Vasomotor Symptoms

Question 1

VMS

Answer 1

-“hot flashes” during the day
-“night sweats” during the night
-sudden intense sensation of heat in the upper body, particularly face, neck, chest; lasting 1-5min
-a/w perspiration, chills, anxiety, some heart palpitations
-# of episodes per day varies
-lasts for median of 7-10ths

Question 2

Intensity of VMS

Answer 2

-Mild - sensation of heat who sweating
-Moderate - sensation of heat w sweating, able to continue activity
-Severe - sensation of heat w sweating, causing cessation of activity
-most intense & frequent in perimeno & for first 1-2yrs after the last menstrual period

Question 3

Prevalence of VMS

Answer 3

-most commonly reported symptom of meno trans; affects 60-80% of women at some point during meno transition
-varies by meno phase
->21% reported VMS in premeno
->41% reported VMS in perimeno
->42% reported VMS in postmeno
-varies racial/ethnic groups
->black > Hispanic > white > Chinese > Japanese

Question 4

RF for VMS

Answer 4

-low socioeconomic position
-low educational attainment
-obesity (only in perimeno)
-tobacco/nicotine use
-hysterectomy/oophorectomy

Question 5

Health-Related outcomes of VMS

Answer 5

-a/w sleep disturbance, depressive sxs, cognitive function changes
-evidence of link between VMS & CVD & poor bone health

Question 6

Physiology of VMS

Answer 6

-not completely understood
-complex interplay between CNS & peripheral physiologic processes
-thermoregulatory center is altered after meno by increase in kisspeptin-neurokinin B-dynorphin (KNDy) neurons; activation of neurokinin-3 receptor (NK3R) causes hot flashes; blockade of NK3R reduces/eliminates them
-also affected by serotonin, epinephrine, norepinephrine, & sympathetic/parasympathetic nerve activity

Question 7

Nonprescription Therapies for VMS

Answer 7

-CBT, exercise, yoga, acupuncture, clinical hypnosis, stellate ganglion block
-S-equal derivatives of soy isoflavones beneficial but supporting evidence is mixed
-behavior modification to minimize sxs (dress in layers, avoid triggers, cool ambient temps)

Question 8

Prescription Therapies for VMS

Answer 8

-tx based on tolerance of sxs, health hx, RFs, personal preferences
-FDA-approved: hormone therapy, paroxetine
-off-label rx: SSRI, SNRI, gabapentinoids, colonizing, oxybutynin