Educating Patients and Providers: Key Takeaways for Better VMS Management
Panelists discuss how providers should actively screen for vasomotor symptoms (VMS), especially given the lengthy wait times to see specialists, emphasizing that education for both patients and health care providers is essential for timely intervention and effective management.
Episode 8
The following transcript has been edited for clarity, style, and length.
Tara K. Iyer, MD: Great. Can you offer any closing thoughts for primary care providers working with women experiencing vasomotor symptoms (VMS) due to menopause? In particular, how can these providers navigate evidence-based treatment discussions and feel comfortable prescribing appropriate medications?
Alexa Fiffick, DO, MBS, MSCP: The main takeaway for primary care providers is that VMS are not just bothersome—they have a significant impact on long-term health outcomes, society, and the economy.
When patients report VMS, treat them. But it's also crucial for primary care clinicians to actively ask about these symptoms. Many women assume menopause symptoms are just a phase they must endure and may not bring them up unless asked. For years, women have been told these symptoms are "normal" and that they just have to get through them, leading many to believe there's no effective treatment. In reality, we now have multiple FDA-approved options, with menopausal hormone therapy (MHT) as the gold standard.
Newer neurokinin (NK) inhibitors expand treatment possibilities, particularly for providers who may not have extensive training or comfort in prescribing MHT. If you are unfamiliar with managing MHT risks and benefits, at the very least, you should be able to assess the risk-benefit profile of non-hormonal therapies and provide options for your patients.
My key takeaways for primary care providers are:
- Ask every patient in the appropriate age range if they are experiencing VMS, even if they don't bring it up.
- Familiarize yourself with available treatment options, including both MHT and non-hormonal therapies, so you can confidently discuss them with patients.
Iyer: I completely agree. Even in major medical hubs like Boston and Cleveland, where you and I practice, the wait times for specialist care are months long. That means primary care providers and gynecologists are often the first and sometimes only point of contact for women seeking help.
If a provider lacks comfort with prescribing menopause treatments, patients often get referred to specialists, leading to extended periods—sometimes years—of untreated symptoms. Developing even a basic level of familiarity with available therapies and having a few go-to treatment options can make a significant difference in women's lives.
The key points to remember are:
- VMS are not benign; they impact more than just quality of life.
- Both hormonal and non-hormonal treatment options exist, each with different efficacy levels, side effect profiles, and accessibility factors.
- Becoming comfortable with prescribing these treatments can drastically improve patient care.
Fiffick: One more thought—many primary care providers were trained in an era where menopause management was deprioritized, especially following the initial Women’s Health Initiative (WHI) study results. It’s important to shift our mindset. If a patient told you they were experiencing palpitations, dizziness, fainting episodes, or persistent pain several times a day, you would take those symptoms seriously. We should apply the same level of concern to VMS, which are not just an inconvenience but a real medical issue with broader health implications.
Iyer: That’s a great point. The American Heart Association highlighted in 2020 that menopause itself—not just early menopause—is a recognized risk factor for cardiovascular disease. Whether it’s due to hormonal changes or the prevalence of VMS during this time, we need to recognize menopause as an opportunity for intervention. Primary care providers, as the first line of defense, should consider it a crucial part of their preventive care strategy.
Fiffick: Absolutely.
Iyer: Thank you so much for your insights, Dr Fiffick, and thank you to everyone for joining this discussion on treatment options for vasomotor symptoms due to menopause.
Fiffick: Thank you, Dr Iyer. Have a great rest of your day.
