Advances in vasomotor symptom treatments
Transcript: Menopause and VMS: Missing links
Dr Sheryl Kingsberg
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
I think that one of the missing links in menopause management is women being aware of the variety of symptoms that might be occurring with menopause and clinicians being aware and asking. So, while vasomotor symptoms are very common, they are not necessarily the ones that impact quality of life the most. And if you looked at what are the common symptoms associated with menopause, we don't really have an exact number that we can sort of count on, but the range could be anywhere from eight to, I have to say, probably 30 symptoms that could be associated with menopause.
But some of the key ones are going to be sleep disturbance and mood changes. And those are primarily during perimenopause for mood. But, we assume that there has been this domino effect with vasomotor symptoms causing sleep disturbance, and sleep disturbance causing mood changes in this sort of domino linear progression. But what we now understand is that they are interrelated, but not necessarily in this domino effect. That sleep disturbance can occur all on its own, and mood disturbance can occur all on its own, they can impact each other. And that the assumption that every woman is going to wake up because of a hot flash, and that creates a sleep disturbance is not accurate. In fact, 30 to 60% of sleep disturbance is without vasomotor symptoms.
So, I think it's important that clinicians understand that they shouldn't assume that if a woman is not having hot flashes or night sweats, that they shouldn't assume that she's not having sleep disturbance, they need to be asking about that anyway. We know that waking after sleep onset, WASO is very common, even with no or mild vasomotor symptoms.
And mood symptoms are also very common. And when I say mood symptoms, I don't necessarily mean clinical depression, it could be clinical depression. But what we know is that in perimenopause, if you have a past history of clinical depression, particularly related to postpartum depression or premenstrual dysphoric disorder, but just a history of depression, you are at higher risk to develop a depression, a clinical depression in perimenopause or early post menopause. If you don't have that history, while you're not at particular risk for a major depressive episode, you still may experience some mood symptoms, and there's sort of a constellation of them that could be anxiety, not necessarily depression, or it could be depressed mood or irritability that may not sort of meet the criteria of a depressive disorder. But they are very common.
And again, women don't know that that may be related to menopause, and clinicians don't pay attention to those symptoms as much as they pay attention to vasomotor symptoms, but they all can interact. With regard to that sleep disturbance, when I talked about WASO, Wake After Sleep Onset, I think it's also important thinking about that domino effect, to pay attention to the kind of sleep disturbance that a woman may be presenting with.
So, as a clinician thinking, are these related to hot flashes? Are they sleep disturbance on their own or are they related to depression? Right. If the sleep disturbance is related to depression, the sleep problem is typically going to be problems falling asleep or early morning wakening. If the symptoms are related to menopause and perimenopause, it's probably going to be the waking after sleep onset.
So, women will say, "I don't have any problems falling asleep, and I don't necessarily wake up early, but I wake up during the night and not necessarily with a hot flash."
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