You know VMS is underdiagnosed. But are you part of the problem?
Industry Buzz
“Vasomotor symptoms, particularly hot flashes and night sweats, are more than just discomfort; they are physiological signals of broader neuroendocrine disruption. We need to move away from seeing VMS as ‘just a phase’ and recognize them as part of a broader hormonal and inflammatory landscape that […] may predispose women to chronic conditions later in life.” — Deanna Minich, PhD, nutrition scientist
When 85% of clinicians underestimate how many women experience vasomotor symptoms (VMS), it begs the question: Are even well-meaning doctors failing their patients during midlife?
Despite being one of the most prevalent and disruptive manifestations of menopause, VMS (eg, hot flashes and night sweats) remain widely underrecognized and undertreated. Research reveals that over 80% of women experience VMS during the menopausal transition,[] yet many clinicians still dismiss them as benign or transient nuisances.
A recent MDLinx survey confirmed the knowledge gap: 85% of OB/GYNs underestimated VMS prevalence, 73% wrongly believed symptoms are only perimenopausal, and 51% failed to identify their links to chronic disease. The result? Delayed diagnosis, inadequate management, and compromised patient care.
“Vasomotor symptoms, particularly hot flashes and night sweats, are more than just discomfort; they are physiological signals of broader neuroendocrine disruption. We need to move away from seeing VMS as ‘just a phase’ and recognize them as part of a broader hormonal and inflammatory landscape that [...] may predispose women to chronic conditions later in life,” Deanna Minich, PhD, a nutrition scientist, tells MDLinx.
Related: Many physicians still consider VMS to be transient and inconsequential, but new research suggests otherwise—are you all caught up?Metabolic risk
A pooled analysis of six prospective studies found that severity, not mere frequency, of VMS correlated with higher CVD risk, including heart disease and stroke, regardless of whether the symptoms began before or after menopause.[]
Several studies point to VMS being associated with metabolic syndrome, type 2 diabetes, osteoporosis, non-alcoholic fatty liver disease, and CVD, suggesting these are more than just transient quality-of-life symptoms.[]
“Estrogen decline participates in bony remodeling... Without good estrogen homeostasis, women can lose up to 20% of their bone density within the first decade after menopause. This not only affects the way we look, but can increase our risk for fractures,” says Sabrina Fabi, MD, a dermatologist and dermatologic plastic surgeon.
Yet, the prevailing belief among clinicians remains that these symptoms are "just a phase." Case in point: A Reddit user nearing age 61 describes how her new OB/GYN tried tapering her off HRT despite severe symptoms, and she had to involve a cardiologist to prove it was safe to continue.[]
Better VMS care
Clinicians aren’t intentionally neglecting VMS, but the system makes it easy to do so. Here are actionable strategies to course-correct:
Incorporate VMS screening into annual wellness or gynecologic exams. A simple question, “Are you experiencing hot flashes or night sweats?” can open the door to more in-depth care.
Use tools like the Menopause Rating Scale (MRS) or the Greene Climacteric Scale to assess symptom severity and track treatment response.
Understand the updated NAMS guidelines: For most healthy women within 10 years of menopause onset and <60 years old, low-dose HT is both safe and effective.[]
For patients with contraindications to HT, evidence-based alternatives like fezolinetant (a newly approved NK3 receptor antagonist) and other nonhormonal therapies show benefit.
“Hormone therapy containing estrogen is quite effective for VMS, but nonhormonal drugs including NK3 antagonists, antidepressants, oxybutynin, or gabapentin are also effective. Lifestyle modification, CBT, and even stellate ganglion block have evidence behind them,” says OB/GYN Alyssa Dweck, MD.
Nonpharmacological management
The Menopause Society also supports the role of CBT for menopause-associated VMS.[] Mind-body practices, circadian rhythm support, and stress mitigation can further reduce symptom burden.
“Evidence-based nonhormonal strategies include botanical interventions, temperature regulation, and mind-body practices like breathwork or meditation, which reduce sympathetic dominance and support the whole endocrine axis,” says Dr. Minich.
Read Next: The new menopause patient: What Gen X women expect from their docs