Many physicians still consider VMS to be transient and inconsequential, but new research suggests otherwise—are you all caught up?

For decades, vasomotor symptoms (VMS)—the hot flashes and night sweats that many associate with menopause—have been considered temporary and relatively benign. But emerging research suggests VMS are not just quality-of-life disruptors, they may also signal deeper health risks.^[][]

And yet, many physicians still view them as inconsequential.

“Vasomotor symptoms can present in various ways, but most commonly include hot flashes, night sweats, daytime flushing, and a general intolerance to temperature changes,” says Jessica Kassis, MD, a board-certified OB/GYN and a Menopause Society-certified provider at Radiant Women's Health.

VMS by the numbers

About 80% of women experience VMS during the menopausal transition. A global survey found that 57% of women aged 40 to 64 report symptoms, and the issue doesn’t stop there. Symptoms often persist well beyond age 64, with a median duration of 7.4 years. Many rate their severity as moderate to severe.^[][]

There's also a clear racial gap: Black women are more likely to experience more frequent and severe VMS, and with greater impacts to their daily life.^[]

“Moderate to severe vasomotor symptoms are associated with an increased risk of future cardiovascular events, particularly when they occur before the age of 60,” Dr. Kassis says. “Individuals experiencing moderate to severe vasomotor symptoms are also more prone to accelerated bone loss and osteoporosis.”

Associated health risks to know

Cardiovascular disease

Data from  SWAN (Study of Women’s Health Across the Nation) and WISE (Women’s Ischemia Syndrome Evaluation) show that frequent VMS are associated with:^[][]

• Elevated blood pressure

• Increased insulin resistance

• Worse lipid profiles

• Greater coronary artery calcium

• Increased carotid intima-media thickness

“VMS have been associated with increased risks of hypertension, insulin resistance, and cardiovascular disease,” according to board-certified psychiatrist Sharon Michelle Batista, MD. “The proposed mechanisms include hypothalamic dysregulation, altered sympathetic nervous system activity, and chronic stress-related inflammation.” 

Metabolic syndrome and diabetes

In a prospective cohort of 2,761 women followed for up to 17 years, those with persistent VMS had a ~50% higher risk of developing type 2 diabetes compared to those with no symptoms. The link appears to involve heightened sympathetic nervous system activity, which can drive central adiposity, insulin resistance, and systemic inflammation.^[]

Bone health

SWAN data also suggests women with moderate to severe VMS may have lower bone mineral density (BMD) at the spine and femur. Estrogen withdrawal likely underpins both phenomena. Lower BMD does not consistently correlate with an elevated fracture risk.^[]

Mental health

VMS is also linked to poor sleep, low energy, trouble concentrating, mood issues, and reduced sexual activity. The more severe the symptoms, the more likely women are to struggle with loss of productivity at work and use more healthcare resources.^[]

“These symptoms often lead to disrupted sleep, chronic fatigue, and a heightened risk of mood and anxiety disorders,” says. Dr. Batista. “Patients present for psychiatric care not for VMS themselves, but for the downstream mood or sleep issues they cause.”

Dr. Kassis proposes a place to start: “The most effective way to assess the severity and impact of vasomotor symptoms is through a thorough, open, and honest conversation with your [patient].”

Clinicians can use assessment tools such as the Menopause Rating Scale, the Greene Climacteric Scale, the Women’s Health Questionnaire, and the Hot Flush Rating Scale.

Beyond fezolinetant, several other nonhormonal therapies like elinzanetant, SSRIs, gabapentin, oxybutynin, and stellate ganglion block (SGB) are also under investigation for managing VMS.