5 Factors That May Predict the Severity of VMS

More than a million women will experience perimenopause and menopause each year in the United States. While its hallmark symptoms of hot flashes and night sweats, also known as vasomotor symptoms (VMS) are common for most, for others they can be severe. VMS are sudden changes in the body’s temperature that can feel like a flare of heat that leads to sweating, flushed, or blotchy skin and are sometimes accompanied by dizziness and an increase in heart rate. They can last anywhere from one to five minutes, vary in intensity, and typically occur in the head, neck, chest, and arms.

“VMS are normal and common, but just because something is common, does not mean it is pleasant,” says Staci Tanouye, MD, FACOG, MD, board-certified OBGYNn and August Advisor.  “Upwards of 80% of women will experience VMS. About 10% will have no VMS, and another 10-15% will have very minimal VMS.” Most women are able to cope with symptoms, but for those who suffer from severe VMS, it can interfere with sleep, concentration, mood, energy, work, day-to-day activities, and sexual activity. In the United States, menopause usually begins between the ages of 45 and 58, with the average age being around 52. And while menopause is a normal and expected transition, there are factors that might predict how severe your VMS could be. 

What triggers VMS

While no one understands the exact mechanism behind VMS, their trigger is mostly due to the decline of estrogen at the time of menopause, explains Lisa Brent, ND, founder and medical director of Be Well Natural Medicine who specializes in women’s health, particularly through the perimenopause and menopause transitions. 

“The loss of this crucial hormone makes our temperature regulation much more sensitive,” says Dr. Brent. “But VMS can also be related to dysfunction of the thyroid gland or other non-hormonal causes, so it’s wise to confirm the cause with your doctor if you are experiencing VMS.”

Some evidence shows that taking supplementary estrogen may help to relieve symptoms, but scientists have not found a strong correlation between the hormones and the reduction of symptoms. There are also non-hormonal medication options that can be prescribed, but for healthy women who meet appropriate criteria, Dr. Tanouye says menopausal hormone therapy is the most effective for vasomotor symptoms and genitourinary symptoms of menopause.

Factors that can make VMS worse

Obesity

For women who are overweight or obese, there is a higher risk of severe VMS. A recent study found that a higher body mass index ( BMI) is positively associated with VMS because body-fat tissues act as strong heat insulators. This insulation makes the distribution of heat harder for the body, which causes women with obesity to suffer more severe symptoms of menopause. These symptoms were also linked to joint and muscular pain and more intense urinary problems.

The study also found that women who were obese before perimenopause, the initial phase of menopause, were more likely to suffer from VMS than women who became obese during perimenopause. 

Lifestyle choices

The combination of diet, exercise, and even relaxation habits can all have an effect on the severity of VMS. While it’s easier said than done to eat a balanced diet, get movement in each day, and keep stress levels low, research has shown these habits can make menopause and VMS easier. 

Dr. Brent recommends quitting smoking and alcohol consumption, decreasing sugar and simple carbohydrates from your diet, avoiding hot drinks and spicy foods, exercising at least three times a week, managing stress through meditation, and yoga, reducing time commitments, and keeping your bedroom cool at night.

“Women can also incorporate some phytoestrogen foods into their diet to help mitigate the loss of estrogen, such as soy like tofu and edamame, ground flax seeds, and cruciferous vegetables like broccoli, cauliflower, and brussels sprouts,” she adds. 

If your mother had severe VMS

If you’re curious about when you’ll enter menopause, research suggests that it will happen around the time your mother did, and there’s a chance your symptoms will be similar. Dr. Brent says that genetics play a major role, and women are more likely to suffer from severe VMS if their mothers did.

If you’re able to speak with your biological mother, ask her about the symptoms she experienced, when they started, their frequency, and if she had any successful strategies for relief.  

Ethnicity 

Most women will experience VMS of some kind, but a landmark study of the racial discrepancies in menopause, the Study of Women’s Health Across the Nation (SWAN) found that your ethnicity is a strong predictor of how severe your VMS might be. 

The study found that Black and Hispanic women reach menopause earlier than white, Chinese, and Japanese women, and Black and Hispanic women experience menopause symptoms for 10 or more years – twice as long as white, Chinese, and Japanese women. 

While the most common symptom among all ethnicities was hot flashes, the study also found that Black women experienced them in more intensity, frequency, and for the longest duration. 

Social determinants of health 

Dr. Tanouye says that factors like poverty, lower education, adverse childhood experiences, and lack of social support are all predictors of severe VMS. Women who had limited access to quality healthcare and health education from an early age are more likely to have the same experience in adulthood, while research has shown that women who were employed, had higher levels of education, or higher levels of income reported better overall health and fewer menopausal symptoms.

The psychological reaction to poverty and lack of support can trigger and worsen stress, which has been proven to worsen VMS symptoms.

“VMS indirectly can have quite negative health effects that may need greater intervention,” says Dr. Tanouye. “For example, if mental health is significantly deteriorating as VMS increases, this might need urgent or even emergent intervention.”

When to seek out medical advice

VMS is a natural part of the menopause transition, but suffering from these severe symptoms should not be normalized. 

“Women at midlife are often at the peak of their professional and personal development,” says Dr. Brent. “To be held back from really enjoying this time in one’s life because of hot flashes, night sweats and lack of sleep is absolutely unnecessary and provides a woman no benefit.”

While VMS will be uncomfortable, if you find symptoms beginning to worsen or affecting your day-to-day routine, speak with your doctor about ways to find relief. They might recommend treatments or lifestyle changes. 

“The time to intervene medically is when all of the lifestyle, diet, and herbal interventions have not provided enough support, and a woman is still suffering from VMS,” says Dr. Brent. “If she is waking up several times a night and or having hot flashes often throughout the day, it is time for medical intervention.”