Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I am 46 years old and have missed 4 menstrual periods this last year. In fact, I have had no period for the last two months. My periods were lighter and shorter as well all last year. I just lost my job and have a few months of severance and no debt. Almost my entire retirement fund was tied up in the company stock that I was given. I worked in the financial sector as an administrator for the tech services section in the same job for 19 years. I am a college graduate and have a strong network of work and college friends.  Many of my friends have been downsized or have lost their jobs as well.

I am suffering from severe hot flashes and night sweats. I don’t sleep at all. I used to have enormous energy but now I have terrible fatigue. I have never been depressed or anxious in my life. I saw my regular doctor who checked me carefully for all the causes of fatigue and I was told that I am really healthy and that I have nothing wrong with my thyroid.

I then saw my gynecologist to see if my symptoms could be related to hormonal change. She said that I wasn’t in menopause and that if I began hormone therapy now, it would cause abnormal bleeding. There are no illnesses or cancer in my family until people are really old. My most recent mammogram was a few months ago and it was normal.

I have never had any gynecologic problems. What can you tell me about women like me who have symptoms that are described as classic for menopause but these women have not gone for a year without a period? Is it possible for me to use hormones before I have had a year with no periods? I have to be in good shape to reinvent myself and look for jobs. I can’t be anxious about having hot flashes and turning red in the face and dripping with sweat. This is not a time for me to just suffer through it.

Bonnie

Dear Bonnie,

I believe that each woman experiences the symptoms of hormonal change in her unique way. Doctors have an opportunity to listen carefully to each woman’s narrative. Your symptoms of hot flashes, night sweats and flushed face with sweating during the day, sleep disruption and fatigue could certainly be explained by hormonal change of the menopausal transition. Often, these episodes come and go, along with the temporary disappearance and return of menstrual cycles as an expected part of the menopausal transition.  According to carefully considered language from the Stages of Reproductive Aging Workshop (STRAW), perimenopause is divided into 2 phases, based on the change in menstrual cycles. You fall between the early and late perimenopausal stage based on your menstrual cycle change. I do suspect that your symptoms are worsened by your appropriate anxiety about our real economic crisis with its destruction of job opportunities and savings

If you feel that your symptoms require a trial of hormone therapy, I suggest that you use the lowest transdermal estradiol patch and a daily oral dose of natural progesterone. Your gynecologist is right that you may have unexpected abnormal bleeding and you will require close monitoring. You should know within a few weeks if this treatment is working for you. If you find that your temperature disruption improves, along with sleep and energy, then you have a reason to use hormone therapy for this period of time. I do suggest that you find a therapist, a network of professional women who are like you, or a life coach to help you address your anxiety and come up with a plan to deal with each of the issues that are making your life difficult.

Short term therapy can help you look at your strengths and the real difficulties you face in a realistic and focused manner. You may find that the use of meditative techniques are effective when you feel periods of panic. Support from a network of your peers and working with a certified life coach may help you review your resume in a more creative way. Many people in this time of economic uncertainty may choose to acquire training and certification in a new professional arena. Review your strengths and passions. Imagine how and where you might like to live. Very little ties you to Wall Street now, so embrace the freedom that this change gives you.

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  • Angie September 19, 2009 at 6:24 pm

    I have just had a full hystorectomy and I am in my fifth week of recovery. I have been looking at bio-indentical hormones rather than HRT. I want to get my body back on track as soon as possible and a s naturally as possible.
    I am fit and active and try to eat well. I am 45 years old. What do you think I should do.
    At the moment I feel like I have gain wieght, my hair is dry and horrible, my face has broken out in spots and a very sore rash. I look and feel a wreck.
    Angie.

    Reply
  • Nancy November 18, 2008 at 6:32 pm

    I am 52 and have not had a period for 3 months. I was told I should take some hormones (pill) to bring on my period as the tissue could build up in me and may become cancerous or cause me to have a heavy period. I don’t want to take hormones. I feel fine otherwise. Anyone else heard of this? Is there anything else I can do to bring on my period> My hormone level was tested and indicates I am not in menopause.

    Reply