Dear Dr. Pat,




Fried_egg_sunny_side_up

Feeling the sizzle



I just read Michelle Slatalla’s New York Times column about her menopause and hot flashes, and felt that I was reading about myself. I’m also 48 years old, and the nightly hot flashes and sweats are driving me crazy. Like her, I end up kicking the covers off, jumping out of bed to throw the windows open, and fanning myself desperately. Then my skin turns clammy and I’m freezing. I run back to bed and grab the covers. (My husband complains like hers, too.)

What’s going on? My body and I have always been friends. Why is it turning against me like this? How long will it last? What can I do?

Roberta

Dear Roberta,

I hear you. No one wants their sleep interrupted night after night by hot flashes and night sweats. Or the daytime exhaustion, memory loss, and mood changes that go with it, all of it caused by significant temperature disruption.

What you need is an action plan. Or I should say, a ‘less action’ plan.

For starters, it’s best not to think of hot flashes in terms of ‘action verbs:’ kick, jump, throw, fan desperately, fly or grab. That kind of thinking stimulates your adrenal glands to produce massive fight-or-flight chemicals that add fuel to the fire:  palpitations, more anxiety, agitation, and recurrent hot flashes.

Here’s what I suggest:

  • Before you get into bed, put a thermos of ice water on your bedside table, along with a small glass and a bowl with a dry washcloth in it.  You’ll use them each time you have a hot flash.
  • Create a quiet time before you go to sleep each night.  Acknowledge that you’ll have hot flashes but remind yourself that you have a plan to address each episode in a calm way. Be positive about your ability to return to sleep. Then do two minutes of breathing exercises before going to sleep.  Remember to use this simple meditation each time you’re wakened by a temperature surge.
  • When you have a hot flash, don’t throw the covers off. Just breathe in a meditative fashion, sit up in bed, and pour a small amount of ice water into the glass and onto the washcloth in the bowl.  Place the cool cloth on the back of your neck, drink one ounce of ice water, and do the meditative breathing for two minutes.  Your body temperature will decrease and you know that you’ll return to sleep.

Here’s the thing: If you’re convinced that you’ll be tortured by hot flashes and temperature disruptions, then you certainly will be.  But if you’re disciplined about taking the steps I’ve described, you’ll have non-medical tools to diminish the impact of the hot flashes.

“The neurobiology of hot flashes is not completely understood,” says Gyatri Devi, clinical associate professor of neurology at NYU’s School of Medicine. “But it surely arises from an errant hypothalamus—our brain’s thermostat.” Hormonal changes affect the normal ability of this temperature regulator. We do know that there is a circadian rhythm tied to the increase in hot flashes at night, but we do not yet know why.  In other words, hot flashes are often much worse at night. Drugs that modify the sympathetic activity from the hypothalamus may have some benefit.  Obviously, hormone therapy works to prevent this problem.

No one can tell you how long the hot flashes will continue.  It is not uncommon to have hot flashes for several years before the last menstrual period, the time of medical menopause, then for a few years after this.

Roberta, menopause is a universal experience, but it’s one that each woman experiences uniquely.  Some women find they cannot function without drug support during this time.  Others are able to manage their symptoms through non-medical means. It’s important to find both a doctor who is interested in menopause and information from other sources that may be helpful.

Each generation of women has to find its way anew in terms of how it will cope with the menopausal transition.  I suggest that you look for mentors and role models who are a decade or so older and ask them what worked.  Seek out women who are functioning well, and find what works for you.

Dr. Patricia Yarberry Allen, director of the New York Menopause Center, is publisher of Women’s Voices for Change.


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