sleeplessness, and menopausal anxiety all add to the decline in quality of life. The sudden outburst of sweat with hot flashes can be daunting when it occurs in a gathering, making women nervous. Vaginal dryness and decreased interest in sexual activities go hand in hand, impacting intimate relationships. All of these stressful changes in daily routine are enough to make any woman anxious.5

Some of the other concerns include brain fog, urinary incontinence, weight gain, hair loss, bone loss, and heart health, to name a few.11

Therefore, women are highly encouraged to not ignore menopausal discomfort and instead have informed discussions with their healthcare providers to find safe solutions for their health needs.12

What are my relief options?
There are several options to reduce the impact of these menopausal symptoms and claim your lifestyle back. The solutions include prescription medications, well-studied supplements, lifestyle changes, and nutrition. Since the trial and error of wrong choices can become painful and lengthy during menopause, it is important to discuss the best option with your provider at the right time.

Hormone replacement therapy (HRT): 
This is the most common prescription option for hot flashes, but it is not usually the first choice. The common forms are tablets, gels, skin patches, injections, and vaginal inserts. HRT is generally best-suited for healthy women and those that are in the early phase of menopause. It is not recommended to start HRT after the age of 60. However, there are some side effects associated with HRT, and it is generally considered unsafe for people with a history of heart conditions, deep vein thrombosis, cancer, and smoking.12

Rheum rhaponticum (ERr 731®): 
This nonhormonal solution is the top recommended natural ingredient by OBGYNs. It has shown to improve 12 of the main menopausal symptoms by 83%. In addition to hot flashes and night sweats, it also improves sleep disturbances, mood swings, sexual discomfort, anxiety, vaginal dryness, and muscle and joint health, to name a few.13

Lifestyle: 
Daily physical activity is important for menopausal symptom relief. Weight management, stress relief, increased metabolism, and improved overall quality of life as a result of active movement are all related to better management of menopause.14 Eating habits, consuming a healthy diet, practicing relaxation or meditation, drinking enough water, getting quality sleep, and avoiding smoking and alcohol all help with relieving the menopausal discomfort.15

Nutrition: 
Taking necessary supplements or eating food rich in vitamin D, E, B6, folic acid, and omegas help reduce intensity of menopausal symptoms.16
Now that you have learned more about menopausal symptoms and their treatment options, you may want to discuss these concerns with your healthcare provider. In our next post, we will go over a few tips on how a patient and their healthcare provider can effectively communicate these menopausal challenges with each other to come up with the best treatment plan.

References:

1. Medical terms – dissected, defined and explained. https://www.ucl.ac.uk/lapt/medterms.htm. Accessed May 5, 2023.
2. Merriam-Webster Dictionary. https://www.merriam-webster.com/dictionary/vasomotor#. Accessed May 5, 2023.
3. Deecher DC et al. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health. 2007;10(6):247-257.
4. Rossmanith WG et al. What causes hot flushes? The neuroendocrine origin of vasomotor symptoms in the menopause. Gynecol Endocrinol. 2009;25(5):303-314.
5. Angelou K et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020;12(4):e7586.
6. Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021;28(8):875–882.
7. Avis NE et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539.
8. Sarmento ACA et al. Genitourinary syndrome of menopause: epidemiology, physiopathology, clinical manifestation and diagnostic. Front Reprod Health. 2021;3:779398.
9. Avis NE et al. Vasomotor symptoms across the menopause transition: differences among women. Obstet Gynecol Clin North Am. 2018;45(4):629–640.  
10. Mahajan A et al. Hot flashes—how long ?? J Midlife Health. 2018;9(2):53–54.
11. Mayo Clinic. Menopause. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397. Accessed May 5, 2023.
12. NIH. What are the treatments for other symptoms of menopause? https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/treatments. Accessed May 5, 2023.
13. Hasper I et al. Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms. Menopause. 2009;16(1):117-131.
14. Mayo Clinic. Fitness tips for menopause: why fitness counts. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/fitness-tips-for-menopause/art-20044602#:~:text=Exercise%20isn’t%20a%20proven,improve%20your%20quality%20of%20life. Accessed May 5, 2023.
15. Mayo Clinic. Menopause: Diagnosis. https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401. Accessed May 5, 2023.
16. Cleveland Clinic. Menopause diet: What to eat to help manage symptoms. https://health.clevelandclinic.org/menopause-diet/. Accessed May 5, 2023.

By Monazza Ahmad, B.Pharm, MSc

To ensure best health outcomes in a healthcare setting, it is important to establish open, effective, and respectful communication between a patient and a healthcare practitioner.

