Understanding VMS in Menopause: Prevalence and Impact
Panelists discuss how vasomotor symptoms (VMS) can persist for years with variable manifestations, significantly disrupting both social and professional spheres, resulting in multibillion-dollar economic losses through decreased productivity and increased insurance costs.
Episode 1
The following transcript has been edited for clarity, style, and length.
Alexa Fiffick, DO, MBS, MSCP: Hello, and thank you for joining this session of Patient Care Primary View, titled Menopause and Vasomotor Symptoms: Safety Considerations and Practical Insights for Primary Care Providers.
I'm Dr Alexa Fiffick and I am a women's health specialist at Concierge Medicine of Westlake in Cleveland, Ohio. Today I am joined by my friend Dr Tara Ayer, who is the medical director of the Menopause and Midlife Clinic at Brigham and Women's Hospital, and is also a clinical instructor in medicine at Harvard Medical School.
Tara K. Iyer, MD: Hi, everyone, and hello, Dr Fiffick. I'm so happy to be here today to discuss vasomotor symptoms (VMS), also known as hot flashes and night sweats.
Today, we will review current therapies for treating VMS and highlight the crucial role that primary care providers (PCPs) play in identifying these symptoms and initiating early treatment. We will also be focusing on relevant safety concerns associated with each therapy and discuss how PCPs can help patients navigate these concerns. Thank you for joining us—let’s begin.
To start, Dr Fiffick, could you provide an overview of VMS due to menopause, including its prevalence and impact on women at midlife?
Fiffick: Absolutely. For those unfamiliar with VMS, they include hot flashes, night sweats, and flushing—symptoms that typically emerge during perimenopause and continue into the menopausal transition. These symptoms affect a significant proportion of women, with prevalence estimates ranging from 75% to 80%, depending on the study.
Previously, it was thought that VMS would resolve within a few years, perhaps 1 to 3 years at most. However, we now know that the average duration is much longer, typically lasting between 7 and 10 years. The frequency and severity vary widely among individuals. Some women may experience only a few episodes per day, while others report 20 or more. The first 2 postmenopausal years tend to be the most intense, statistically speaking. However, some women, often referred to as “super flashers,” continue to experience VMS for the rest of their lives. Given that 80% of women experience these symptoms with an average duration of seven to ten years, their impact is profound.
Iyer: Yes, I absolutely agree with you. And how does this really affect our patients on a daily basis? I know you must hear this often in your practice, but I frequently hear from patients about how significantly this impacts their lives on many different levels. It can be very disruptive, particularly in terms of sleep at night, and how that disruption, in turn, can negatively affect their mood, energy levels, and cognitive function. I've had many patients share compelling and frankly debilitating stories about how these symptoms impact their daily functioning. For example, patients have told me about avoiding work presentations because they almost always experience a hot flash during them, and they feel like they've missed career advancement opportunities because they can't perform as well, partly due to these symptoms. I'm sure you hear similar experiences from your patients as well.
Fiffick: Definitely. Every woman experiences menopause differently, but I frequently hear about the disruptive nature of VMS. Many women describe situations where they have to step out of important meetings, remove layers of clothing due to sudden sweating, or feel self-conscious in professional settings. Some even believe that these symptoms have held them back in their careers.
To put this into a numerical perspective, a 2023 Mayo Clinic study estimated that untreated menopause leads to approximately $1.8 billion in lost work time annually in the US. When we consider the associated health care costs—including employer expenses, insurance claims, and out-of-pocket payments—the total economic burden rises to $26.6 billion per year. This underscores not only the personal toll of untreated menopausal symptoms but also their broader impact on workforce productivity and the economy.
