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Frequently asked questions

The most bothersome symptoms of menopause—and the most common reason women seek medical care during the menopausal transition—are hot flashes and night sweats, also known as VMS.1

Hot flashes are characterized by a sudden intense sensation of heat in the upper body, particularly the face, neck, and chest. Episodes of VMS typically last 1 to 5 minutes, and can be accompanied by perspiration, chills, anxiety, and heart palpitations. However, individual experiences of VMS vary.2

Estrogen declines during menopause. Among the effects of this decline are vaginal atrophy, ageing of skin, osteoporosis, and VMS.1,3,4

In the case of VMS, we now know that during menopause, less estrogen reaches the estrogen receptors of KNDy neurons, which are located in the thermoregulatory centre of the hypothalamus. The reduction in estrogen alters the activity of the KNDy neurons, and that altered activity is one of the causes of VMS.3-5

VMS are physiological symptoms associated with menopause.1,2



In the thermoregulatory centre in the hypothalamus:

  • NKB and estrogen modulate KNDy neurons in a delicate balance, contributing to body temperature regulation. KNDy neurons are stimulated by NKB and inhibited by estrogen3,6,7
  • Through the menopausal transition, estrogen declines, disrupting the balance with NKB3,6,8
  • Unopposed, NKB signalling causes heightened KNDy neuronal activity, which leads to hypertrophy of KNDy neurons and altered activity in the thermoregulatory centre3,6,8
  • As a result, the thermoregulatory centre triggers heat dissipation effectors that cascade into hot flashes and night sweats—VMS3,6,8


Watch VMS in action

Studies have shown that the frequency and severity of VMS may be used as a predictor of chronic diseases in the future, such as cognitive impairment, cardiovascular disease, and osteoporosis.9,10

Up to 80% of women are affected by VMS during the menopausal transition.1,10,11

VMS last for a median duration of 7.4 years, and women reported the following menopause-related symptoms having severe impacts on their quality of life: feeling tired/worn out (72%), lack of energy (67%), sleep disturbances (57%),  work disruptions (50%),  negative effect on relationship with spouse or partner (41%), negative effect on mood (39%) and having low libido (37%).12-14

Not all women realize that VMS are a medical condition worthy of discussion, leaving them feeling unprepared and alone.13 Having a productive dialogue is crucial in helping women impacted by VMS. Studies show that women want to have open and honest conversations about menopause symptoms and treatment options with their doctor.14

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Exploring the science behind VMS

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KNDy: kisspeptin/neurokinin B/dynorphin; NKB: neurokinin B; VMS: vasomotor symptoms.

References

  1. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199-215.
  2. Thurston RC. Vasomotor symptoms. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A Clinician's Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society, 2019;43-55..
  3. Rapkin AJ. Vasomotor symptoms in menopause: physiologic condition and central nervous system approaches to treatment. Am J Obstet Gynecol. 2007;196(2):97-106.
  4. Padilla SL, Johnson CW, Barker FD, Patterson MA, Palmiter RD. A neural circuit underlying the generation of hot flushes. Cell Rep. 2018;24(2):271-7.
  5. Modi M, Dhillo WS. Neurokinin 3 receptor antagonism: a novel treatment for menopausal hot flushes. Neuroendocrinology. 2019;109(3):242-8.
  6. Krajewski-Hall SJ, Blackmore EM, McMinn JR, Rance NE. Estradiol alters body temperature regulation in the female mouse. Temperature. 2018;5(1):56-69.
  7. Wakabayashi Y, Nakada T, Murata K, et al. Neurokinin B and dynorphin A in kisspeptin neurons of the arcuate nucleus participate in generation of periodic oscillation of neural activity driving pulsatile gonadotropin-releasing hormone secretion in the goat. J Neurosci. 2010;30(8):3124-32.
  8. Krajewski-Hall SJ, Miranda Dos Santos F, McMullen NT, Blackmore EM, Rance NE. Glutamatergic neurokinin 3 receptor neurons in the median preoptic nucleus modulate heat-defense pathways in female mice. Endocrinology. 2019;160(4):803-16.
  9. Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. 2005;3:47.
  10. Yuksel N, Evaniuk D, Huang L, et al. Guideline No. 422a: Menopause: vasomotor symptoms, prescription therapeutic agents, complementary and alternative medicine, nutrition, and lifestyle. J Obstet Gynaecol Can. 2021 Oct;43(10):1188-1204.e1.
  11. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.
  12. Todorova L, Bonassi R, Guerrero C, et al. Prevalence and impact of vasomotor symptoms due to menopause among women in Brazil, Canada, Mexico, and Nordic Europe: a cross-sectional survey. Menopause. 2023;30(12):1179-1189. 
  13. Menopause Foundation of Canada. The Silence and the Stigma: Menopause in Canada. 2022; 1-21. Accessed February 7, 2024. https://menopausefoundationcanada.ca/wp-content/uploads/2023/01/MFC_The-Silence-and-the-Stigma_Menopause-in-Canada_Oct22_v2.pdf
  14. Menopause Foundation of Canada. Menopause and Work in Canada. Accessed February 7, 2024. https://menopausefoundationcanada.ca/pdf_files/Menopause_Work_Canada_2023EN.pdf
  15. Parish SJ, Nappi RE, Kingsberg S. Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment. Menopause. 2018;25(8):937-49.