Vasomotor symptoms are the most frequently reported symptoms in postmenopausal women. Common vasomotor symptoms include hot flushes and sweats, e.g., night sweats. Due to their random onset and association with poor sleep and depressive mood, these bothersome symptoms can significantly impact the quality of life of postmenopausal women.
A study published in early 2023, assessed the prevalence and health-related quality of life (HRQOL) burden of vasomotor symptoms in women aged 40–65 years in a European cohort (France, Germany, Italy, Spain, UK) via online questionnaires.
The study was funded by Astellas Pharma Inc. who recently gained approval by the federal food and drug administration (FDA) in the US for their non-hormonal drug fezolinetant for the treatment of moderate to severe vasomotor symptoms. The drug is currently being investigated for approval by the Swissmedic.
30–50% of postmenopausal women suffer from vasomotor symptoms
The prevalence of moderate to severe vasomotor symptoms was highest in Italy with 52% and lowest in France with 31% (Germany: 36%, Spain: 41%, and UK: 40%). Postmenopausal women (without periods for ≥12 months) who did report at least one moderate-to-severe vasomotor symptom in the past 12 months, were never diagnosed with breast cancer and not treated with antiestrogens, aromatase inhibitors, or gonadotropin-releasing treatment in the last 12 months, were sent an extension to the questionnaire.
The extended questionnaire included 37 questions on their medical condition, their experiences with menopausal symptoms including management, and their quality of life. This detailed questionnaire was filled out by 405–413 women in each country.
Women included in the analysis had a median age of 56 years, 53–65% were married and 48% (Italy) to 63% (Spain) were employed. In France (87%), Germany (83%), Spain (83%), and the UK (87%) most women rated the severity of their vasomotor symptoms as moderate, while Italian women (74%) reported to experience severe vasomotor symptoms. Most women experienced both night sweats and hot flushes (54–69%).
Acceptance of hormone replacement therapy (HRT) was low
Besides their experience with vasomotor symptoms, study participants were asked about their opinion on hormone replacement therapy (HRT). They could choose between 5 categories (multiple answers possible):
- HRT-willing: women who are currently using HRT or are willing to do so.
- HRT-averse: women who are not using HRT and who are not willing to do so.
- HRT-contraindicated: women who were assessed by a physician and advised not to use HRT due to underlying medical conditions.
- HRT-stoppers: women who had previously received HRT.
- HRT-caution: women with underlying medical conditions that warrant risk assessment before prescribing HRT.
In Italy, 35% of participants were willing to take HRT. In the other countries willingness was much lower with approximately 20% of women taking or considering HRT. Most women seemed to be HRT-averse (50–64%) or HRT-cautious (64–75%). Around 10% of women had stopped HRT and another ~10% had contraindications.
Perception of menopause. Participants choose on a 7-point scale with a score of 1 meaning “I strongly disagree” and a score of 7 meaning “I strongly agree”.
The figure above displays participants' perception of menopause. Women across countries agreed that menopause is a natural and inevitable part of the aging process and most of them were glad they didn’t have to worry about their periods anymore.
There was a tendency to agree that menopause means a loss of fertility and youth and that it is an undesired time due to bothersome symptoms. To a small extent women also agreed that menopause is a new, positive phase in a woman’s life and that it is a happy end to a lot of hormonal issues affecting women’s bodies.
Vasomotor symptoms and feeling tired are among the most bothersome symptoms according to the study.
When assessing symptoms experienced in the past week, feeling tired and worn out, difficulty sleeping, night sweats, aching in muscles and joints, hot flushes or flushes, lack of energy, and feeling anxious or nervous have been reported most frequently across all countries. Weight gain was mentioned as one of the most bothersome symptoms.
Most women in the study did not consider HRT
Despite a similar symptom burden, less women in the UK (27%) had contacted a health care professional (HCP) to discuss their vasomotor symptoms within the last 12 months before taking the questionnaire than in the four other countries (56–64%). However, more women in the UK were currently or formerly using HRT than in other countries.
Approximately half of the women stated that they did not use HRT because they think there is no need to treat menopause with drugs since it will pass by itself. Around 20–30% of women seemed to be concerned about side effects or long-term risks of HRT. Especially in Germany, concerns regarding HRT side effects and long-term outcomes were common.
Only a small proportion of women (less than 10%) had discussed HRT with their physician and/or were advised not to use it due to higher risk or underlying conditions.
Instead of or besides using drugs, most women (66–79%) implemented life-style changes to cope with their menopausal symptoms. The most popular lifestyle changes included increasing the level of exercise, changing the diet, keeping cool, increasing rest and relaxation, wearing loose/breathable clothing, or dieting for weight loss.
Many women used over-the-counter products (France, 40 %; Germany, 45 %; Italy, 52 %; Spain, 49 %; UK, 37 %) such as vitamin- D and E, soy, calcium, sage, evening primrose oil, sleep aids, black cohosh, ginkgo biloba, St. John's wort, starflower oil, agnus-castus, and traditional Chinese medicine.
The impact of vasomotor symptoms is likely to be underestimated and women do not seek/receive appropriate treatment.
Many postmenopausal women in Europe experience moderate-to-severe vasomotor symptoms. Yet, the true impact of these symptoms is likely to be underestimated as not all women seek healthcare advice for it. Although vasomotor symptom can significantly impact health-related quality of life and increase risk factors for chronic conditions, only a small proportion of women are treated for menopausal symptoms. Access to hormone therapy and nonhormonal prescription treatment options may help improve management of vasomotor symptoms.
