It’s getting hot in here!! The Vasomotor (VM) symptoms of Menopause - and how exercise may help
(For the sake of ease in this Blog Vasomotor Symptoms (VM), Menopause Transition (MT), also refers to perimenopause)
“Is it hot in here? Yes it is. Can we open the window? I need some air” - as she says while she looks around and everyone else seems oblivious and comfortable.
Have you experienced this? A hot flush or “flash”? Do you find yourself generally hotter all the time than you used to be? Do you often feel hot and clammy, maybe even cold and clammy for a short period, then the feeling passes? Do you wake up at night hot and sweaty and find it hard to go back to sleep? Do you feel anxiety or heart palpitations associated with this sometimes?
You are not strange, imagining it or suffering from some serious illness. You are likely experiencing Vasomotor symptoms of Menopause, especially if you are 45 years or older and have functioning ovaries.
Fun facts:
VM symptoms can be one of the earlier symptoms of MT.
Up to 85% of females (depending on where you read and what study, country etc) can experience VM symptoms as part of their MT.
VM symptoms can present as hot flushes/flashes, general feeling of hotness, sweatiness, night sweats, cold sweats, flushing in the face, shivers, cold and clammy.
VM symptoms can sometimes be associated with anxiety and heart palpitations.
So, what causes this very un-nerving, strange and inconvenient myriad of symptoms?
There is a very specific pathophysiology and hormonal process that underpins the mechanism of VM symptoms that is beyond the scope of this Blog. However, in summary VM symptoms in general are a results of the changes and fluctuations in Estrodial (E2, our primary female hormone that does roller-coasters for 5-10 years prior to actual Menopause). This acts on other hormones, modulators and feedback loops which results in over stimulation of our thermoregulatory centres in our hypothalamus. The hypothalamus is a big hormone centre in the brain responsible for lots of different functions, including our temperature regulation. Our hypothalamus becomes very sensitive to small temperature changes and over-regulates or corrects, generally getting it wrong.
There is also thought that the capacity of our blood vessels to dilate and contract well during MT (as Estrodial also affects this mechanism hence the word Vasomotor – how our vascular system operates) also affects this process and can keep us hotter by not contracting and dilating efficiently in response to thermoregulatory cues.
In summary our brain and blood vessels are a little haywire and the end result is some uncomfortable and inconvenient symptoms that make us hot, hot, hot (sweaty, cold, clammy **insert individual experience here!)
How can exercise help with VM symptoms?
Direct benefits
Until recently there was limited evidence that exercise can help with VM symptoms. The current information contained on the Australasian Menopause Society is based on a systematic review completed in 2014 (1) (a systematic review is basically a fancy research way of saying they picked a number of research reviews that met certain research standards up until 2014, compared all the information in a high quality research and reviewed way and came up with a general answer). This review indicated there was not a lot of evidence to show that exercise can help. The North American Menopause Society also did not find compelling evidence enough to recommend exercise as a non-medical option to assist with MT symptoms either, in a review of their position statement on non-medicinal management of Menopause symptoms (2).
HOWEVER……research is always happening and always evolving and there is so much research going on right now in the exercise medicine space.
A more recent systematic review and meta-analysis (which is better than a systematic review alone) completed in 2022 has stated there is a strong indication that exercise may reduce the effects of VM symptoms and further research is needed to determine the specific prescription required (3).
A narrative database review completed by The North American Menopause Society in 2022, looked at all randomised controlled trials (a higher-level form of research) conducted between 2020 and 2022 looked at the evidence for exercise in controlling hot flushes. They concluded that aerobic and resistance exercise may be an effective therapy to reduce hot flushes and women should be counselled on the benefits of exercise (4) – maybe a change in their position statement may follow?
A qualitative study was also completed in 2020 incorporating 261 females in the UK as part of the Active Women study. All participants talked positively about physical activity as a treatment for their menopausal symptoms, with most reporting participation had improved their hot flushes and night sweats. They reported that they had experienced improved sleep, physical health and psychological well-being. Those who received the physical activity plus social support intervention reported their ability to cope with their menopausal symptoms had improved. Many participants commented that they would prefer doctors to discuss physical activity as a possible treatment for their hot flushes and night sweats, before offering medication (5).
So, while the jury is still out on the direct benefits of exercise for VM symptoms, emerging evidence is more promising and there is a stronger indication that exercise can be beneficial, especially self-reported qualitative evidence and if combined with a social support approach (group-based exercise). Evidence is also emerging for a both aerobic and resistance-based exercise protocols.
Indirect benefits:
While evidence is still not conclusive in regard to the direct benefits, the indirect benefits of exercise on the management of VM symptoms is really strong.
Females are at higher risk of increased VM symptoms if they are overweight – exercise can help with this (the evidence is clear).
Females are at higher risk of increased VM symptoms if they have low muscle mass – exercise is a key factor in maintenance and growth of muscle mass even in mid-life.
Exercise is a strong factor in maintaining optimal endothelial function (function of your blood vessels), as your blood vessels are more efficient at dilation and constriction.
Females that have more significant VM symptoms are at higher risk of increased cardiovascular (CV) dysfunction post menopause. Exercise massively improves CV function.
VM symptoms affect sleep, mood, concentration and energy. Exercise can assist in offsetting the affects here and evidence for exercise here is well established.
Where can I start, you ask?
If you are a regular exerciser already, keep it up. Exercise helps with a variety of MT related challenges so get as much as you can.
If you currently aren’t exercising, it is important to start slow and where you can. Something is better than nothing.
I have a friend right now who is embarking on exercise in mid-life for her health and her life. I commend her. She is starting with yoga and walking. Nothing huge, nothing complex. Start where YOU can and build from there. The most important thing is to pick something you enjoy, as you definitely will not be consistent or have longevity with something you don’t. Tiresome, frustrating and BORING!! Who has time for forcing yourself to do something?
Over time as you develop a like for exercise, a habit and see how much it will benefit you; you will start to branch out and explore more options.
Don’t rush, don’t feel panicked, don’t let it overwhelm you. Play the long game. You are in this for life.
Kathy xxoo
**Disclaimer – this is general information only based on my scope of practise as an AEP with Women’s Health specialty. It is not medical information specific to all individuals. See your GP for specific medical management if you are concerned about any symptoms you may be experiencing.
References:
Daley A, Stokes-Lampard H, Thomas A, MacArthur C., Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews 2014, Issue 11.
The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society 2023, Vol. 30, No. 6, pp. 573-590
T. Liu, S. Chen, G. I. Mielke, A. L. McCarthy & T. G. Bailey., Effects of exercise on vasomotor symptoms in menopausal women: a systematic review and meta- analysis, Climacteric 2022, 25:6, 552-561
Sarah Witkowski, PhD, Rose Evard, Jacquelyn J. Rickson, PhD, Quinn White, and Lynnette Leidy Sievert, PhD., Physical activity and exercise for hot flashes: trigger or treatment?, Menopause: The Journal of The North American Menopause Society 2022, Vol. 30, No. 2, pp. 218-224
Adèle Thomas and Amanda J. Daley., Women’s views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study, BMC Women's Health 2020, 20:203
Kathy is an Accredited Exercise Physiologist and Accredited Exercise Scientist and has worked in the industry for over 20 years. She has a special interest in Womens Health and has completed further study in the area.