VMS in Menopause: Understanding the Clinical Burden and Today's Treatment Landscape

Welcome back to another Contemporary OB/GYN Case-Based Peer Perspectivesseries. In this episode titled, “VMS in Menopause: Understanding the Clinical Burden and Today's Treatment Landscape,” Dr. Elizabeth Lapeyre and Nisha McKenzie open with an examination of the clinical burden of vasomotor symptoms (VMS) during the menopause transition. They explain that VMS affect approximately 50–80% of women, with a meaningful subset experiencing moderate to severe symptoms that extend well beyond hot flashes and night sweats. They emphasize that VMS carry a broad quality-of-life impact, disrupting sleep, cognition, mood, workplace productivity, relationships, and sexual health. Drawing on a vivid patient example — an attorney unable to complete a closing argument mid-hot flash — Nisha McKenzie underscores that these symptoms are far from trivial.

The discussion turns to duration, referencing the SWAN study's findings that VMS can persist anywhere from two to more than ten years, with Black and Hispanic women reporting longer duration and greater severity compared to white and Asian cohorts. The menopause experts highlight the significant barriers women face in seeking care, noting that delays of nearly a year from symptom onset to clinical presentation are not uncommon.

The conversation then shifts to the treatment landscape, which the panel organizes into three broad categories: lifestyle modifications, non-hormonal therapies, and hormonal options — including newer NK3 receptor antagonists such as fezolinetant and elinzanetant. They describe a shared decision-making approach that invites patients to identify which treatment category they want to explore first, allowing clinical guidance to be personalized and time-efficient, with the flexibility to layer in additional options as needed to bring patients closer to meaningful symptom relief.

In the next episode, "A Case of a 52-Year-Old Woman with VMS and a History of Breast Cancer," the panelists continue their discussion on VMS in menopause and highlight a challenging case of a breast cancer survivor with severe, refractory VMS, while examining the critical gaps in clinician training and the barriers that prevent women from receiving timely, appropriate care.