Hot flashes and night sweats: a cardiovascular signal of menopause

What you’ll learn: 

• How vasomotor symptoms relate to arterial and endothelial health 
• Why the timing of hot flashes matters for cardiovascular risk 
• Which cardiometabolic risk factors often cluster with VMS 
• Which supplements are best for VMS 

Why do women get hot flashes?

For decades, hot flashes and night sweats (collectively known as vasomotor symptoms) were dismissed as temporary quality-of-life inconveniences. However, modern cardiovascular research tells a different story. Far from being isolated, hormonal symptoms, severe VMS are increasingly recognized as signals of underlying vascular dysfunction. 

Large population studies now show that women who experience severe or early-onset hot flashes are more likely to exhibit changes in arterial health, including endothelial dysfunction and subclinical atherosclerosis. In other words, the symptoms you feel on the surface may reflect changes occurring deep within your blood vessels. 

Understanding this connection allows women to reframe VMS not as something to “push through,” but as an opportunity to assess and protect long-term heart health.

Are hot flashes linked to arterial health?  

Yes. Multiple large observational studies, including the landmark Study of Women's Health Across the Nation (SWAN), have demonstrated a clear association between vasomotor symptoms and vascular health. 

Women who report severe hot flashes have been shown to: 

• Have elevated plaque buildup
• Have impaired endothelial function (which reduces healthy blood flow) 
• Show greater arterial stiffness compared to women without severe VMS 

These findings suggest that VMS are not merely driven by temperature dysregulation alone, but are linked to changes in vascular tone, nitric oxide signaling, and oxidative stress. Hot flashes may reflect reduced flexibility and responsiveness of the blood vessels themselves. 

Why does the timing of hot flashes matter? 

Not all vasomotor symptoms carry the same cardiovascular implications. Research indicates that when hot flashes begin is just as important as how severe they are. 

Women who experience early-onset VMS (beginning in the late reproductive years or early perimenopause) appear to have a stronger association with subclinical atherosclerosis than women whose symptoms begin later in the menopause transition. 

Early-onset symptoms may signal: 

• Earlier loss of estrogen-mediated vascular protection 
• Greater sensitivity to oxidative stress 
• Accelerated endothelial dysfunction 

This helps explain why some women develop cardiovascular disease earlier than expected, even in the absence of traditional risk factors.

What other heart risks are associated with VMS?  

Vasomotor symptoms rarely occur in isolation. Instead, they often cluster with an adverse cardiometabolic profile that further increases cardiovascular risk. 

A recent review by Carson and colleagues highlights that women with frequent hot flashes or night sweats are more likely to have: 

• Higher blood pressure, reflecting loss of estrogen-mediated vasodilation 
• Central (abdominal) adiposity, which promotes inflammation and oxidative stress 
• Insulin resistance, impairing glucose regulation 
• Unfavorable lipid profiles, including higher LDL and triglycerides 

Importantly, many of these changes emerge during perimenopause, well before overt cardiovascular disease develops. This reinforces the idea that VMS may serve as an early warning sign, highlighting the need for proactive cardiovascular assessment rather than symptom suppression alone. 

Which supplements are best for VMS? 

While hormonal replacement therapy is often the gold-standard treatment for menopause-related symptoms, many women seek alternative therapies. There are a number of supplements, including more mild phytoestrogens, that can help alleviate some VMS. 

• S-Equol: 10mg per day. An effective phytoestrogen that is more bioavailable than standard soy isoflavones. S-Equol has been shown to improve hot flashes, insomnia, and metabolic parameters in women going through menopause. 
• Shatavari: 50-200mg per day. Shatavari is an ayurvedic herb that helps to balance hormones and reduce symptoms like mood changes, sleep, hot flashes, and reduced libido. 
• Black Cohosh: 20-40mg day: Black Cohosh helps to modulate thermoregulation, making it a good alternative for women who wish to avoid estrogenic compounds. Helps to reduce hot flashes and general menopause symptoms scores. 

Why VMS should prompt a heart health check  

Hot flashes are more than a menopause nuisance; they are a window into vascular health. Frequent or early-onset vasomotor symptoms have been linked to arterial stiffness, endothelial dysfunction, and cardiometabolic risk factors that predict future heart disease. 

If you are experiencing persistent VMS, this is an important time to monitor cardiovascular biomarkers such as blood pressure, lipid levels, glucose regulation, and inflammatory markers. Addressing vascular and mitochondrial health early, through lifestyle strategies and targeted nutritional support, may help manage symptoms while also protecting long-term heart health. 

Learn more about menopause and heart health here.