What You Should Know About Vasomotor Symptoms (VMS) of Menopause and Treatment Options

Vasomotor symptoms of menopause — also called VMS — is a medical condition that causes hot flashes and night sweats. These internal infernos can interrupt sleep and everyday activities. 

People with VMS experience more than just physical discomforts. VMS can affect your ability to focus, your mood, and your energy levels. This can, in turn, impact your performance at work and interfere with your personal and romantic relationships. 

If you’re experiencing VMS, here’s what you should know about the condition and your treatment options.

What are vasomotor symptoms of menopause?

VMS is a medical condition that occurs before, during, and after menopause. VMS includes:

• Hot flashes

• Flushing

• Night sweats

It’s not entirely clear why VMS develops as people approach menopause. Researchers believe that as you approach menopause, your brain reacts differently to your internal body temperature. Your hormones, nerves, and other signals all play a role in why your brain suddenly reacts differently to your body temperature. 

Normally, when your body temperature increases by several degrees, your brain recognizes this as a problem and trigger’s your body’s natural cooling mechanisms, like sweating, flushing, and chills. That’s why when people have a fever, they often develop chills and sweats.

Your body temperature normally fluctuates by 1°F to 2°F many times during the course of the day. Typically, your brain recognizes this as normal and doesn’t react. But with menopause, the brain triggers cooling mechanisms even if your body temperature changes only by a small amount. The result is that you can experience VMS multiple times throughout each day. 

VMS can start early. Most people enter perimenopause — the years before menopause — in their 40s. But people as young as 40 years old can develop VMS. About 80% of women experience VMS as they enter perimenopause. And these symptoms can go on for up to 10 years. Unsurprisingly, people are looking for options that can provide reliable and lasting relief from VMS.

The good news is that there are effective treatment options for VMS. Whether you’re looking for prescription treatments, natural treatments, or a combination of both, these tools can ease symptoms.

Prescription treatments for vasomotor symptoms of menopause

There are several prescription treatment options for VMS. They can all be grouped into two categories: hormone treatments and non-hormone treatments. 

Hormone therapy for VMS

Hormone therapy for VMS has been around for decades. It’s considered the most effective treatment option for VMS. And it starts working within a month. People taking hormone therapy experience 75% fewer vasomotor symptoms. And when they do have episodes, these episodes are up to 90% less intense.

Hormone therapy for menopause includes estrogen therapy, progesterone therapy, and combination estrogen therapies. These therapies come in: 

• Pills

• Creams

• Gels

• Shots

• Implants

• Vaginal rings

The wide variety of options lets you find a hormone treatment strategy that fits into your life and helps you achieve symptom relief. But not everyone can take hormone therapy. Your healthcare provider can help you decide if hormone therapy is the best fit for you.

Non-hormone therapy for VMS

If you can’t take hormone therapy (or prefer to avoid it), non-hormone therapies for VMS are another option that can help improve your symptoms. The most commonly prescribed medications include:

• Paroxetine: Low-dose paroxetine is the only SSRI / SNRI that is FDA approved to treat VMS. SSRI / SNRIs are medications that are typically prescribed to treat depression, anxiety, and other mental health conditions. But studies show that these medications can also help treat VMS in as little as 4 weeks. Other SSRI / SNRIs can be used off-label to treat VMS.

• Fezlolinetant (Veozah): Fezlolinetant is FDA approved to treat VMS. It’s the only VMS treatment that works by targeting receptors in the brain that control internal body temperature. In clinical studies, women reported fewer hot flashes and less sleep interruptions. 

• Gabapentin: Gabapentin can be used off-label to help relieve VMS. In studies, people who took gabapentin had fewer awakenings from night sweats and hot flashes during sleep. 

• Clonidine: Clonidine is a medication that can be used off-label to treat VMS by increasing the body’s sweating threshold. In studies, it reduced VMS by a modest amount. But clonidine can cause side effects, which makes it a less-popular option than other non-hormone treatment options. 

You can try more than one of these treatments. If the first medication you try doesn’t work well, you can switch to another option. 

Natural treatments for vasomotor symptoms of menopause

If you prefer to avoid prescription medications, there are still options you can try to relieve your VMS. You can try these natural treatment options for VMS: 

• Exercise: Regular exercise won’t reduce your VMS. But in small studies, people who exercised 3 times a week reported being less bothered by their hot flashes.

• Diet changes: Changing your diet won’t eliminate your VMS completely. But making some simple changes may ease your symptoms. In some studies, people who follow a Mediterranean diet reported fewer hot flashes. In other studies, people who ate more soy-based foods also reported fewer hot flashes. 

• Clothing swaps: Changing your wardrobe won’t stop your VMS either. But changing what you wear can keep you more comfortable when you do experience symptoms. You can opt for loose layers over more form-fitting clothing. You can also add moisture-wicking items to your wardrobe. 

• Supplements: In some studies, people have experienced fewer VMS while taking black cohosh, St. John’s wort, and omega-3 fatty acids. Talk with your healthcare provider before starting supplements for menopause symptoms. Some of these supplements can interact with medications or worsen underlying health conditions. 

• Mind-body treatments: You can also try mind-body treatments to help with VMS. The International Menopause Society suggests trying mind-body practices for managing VMS. These treatments include cognitive behavioral therapy (CBT), structured mindfulness training, hypnosis, aromatherapy, and acupuncture. 

Keep in mind that these treatments aren’t supported by strong research. That means it’s impossible to know how well these treatment options will work for you — or even if they’ll work at all. But since these treatments are relatively safe and cost effective, it may be worth giving them a try. You can also add them to your prescription treatment plan.

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Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Adriena Beatty D.O., MBA, CPE

Adriena Beatty, DO, MBA, CPE, is an Army veteran and board-certified obstetrician and gynecologist with over 20 years of experience. She is a graduate from Tuskegee University with a degree in chemical engineering and chemistry.

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