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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,




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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  • Petra Taylor August 9, 2016 at 11:02 am

    I feel as if I am in good company here with the other women who are experiencing hot flashes. Mine started like clockwork just as I was turning 50 years old, 4 years ago. Each one starts with a feeling of chest “heaviness” that lasts about 5 seconds, proceeding to a wave of heat that envelops my body from head to toe. After approximately 2-3 minutes of this heat, during which time I have broken into a sweat, it slowly dissipates and then I get chilled. My hot flashes are definitely worse at night, disrupting my sleep frequently, and as I am already a light sleeper, I have a lot of trouble getting back to sleep, often lying awake for hours as hot flash after hot flash comes at me in waves for about 2 hours every night. I have tried the mindful breathing, which does help when I have the discipline to do it. I also spoil myself and take half a zopiclone every 3 nights just to have a better sleep, as it helps me to go back to sleep between the 2 hours of non-stop hot flashes. