You were told they last a couple of years. It has been eight, or you are sixty-three, or they came back after you stopped treatment. Persistent vasomotor symptoms are more common than the standard framing suggests, and being told they should have finished by now is not a reason to stop asking for treatment.

Where we stand: Menova is an independent publication. We sell no hormones, we are not your doctor, and this is general education, not medical advice.

How long they actually last

The "two years" figure is wrong for most women.

Large studies following women through the transition have found median total duration of vasomotor symptoms measured in years, commonly around seven to ten, with substantial variation. A meaningful proportion have them for longer still, and some into their sixties and seventies.

Two patterns are associated with longer duration:

  • Starting early, in early perimenopause, rather than around the final period
  • Frequent or severe symptoms from the outset

Differences by ethnicity have also been reported, with some groups experiencing longer duration on average — which matters because "it should be over by now" is applied uniformly. See menopause across ethnic groups.

So if yours have run a decade, you are not unusual and nothing has gone wrong.

What to check when they persist

Before assuming it is simply a long transition:

Thyroid disease, which causes sweating and heat intolerance — see perimenopause versus thyroid.

Medication. Several cause flushing or sweating, including some antidepressants, opioids, tamoxifen and aromatase inhibitors — see medications that mimic menopause.

Rosacea, which is frequently mistaken for hot flashes and treated completely differently — see rosacea versus hot flashes.

Alcohol, which is a reliable trigger and easy to underestimate — see alcohol in midlife.

Sleep apnea, if night sweats dominate and you wake unrefreshed — see sleep apnea after menopause.

Anxiety, which produces sweating and palpitations that overlap closely.

Rarely, other causes. Persistent flushing with diarrhoea, wheeze or weight loss, or drenching night sweats with fever and swollen glands, need proper assessment rather than attribution to menopause — see night sweats in perimenopause.

If they returned after stopping HRT

Common, and worth understanding.

Hormone therapy treats symptoms; it does not shorten the underlying transition. Stopping reveals whatever is still there — which is why symptoms often return, sometimes strongly in the first weeks.

That rebound is not proof you will have them forever. A gradual taper over months rather than an abrupt stop gives a clearer picture of what is genuinely left. If symptoms return and remain disruptive, restarting is a legitimate option to discuss — there is no rule that says you get one attempt. See how long you can stay on HRT.

The age question

Two separate things get confused, and the confusion costs women treatment.

Starting systemic hormone therapy for the first time over 60, or more than ten years after menopause, shifts the risk-benefit balance and needs a considered discussion.

Continuing it past 60 is a different question. There is no arbitrary age or duration limit in current guidance — continuation is reviewed annually on your own balance of risks and benefits.

If you were told to stop simply because you reached an age or a number of years, that is worth questioning — see HRT in your 60s and beyond and what to do if your doctor says no.

What is available if hormones are not

The options have improved, and most women with long-running symptoms have never been offered them.

Non-hormonal prescription medication, including a class developed specifically for vasomotor symptoms, alongside older options used off-label — see non-hormonal prescription options.

CBT, which appears in guidance and reduces how bothersome symptoms are — see CBT for menopause.

Clinical hypnosis, which has trial evidence including in breast cancer survivors — see hypnotherapy for hot flashes.

Trigger management, which is not trivial when symptoms are frequent — alcohol, caffeine, heat, spicy food; see hot flash triggers and relief and getting through summer.

After breast cancer, several of these are the mainstay — see menopause after breast cancer.

Why it is worth treating rather than enduring

The argument that persistent symptoms are merely uncomfortable does not hold up well.

  • Sleep. Years of fragmented sleep affects mood, cognition, blood pressure and glucose handling — see perimenopause sleep problems
  • There is an association between frequent or persistent vasomotor symptoms and markers of cardiovascular risk. It is an association rather than established cause, and it is a reason to treat severe symptoms as a prompt for a cardiovascular check rather than as cosmetic — see hot flashes and heart health
  • Quality of life, over a decade, is not a small thing to dismiss

Bring numbers

The most common reason long-running symptoms get dismissed is that they are described vaguely by someone who has stopped expecting to be taken seriously.

"I'm 61. I still get fourteen hot flashes a day and wake three times a night, and I've had them for eleven years. I've never been offered anything except being told they'd pass. I'd like to discuss treatment — hormonal or non-hormonal — and I'd like my thyroid checked and my medications reviewed."

That is a different consultation from "I still get flushes sometimes."

Our free 30-day symptom tracker produces the count, and the free printable visit prep sheet turns it into one page. See not being dismissed.

And the thing that does not resolve on its own

Worth repeating here because it is the symptom most often left untreated in this group: vaginal dryness, urinary urgency and recurrent infections do not settle with time the way hot flashes eventually do. They progress.

Local vaginal estrogen has no age limit and is appropriate for many women who cannot take systemic hormones — see how to use vaginal estrogen and GSM and urinary changes.

The free 2-minute Menova self-check organizes your wider symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice. Persistent flushing with other systemic symptoms, or night sweats with fever or weight loss, requires medical assessment. Treatment decisions belong with a licensed clinician.

Sources: The Menopause Society, NICE NG23 — Menopause, ACOG — The Menopause Years, and National Institute on Aging — Menopause.