What are the treatments for vasomotor symptoms (VMS)?

Vasomotor symptoms (VMS) are the most common symptoms of menopause. They are episodes of feeling too warm or hot, often referred to as hot flashes or night sweats (when they happen during sleep). These episodes occur suddenly, and symptoms can include flushed skin (especially in the upper body), sweating, and increased heart rate. Episodes can last for several minutes and are often followed by chills.

While menopause is a natural part of the aging process and VMS is an expected part of menopause, these symptoms can disrupt and lower a person’s quality of life. For example, they may occur at work or could interfere with sleep.

Anyone experiencing VMS should speak to a healthcare provider about their symptoms. While VMS typically resolves with time, there are therapies that can help manage VMS during menopause.

Treatment options for VMS

Therapies that can ease and manage VMS can be divided into two broad categories—hormonal treatment and non-hormonal treatment.

Hormonal treatments for VMS

Menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT), involves taking medications that contain the female sex hormone estrogen, often combined with progestin (a synthetic version of the sex hormone progesterone).

These medications reduce the severity and frequency of VMS, as well as other menopausal symptoms. They are available in different forms (oral medications, skin patches, injections), different formulations, and different dosage strengths. A full assessment of current health and medical history will be needed before beginning treatment.

MHT and disease risk

Using MHT can affect disease risk. For example, research suggests that generally, it helps to prevent osteoporosis (bone loss) and may help lower the risk of colorectal cancer.

But other effects may depend on the type of therapy used—whether it’s estrogen-only or estrogen-progestin. For example, the risk of blood clots and endometrial cancer increase with use of estrogen-only MHT, but not with estrogen-progestin MHT.

When deciding on a type of MHT, speak with a healthcare provider about your risk of disease. Since it depends on age, genetics, lifestyle, health status, and many other factors in addition to MHT, a provider can help you weigh the benefits and drawbacks and decide which MHT might be more appropriate for you.

Non-hormonal treatments for VMS

There are also a variety of non-hormone therapies used to treat VMS. Some are approved specifically for the treatment of VMS, while others are prescribed “off-label.”

Approved non-hormonal medications

There are two medications specifically approved for the treatment of VMS. One is a type of antidepressant called an SSRI (selective serotonin reuptake inhibitor), a drug that increases the levels of serotonin.

The second is a type of drug called an NK3 receptor antagonist. This drug works by blocking the activity of specific neurotransmitters (brain chemicals) in the hypothalamus, the part of the brain that regulates body temperature. During menopause, changing hormone levels causes the hypothalamus to overreact to slight changes in temperature, which is how VMS occurs.

Off-label non-hormonal medications

Off-label prescribing means that medication is being used to treat a condition for which it’s not approved. This is a common practice, especially for conditions with a limited number of treatment options. Medications prescribed off-label for VMS include certain drugs that are approved to treat depression, epileptic seizures, and high blood pressure.

What is the best treatment for VMS?

VMS is a different experience for every person. There is no best treatment to help manage symptoms, only the treatment that is best for a particular person. Deciding on a treatment for VMS involves the careful consideration of potential risks and benefits, and your best source of information will be a healthcare provider.

Treatment may also involve lifestyle changes and avoiding things that trigger episodes of VMS. Common triggers can include hot or warm environments, spicy foods, caffeine, and alcohol. Lifestyle changes can include exercising more, making changes to what you eat, weight loss, reducing alcohol consumption, and quitting smoking (if you smoke).