What's in a name: are menopausal “hot flashes” a symptom of menopause or a manifestation of neurovascular dysregulation?

Abstract

Hot flashes have typically been classified as "symptoms of menopause" that should be tolerated or treated until they resolve. However, mounting evidence points to hot flashes as a manifestation of one or several underlying pathophysiological processes. Associations exist between the presence, timing of onset, severity, and duration of hot flashes, and the risk of several neurological (affecting sleep, mood, and cognition) and cardiovascular conditions. In addition, four consistent patterns of vasomotor disturbances have been identified across different countries, making it unlikely that these patterns are solely explained by socioeconomic or cultural factors. The changing hormonal environment of menopause may unmask differences in the autonomic neurovascular control mechanisms that put an individual woman at risk for chronic conditions of aging. These differences may have a genetic basis or may be acquired across the life span and are consistent with the variability of the clinical manifestations of aging observed in women after bilateral oophorectomy. It is time to investigate the pathophysiological mechanisms underlying the four patterns of vasomotor symptoms more closely, and to shift from describing hot flashes as symptoms to be tolerated to manifestations of an underlying autonomic neurovascular dysregulation that need to be addressed.

A qualitative assessment of health behaviors and experiences during menopause: A cross-sectional, observational study

“…Despite this, mounting evidence supports that menopause symptom severity (especially VMS) is indicative of the clinical manifestation of one or several underlying pathophysiological processes [25]. Furthermore, hormone dysregulation during the menopause transition is thought to lead to a narrowing of the thermoneutral zone, resulting in increased VMS severity and thereby increased episodes of insomnia.…”

“…In the present study, women who reported higher exercise frequency had modestly less severe menopause-related symptoms. Nonetheless, the reliance on subjective, selfreporting of VMS as a primary endpoint and the lack of valid, objective methods to assess VMS dynamics has limited research progress [25,29]. …”

Menopausal vasomotor symptoms: central triggers, effectors, and new possibilities of pathogenetic therapy

“…Исследования, посвященные этому, немногочисленны, и данный вопрос требует дальнейшего изучения. Некоторые ученые предложили вместе с этим исследовать гены нейромедиаторных систем, таких как норадренергическая и серотонинергическая, поскольку через их пути осуществляются основные звенья патогенеза приливов жара [1].…”

“…В настоящее время ученые предлагают перестать рассматривать «приливы жара» лишь как симптом менопаузы, который легко можно купировать приемом эстрогенсодержащих препаратов или просто дождаться его окончания [1]. Вазомоторные симптомы должны быть признаны частью единого патофизиологического процесса, сопровождающего климактерий, проявлением нейроэндокринной и сосудистой дизрегуляции.…”

Multimorbidity After Surgical Menopause Treated with Individualized Classical Homeopathy: A Case Report

“… 3 There is also a need to understand the underlying neurophysiological mechanisms in the climacteric syndrome, as many neuroendocrinal pathways seem involved in this process and considering it merely as an annoyance that needs to be handled for the time being may be a detrimental attitude. 6 Climacteric syndrome may be associated with deeper neurological disturbances which may have a bearing on future diseases. 6 …”