From the Guidelines
Vasomotor symptoms in menopause are associated with an increased risk for cardiovascular disease (CVD), with women experiencing moderate to severe hot flashes and night sweats having a higher risk of developing cardiovascular events compared to those with mild or no symptoms. This association appears to be independent of traditional cardiovascular risk factors, and the connection likely stems from shared underlying mechanisms, as vasomotor symptoms reflect systemic vascular and autonomic nervous system dysfunction that may parallel cardiovascular pathology 1. During a hot flash, there are rapid changes in blood vessel dilation and constriction, heart rate variability, and increased sympathetic activation - all processes that, when chronically dysregulated, can contribute to atherosclerosis and endothelial dysfunction.
The hormonal changes of menopause, particularly declining estrogen levels, affect both vasomotor stability and cardiovascular health. According to the 2024 guideline for the primary prevention of stroke, early menopause (before 45 years of age) is a risk factor for stroke, and multiple prospective studies have consistently shown an increased risk of stroke among those with premature or early menopause 1. Additionally, the decline of estradiol levels in the menopausal transition can lead to a rise in LDL levels and a decline in high-density lipoprotein levels, as well as an increase in blood pressure, further contributing to the risk of CVD 1.
Women experiencing significant vasomotor symptoms should consider this an opportunity for cardiovascular risk assessment and potentially earlier intervention with lifestyle modifications, including:
- Regular exercise
- Heart-healthy diet
- Smoking cessation
- Stress management to protect long-term cardiovascular health. It is also important to note that menopausal hormone therapy (MHT) is not recommended for CVD prevention, as it has been shown to have potential harm and no cardiovascular benefit 1. However, transdermal formulations of estrogen may be considered for women with low cardiovascular risk profiles who do not have unexplained vaginal bleeding or liver disease 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Vasomotor Symptoms and Cardiovascular Disease Risk
- The relationship between vasomotor symptoms in menopause and the risk of cardiovascular disease has been investigated in several studies 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that the presence of vasomotor symptoms was associated with an increased risk of cardiovascular disease events, particularly in women under 60 years of age at baseline 3.
- Another study found that the severity of vasomotor symptoms, rather than their frequency, was associated with an increased risk of cardiovascular disease 5.
- The timing of vasomotor symptoms also appears to play a role, with early-onset symptoms associated with a higher risk of cardiovascular disease in some studies 5, 6.
- However, the evidence is not consistent, and some studies have found no significant association between vasomotor symptoms and cardiovascular disease risk 2, 6.
Key Findings
- A pooled analysis of six prospective studies found that women who experienced night sweats "sometimes" or "often" had a higher risk of cardiovascular disease 5.
- The same study found that increased severity of hot flashes or night sweats was associated with a higher risk of cardiovascular disease 5.
- A systematic review and meta-analysis found that the presence of vasomotor symptoms was associated with a relative risk of 1.48 for cardiovascular disease, although this association was attenuated after adjusting for cardiovascular risk factors 4.
Age and Vasomotor Symptoms
- The association between vasomotor symptoms and cardiovascular disease risk appears to vary by age, with a stronger association observed in women under 60 years of age at baseline 3.
- One study found that early-onset vasomotor symptoms were not associated with an increased risk of cardiovascular disease, while late-onset symptoms were associated with a higher risk 6.