Risk factors, management and consequences of severe menopausal vasomotor symptoms

Menopause, particularly the consequences of severe symptoms, has become the subject of intense media interest. Reducing the prevalent stigma around women's reproductive health has allowed more women to speak openly about their menopause experiences, the effects on their lives and the barriers they face. These effects are far-reaching and illustrate the importance of improving the understanding, management and awareness of severe menopausal symptoms. The cardinal symptoms are hot flushes (or flashes) and night sweats (vasomotor symptoms), although symptoms can vary by ethnicity. For example, some Asian women report other primary symptoms (such as bone and/or joint pain). Vasomotor symptoms affect around 70% of perimenopausal and postmenopausal women and are moderate or severe in around one-third of these women. The US Food and Drug Administration considers vasomotor symptoms to be severe if they cause the person to stop their current activity. Severe vasomotor symptoms drive treatment seeking and can affect quality of life, mental health and work ability. We review the incidence, management and potential long-term health consequences of severe vasomotor symptoms, including cardiovascular disease, diabetes mellitus, cognitive dysfunction, bone health and quality of life. We discuss potential underlying mechanisms and the efficacy of available treatments. Finally, we highlight the evidence gaps in this field and directions for future research.