We're Calling BS on Medical Language: Why ALL Vasomotor Symptoms are Serious with Dr. Aoife O'Sullivan

Dr. O'Sullivan broke down what actually happens during a hot flash in a way any 10 year old male would understand, and we can't stop thinking about it. Picture your brain like a spaceship docking station from Star Wars—those estrogen receptors are the ports where estrogen needs to dock. When everything's working properly, estrogen slides right in and keeps your temperature regulation smooth as silk.

But when we lose estrogen during menopause? Those ports are left empty, and the KNDy neurons (yes, that's actually what they're called) in your hypothalamus go absolutely berserk. Even the slightest change in temperature or activation of your sympathetic nervous system—like anxiety—sends these neurons into overdrive. They think you've walked into a sauna and desperately try to cool you down. This isn't happening just to our skin, people. This is our brain malfunctioning because it doesn't have what it needs to do its job.

Hold the genitalia jokes...ED can be a sign of something serious, and so are vasomotor symptoms.  Dr. O'Sullivan compared vasomotor symptoms to erectile dysfunction in men—when a man comes in with ED, doctors immediately start thinking about his cardiovascular health because what's happening in one area of the body often signals what's happening elsewhere.

The same is true for hot flashes. Research shows that women experiencing vasomotor symptoms have a "70% or more increased risk of cardiovascular disease compared to women who don't have hot flashes." We're talking about heart attacks and strokes, not just "a little discomfort."

Still confused? Think about an older home...If there is rot in middle of the house, there is likely rot in the walls, the attic, and the basement. Now think of your body like that house (I am not saying that we are old...). Symptoms in one area of the body are rarely contained to that area. Vasomotor symptoms are a sign that our bodies are malfunctioning. Attention must be paid.

This data blew my mind and then promptly frustrated the heck out of me because it isn't new, AND no one talks about it! When researchers do MRI scans on women who are having hot flashes, they find white matter hyperintensities—the same brain changes you see when someone has had a stroke. In case anyone else wants to be ticked off, this research is from 2016.

Dr. Rebecca Thurston et al's., groundbreaking research showed that more physiologically-monitored hot flashes during sleep were associated with greater white matter hyperintensity burden among midlife women free of clinical cardiovascular disease. Subsequent larger studies found that for every additional night sweat, there was approximately a 6% increase in the amount of white matter hyperintensities in the brain. You scared yet? Same girl, same.

The moral of the research: the more hot flashes and night sweats we have have, and the more severe they are, the more of these brain lesions that develop. These aren't just random spots—white matter hyperintensities are linked to later stroke, cognitive decline, dementia, and mortality.

Now, I am not a healthcare practitioner, and I don't even play one on TV. There is some pretty complex information in this article, that was shared by a HIGHLY qualified HCP, and every individual deserves to know the risks. If there is an objection to a lay person sharing this level of data (which is publically available, btw), I suggest more doctors learn and share this life changing information!

One of the most important takeaways from our talk with Dr. Aoife was about the dangerous language used in medical literature. Everything is couched in terms like "if you're having bothersome hot flashes" or "moderate to severe hot flashes." What is 'bothersome or moderate' to me could be next to nothing for you and vice versa. These words don't come with a map that quantifies the experience.

Here's the real kick in the pants: when researchers put sensors on women's bodies, they discover we're missing 40% of the hot flashes we're actually having. What the ever living heck (stronger language deserved)? We don't even know we're having them all? So when we do report symptoms, we're already massively underreporting.

And maybe you have a different lived experience, but I've never known a woman to say something is moderate to severe? We downplay everything and keep going until things are very, very bad before we ask for help. This language creates the conditions for unnecessary suffering.

The good news? We have options. Hormone replacement therapy remains the gold standard for vasomotor symptoms because we're treating the root cause—the loss of estrogen. Current evidence supports cardiovascular benefit for hormone therapy initiated early among women with premature or surgical menopause and within 10 years of menopause in women with natural menopause.

Don't be snowed by claims of bioidentical hormones...It's marketing, plain and simple. The estradiol patch and micronized progesterone you get from your corner pharmacy are "bioidentical" too. Don't believe me? Here's what the Mayo Clinic has to say! 

For women who can't or don't want to take hormones, but still need to get rid of VMS, there are other FDA-approved options, many of which are generic and lower cost (copay card linked to Veozah):

• SSRIs and other antidepressants (often at lower doses than used for depression)
• Gabapentin
• Oxybutynin
• Fezolinetant (Veozah)—a newer medication that works directly on those KNDy neurons

It's high time we stop minimizing our experiences. Stop accepting "moderate to severe" as a threshold for care. Every vasomotor symptom is telling us something important about our health.

Therapeutic prevention isn't about vanity or comfort—this is about reducing our risks of heart disease, stroke, and cognitive decline. When we advocate for treatment for our hot flashes and night sweats, we're advocating for our brains, our hearts, and our healthspans.

We deserve informed care. We deserve appropriately educated healthcare professionals who don't minimize dangerous symptoms. We deserve to live full, healthy vibrant lives. Demanding complete information isn't disrespectful—it's our right and it's critically necessary.

What would change if we stopped apologizing for taking up space and started demanding the care we deserved?

Ready to take control of your menopause journey? The Fuchsia Tent is here to help. Whether you seek free evidence-based resources, expert-led 1:1 coaching, or supportive community , we've got you covered!