Up to 80% of women experience vasomotor symptoms (VMS) as they transition into the menopause phase. While clinical guidelines suggest that VMS typically last from 6 months to 2 years, we often see women with VMS lasting for a much longer period of time. To more accurately assess the duration of VMS in perimenopausal women, researchers analyzed data from 1449 women included in the Study of Women’s Health Across the Nation (SWAN), an observational study of women entering menopause.  Here is a summary of the key findings:

The median total duration of VMS was 7.4 years.

Among the 881 women who recalled the time of their final menstrual period (FMP), the median duration of VMS post-FMP was 4.5 years.

The longest duration of VMS (median, >11.8 years) occurred among women who started having VMS when they were premenopausal or in early perimenopause; in contrast, the shortest VMS duration occurred in women who were postmenopausal when VMS began (median, 3.4 years).

Black women had the longest total VMS duration (median, 10.1 years), whereas Japanese and Chinese women experienced the shortest VMS duration (median, 4.8 years and 5.4 years, respectively).

Other risk factors for longer VMS duration included younger age, lower educational level, history of smoking, greater perceived stress, and depression and anxiety at the onset of VMS.

This report gives us a much better sense of the trajectory of vasomotor symptoms. A sizeable proportion of women experience vasomotor symptoms over a period of 5 or more years; thus, many women may not want to “tough it out” without treatment and will require interventions that are both safe and well-tolerated over long-term use.

Younger women who present with VMS may still be fertile. These women could be treated with low-dose combined oral contraceptives which would provide birth control while at the same time managing VMS.

Because clinical guidelines now recommend a shorter duration of hormonal therapy (less than 5 years) for the treatment of menopausal symptoms, many women will prefer to use non-hormonal treatments.  These women may benefit from a variety of interventions including acupuncture and cognitive behavioral therapy (CBT).  Effective pharmacologic interventions include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, pregabilin, and clonidine.

Ruta Nonacs, MD PhD

Avis NE, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015.

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