As a patient, it is not only your right but in your best interest to ask your doctor for clarification or further explanation on your health condition and treatment plan. As a healthcare provider, it is your responsibility to provide a safe and comfortable environment for your patients to openly discuss their health concerns and make sure your diagnosis and treatment plan is well understood.
That said, menopause can trigger many complex and confusing symptoms that can be uncomfortable to talk about, which can make managing the symptoms difficult. Here are some tips for both patients and practitioners to start the conversation around menopause and its symptoms that we discussed in our previous post, Menopausal Symptoms.

When should I talk to my doctor about menopause?1
First of all, don’t feel awkward. Menopause is a natural phase of life, and your doctor is likely familiar with all possible symptoms. Describe your condition and symptoms in detail and explain how they are affecting your lifestyle and relationships. The provider needs to rule out any other underlying conditions before determining it is menopause.
Reach out to your doctor if:

• You haven’t had your period for two consecutive months
• You have more than one period in a month or your cycle is unusually irregular
• You have uncomfortable vaginal dryness
• The symptoms are interfering with your daily activities
• The symptoms are affecting your sexual life and intimate relationship
• You consistently get brain fog and feel sad
• You often start sweating suddenly, and it doesn’t feel normal
• You are gaining weight unusually
• Other therapies are not helping with the symptoms

Don’t forget to tell your doctor if you have any allergies or other health conditions. Also mention any medications or supplements you’re already taking for menopause symptoms or other conditions.

What shall I ask my doctor?
Medical appointments can be stressful, and we often feel rushed. When you have a delicate issue to bring up, being prepared can help. Here are some of the questions you can ask your practitioner:

1. How do I know when I start menopause?
2. What is the difference between perimenopause, menopause, and postmenopause? And how do I know which phase I am going through?
3. What are the different challenges of each phase?
4. How can I tell hot flashes apart from normal sweating?
5. What can I do to relieve my symptoms such as hot flashes and vaginal dryness?
6. Why do I feel so much menopausal anxiety, and how can I overcome this?
7. What are my treatment options, and how long does each option takes to work?
8. Are there any side effects with these options?
9. What are the safe, nonhormonal solutions to manage menopausal symptoms that I can try first?
10. When should I seek further medical assistance?

How can healthcare providers ensure the right care during menopause?
Often, the reluctance from healthcare professionals to address these female issues can also cause lack of awareness. It is the healthcare provider’s obligation to make sure patients feel comfortable in discussing their menopausal concerns and understand the treatment plan.2
According to a survey by NIH, patients are likely to discuss menopause transition with providers who don’t make them feel rushed, are good listeners, and have expertise in this area of women’s health.
Here are some ways to help your patients receive the best care:

1. Keep your tone friendly.
2. Be empathetic and sensitive about their health challenges.
3. Use plain language and avoid medical jargon (do not assume that your patients are familiar with the complex medical terms).
4. Create communication material beforehand at 5th– to 8th-grade level of understanding.
5. Give women time to reflect and find words to articulate concerns.
6. Ask both closed-ended and open-ended questions to discover more.
7. Make sure to ask if they understand the treatment plan and what concerns they have about the treatment options or compliance. Offer to repeat the plan.

​What to ask your patients:3

• Do you get sudden outbursts of sweat to the level that it makes you feel embarrassed?
• Do you have vaginal dryness accompanied with discomfort, and is it affecting your sexual life?
• Do you get brain fog and feelings of sadness? What do you feel like when this happens? How do you cope with it?
• Do you feel a lack of interest in daily activities? What does your day look like?
• Do you have any concerns about the treatment plan we discussed?
• Do you want me to go over the treatment plan again?

The menopausal rating scale and symptoms evaluation form can be used to track symptom improvement to see what treatment options are working:4,5

Menopause symptoms evaluation form and rating scale (click to enlarge)Menopause is a natural phase in a woman’s life, and its challenges need to be accepted and understood at work, at home, and on a social as well as a societal level. Unless these concerns are progressively communicated in a healthcare setting, it will be tough for us to understand the impact of this condition on a woman’s life.

​References:

1. Sachdev P. Talking to your doctor about menopause. https://www.webmd.com/menopause/guide/menopause-talking-to-doctor. Accessed May 16, 2023.
2. Angelou K et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020;12(4):e7586.
3. Newson L et al. Guidance on diagnosis and management of urogenital atrophy or genitourinary syndrome of the menopause (GSM). https://pcwhf.co.uk/wp-content/uploads/2018/11/GSM-Guideline.pdf. Accessed May 16, 2023.
4. Heinemann K et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes. 2004;2:45.
5. Hauser GA et al. About MRS. https://zeg-berlin.de/expertise/diagnostics-tools/menopause-rating-scale/about-mrs/. Accessed May 16, 2023.