Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages

Arch Womens Ment Health (2007) 10: 247257 DOI 10.1007/s00737-007-0209-5 Printed in The Netherlands

Review Understanding the pathophysiology of vasomotor symptoms (hot ushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages

D. C. Deecher1, K. Dorries2

1 Womens Health Research, Wyeth Pharmaceuticals, Collegeville, Pennsylvania, USA

2 Advogent Group, Piscataway, New Jersey, USAReceived 10 May 2007; Accepted 1 October 2007; Published online 12 December 2007 # Springer-Verlag 2007

Summary

Vasomotor symptoms (VMS), commonly called hot ashes or ushes (HFs) and night sweats, are the menopausal symptoms for which women seek treatment during menopause most often. VMS are a form of temperature dysfunction that occurs due to changes in gonadal hormones. Normally, core body temperature (CBT) remains within a specic range, oscillating with daily circadian rhythms. Physiological processes that conserve and dissipate heat are responsible for maintaining CBT, and tight regulation is important for maintenance of optimal internal organ function. Disruption of this tightly controlled temperature circuit results in exaggerated heat-loss responses and presents as VMS. The mechanistic role related to changes in gonadal hormones associated with VMS is not understood. Hormone therapy is the most effective treatment for VMS and other menopausal symptoms. Estrogens are known potent neuromodulators of numerous neuronal circuits throughout the central nervous system. Changing estrogen levels during menopause may impact multiple components involved in maintaining temperature homeostasis. Understanding the pathways and mechanisms involved in temperature regulation, probable causes of thermoregulatory dysfunction, and brain adaptation will guide drug discovery efforts. This review considers the processes and pathways involved in normal temperature regulation and the impact of uctuating and declining hormones that result in VMS during the menopausal transition.

Keywords: Temperature; estrogen; woman

Introduction

At some time during the menopausal transition, as many as 80% of women will experience the classic menopaus-

al vasomotor symptoms (VMS), hot ashes or ushes (HFs) and night sweats (National Institutes of Health 2005a). These symptoms can start to occur in the perimenopausal period (Soules et al. 2001), a stage of hormonal uctuation that leads up to menopause (1 year after the last menstrual cycle), and can last throughout the postmenopausal phase (Roodstroom et al. 2002). Hot ushes and night sweats vary greatly in intensity, both between women and within individual women, over time. Mild HFs...