Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease

Abstract

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.

Keywords: blood pressure; hot flushes; menopause; night sweats; sex differences.

Figure 1.

Difference in systolic (SBP) and diastolic (DBP) blood pressure in females with hot flushes compared with females without hot flushes. The dotted horizontal line at 0 represents no change. Data points above 0 indicate a greater increase in females with hot flushes compared with females without hot flushes. Percent differences were calculated based on the absolute data provided in each of the publications indicated. For example: [(BP in females with VMS − BP in females without VMS)/(BP in females without VMS) × 100]. Citations are in parentheses on the x-axis. BP, blood pressure; VMS, vasomotor symptoms.

Figure 2.

Conceptual model and proposed pathways of how vasomotor symptoms (VMS) of menopause can influence autonomic (ANS) function and cardiovascular disease (CVD) risk. The loss of sex hormones, particularly estradiol, triggers thermodysregulation and VMS in some females. Although there are other mechanisms for anxiety/depression in menopausal females, VMS are also a suspected contributor. Sleep difficulties often occur with menopause and may be exaggerated by nighttime hot flushes or night sweats. Finally, this cascade of events can be exaggerated by external stressors, such as stress, trauma, and low socioeconomic status. Image was created with Biorender.com and published with permission.