What Causes VMS? Your Hormones May Play a Larger Role Than You Think

Vasomotor symptoms, otherwise known as VMS due to menopause, are characterized as hot flashes and/or night sweats that can impact many aspects of your life such as sleep, ability to focus, and personal relationships. These symptoms can range from mild, to moderate to severe, and can last longer than 10 years in some women. If you or someone you know has experienced VMS, then you know how debilitating it can be. Fortunately, there are treatments that can help, but in order to know which treatment route is best for you, it’s important to understand exactly why this happening and the role hormones play in vasomotor symptoms and menopause.

We often hear a lot of talk relating to our hormones, but according to Dr. Juliana M. Kling, M.D., M.P.H., a Women’s Health Specialist at the Mayo Clinic in Scottsdale, Arizona, the main hormone that needs to be discussed when treating VMS is estrogen. “Estrogen does all the heavy lifting, meaning it treats the symptoms,” she tells SheKnows. There are many different types of formulations for estrogen intake, making it an effective route for those wanting to treat VMS.”

What causes VMS?

VMS all starts in the hypothalamus. That’s right, it’s all in your head (kind of). The hypothalamus is also known as the part of the brain that regulates your body’s temperature. To keep your body temperature in check, your body needs to have a balance between estrogen and a brain chemical called Neurokinin B (NKB). However, during menopause, levels of estrogen and NKB become unbalanced, which causes the neurons in your hypothalamus to tell you you’re hot when you’re not. And in order to cool down, your body triggers hot flashes and night sweats.

What role does estrogen play in VMS?

“Hormones are like a roller coaster during perimenopause,” Dr. Kling says. “You could check one day and they could be way up, or you could check the next day and it’s way down. So, checking hormones are not as reliable as checking your symptoms.” She adds, “During perimenopause, the hormones fluctuate up and down because, oftentimes, the brain is still talking to the ovaries and intermittently making hormones. But once you hit menopause, your ovaries are not making any more estrogen so the estrogen is low and stays low, and the hormone secreted from the brain is high and stays high.” You no longer get the fluctuations of hormones postmenopause, but you could still have VMS, which for Black or Hispanic women could last much longer than their White counterparts.

What are gonadal hormones?

Gonads are glands that produce hormones that are involved in reproduction and other functions of the body. Those hormones include estrogen, progesterone, and testosterone. The brain is a target of gonadal hormones, and according to the National Library of Medicine, VMS occurs due to changes in gonadal hormones. Normally, core body temperature remains within a specific range, oscillating with daily circadian rhythms, but when these hormones are disrupted, the usually controlled temperature circuit results in an exaggerated heat-loss response, which presents as VMS. 

What else contributes to VMS?

As mentioned above, the brain also plays a part in the onset of VMS. VMS  actually originates in the hypothalamus, which regulates your body’s temperature. To ensure your temperature stays regulated, your body relies on having a balance between estrogen and a brain chemical called NKB. During menopause, levels of estrogen and NKB become unbalanced and this causes the KNDy neurons, which are in charge of temperature control, to tell your body you’re hot when you’re not. As a result, your hypothalamus triggers hot flashes and night sweats to cool down.

What can I do to treat VMS?

“For so long, our culture hasn’t created a space to talk about this,” says Dr. Kling. “Women in their 40s are either finished or finishing having children and going on, trying to balance everything in their lives. But when they start having symptoms like changes to their menstrual cycle, sleep issues, cognitive fog, vaginal dryness, or even symptoms such as joint pain, they don’t make the connection that all of these things are commonly associated with perimenopause.” Dr. Kling highlights that if the two aren’t connected, women may think something bad is happening or try to “tough it out and not talk to a doctor.” But the reality is, there are a lot of tools that have been developed to help women experiencing these symptoms. So, if you’re one of those women who thinks she can “tough it out,” there’s no shame in consulting with a healthcare provider to find the treatment that’s right for you.

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