Facial Flushing Why Treatment Is Essential

When entering the menopausal years, many women experience hot flashes—where the face and upper body suddenly burn—and night sweats, where cold sweat flows at night. These two symptoms are grouped together and called vasomotor symptoms (VMS), the representative symptoms most commonly appearing in the menopausal transition. In the clinic, there are not a few who, regarding it as "just something everyone goes through with age," endure it and come only after sleep has collapsed and daily life has been shaken. But recent studies consistently report that vasomotor symptoms can, beyond simple discomfort, affect quality of life and long-term health. So in this article, I will organize with a focus on "why you must not leave it untreated."

Vasomotor symptoms are the symptoms most commonly reported in menopausal women. A pattern of heat suddenly starting in the face and upper body and spreading to the whole body is common, usually lasting about several minutes per episode. When the heat subsides, sweating occurs, and palpitations, trembling, and anxiety can come together.

The intensity and frequency of symptoms have large individual variation. Some pass lightly, but many have it at a moderate level or worse that disrupts daily life. Prevalence is reported to differ by region and ethnicity, and to that extent it is not a symptom that appears the same in everyone.

People commonly think "it passes if you endure a few months," but according to the U.S. women's health longitudinal study (SWAN, 2015), frequent vasomotor symptoms last on average around 7 years, and in some are reported to continue 10 years or more. In other words, it is not a temporary symptom that ends quickly but one that can affect life for a considerable period. If you are curious about menopausal changes overall, referring to the article on menopausal bodily changes, symptoms, causes, and mechanisms helps.

The core cause of vasomotor symptoms is the decrease in estrogen (female hormone). When estrogen becomes insufficient, a change occurs in the function of the hypothalamus, which regulates body temperature.

Simply put, our body has a safe zone of temperature that allows "up to this temperature is fine," and in the menopausal years this zone narrows. So the body reacts oversensitively even to small temperature changes that would normally not be noticed. Even with a slight rise in perceived temperature, the peripheral blood vessels dilate and skin blood flow increases, producing heat, and the body tries to rapidly lower core temperature by sweating.

In addition, in the menopausal transition, it is known that changes in the concentration of neurotransmitters such as serotonin and noradrenaline accompany it and affect the thermoregulatory center. The reason hot flashes have a meaning beyond simple "burning" is precisely because such complex neural, vascular, and hormonal changes are in the background.

Smoking, obesity (increased body fat), anxiety/depression, and decreased physical activity are reported as factors that make symptoms more severe. In clinical experience, those with overlapping lifestyle factors tend to have greater symptom complaints.

When vasomotor symptoms are left untreated, the first thing to be affected is sleep. Night sweats wake you from sleep with sudden heat and sweat, and make it hard to fall back asleep.

When sleep is interrupted every night, a vicious cycle like the following tends to follow.

• Not getting deep sleep causes daytime fatigue and decreased concentration.
• Sleep deprivation grows mood change and anxiety, and this in turn makes symptom perception more sensitive.
• Chronic sleep deprivation also affects appetite/metabolism regulation, making weight management difficult.

In fact, vasomotor symptoms are reported to negatively affect sleep, mood, and quality of life, and to affect work and home life. It is necessary to remember that, rather than passing it off as "just losing a bit of sleep," lowered sleep quality can spread to daily life as a whole. If insomnia itself is your concern, I recommend also examining the article: insomnia in women in their 50s—is it because of menopause?.

Vasomotor symptoms have drawn attention as more than a simple discomfort symptom, as their association with cardiovascular/metabolic health has been reported. In the past it was regarded as about "the discomfort one naturally goes through in the menopausal years," but several studies have raised the point that vasomotor symptoms are related to changes in vascular function.

In large-scale studies such as the WHI (Women's Health Initiative), associations with blood pressure, cholesterol, vascular endothelial function, and insulin resistance were reported in women who experience vasomotor symptoms. The explanation is that repeated stimulation of the sympathetic nervous system can affect vascular function.

Also, associations with various health problems such as obesity, metabolic syndrome, diabetes, fatty liver, osteoporosis, depression/anxiety, and changes in cognitive function are being discussed together. However, this is correctly understood not to mean "if you have hot flashes, you will definitely get a disease," but that you need to receive the symptom as a signal and examine your overall health together. The reason metabolic/cardiovascular risk must be managed from a lifelong perspective also touches the context of the article on polycystic ovary syndrome and cardiovascular/diabetes risk.

Organizing the misunderstandings often encountered in the clinic makes clear how to view the symptoms.

Symptoms are usually most severe around menopause and show a course of gradual relief afterward, but the start point and duration differ from person to person. So it is hard to say uniformly "where my symptoms are now and how much longer they will go." What is important is that if symptoms are at a level disrupting daily life, accurately grasping your own state, rather than vaguely enduring it.

Vasomotor symptoms can be managed by various methods, and the approach differs depending on individual condition and risk factors. Since one method is not the right answer for everyone, the key is to decide the direction that suits you through consultation.

• Hormone therapy: The North American Menopause Society (NAMS, 2022) organizes that hormone therapy is known as the most effective treatment for vasomotor symptoms and also helps prevent bone loss. However, since benefit and risk differ depending on the age of starting and the time elapsed since menopause, individual evaluation is needed.
• Non-hormone therapy: When hormone treatment is difficult or not wanted, other medications or non-pharmacological methods can be considered (NAMS non-hormone treatment position statement, 2023). Recently, research on a new class of treatment is also reported to be continuing (ACOG conference presentation, 2024).
• Lifestyle management: Quitting smoking, maintaining an appropriate weight, regular physical activity, and controlling caffeine/alcohol can help. Phytoestrogen foods such as soybeans and pomegranate are also mentioned, but in cases with liver function problems and the like, caution is needed in intake.

Whatever the method, specialist consultation comes before self-judgment. If you need a check on the menopausal years overall, you can refer to menopausal screening, and if you are curious about hormone treatment, menopausal hormone care.

In cases like the following, I recommend getting consultation through an examination rather than vaguely enduring it.

• When sleep is frequently disturbed by hot flashes or night sweats
• When symptoms have caused disruption to daily life, work, or mood
• When symptoms persist for several months or more, or gradually worsen
• When metabolic/cardiovascular risk factors such as high blood pressure, diabetes, and dyslipidemia are present together

Vasomotor symptoms are closer to symptoms to "examine and manage" than symptoms to "endure and pass off." Examining the intensity of symptoms and accompanying risk factors together lets you decide the management direction that suits you more clearly. Thinking every day about how to help patients more comfortably and healthily is our work, and today too we try to take one step further.

If symptoms are shaking your daily life, rather than enduring alone, start with an accurate examination.

Written by: Lee Dong-hee Director · Obstetrics and Gynecology Specialist · View medical staff profile

First published January 15, 2024 · Last reviewed May 30, 2026

References: North American Menopause Society (NAMS) 2022 Hormone Therapy Position Statement, North American Menopause Society (NAMS) 2023 Nonhormone Therapy Position Statement, Study of Women's Health Across the Nation (SWAN) (2015), Women's Health Initiative (WHI), American College of Obstetricians and Gynecologists (ACOG) (2024)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through an examination.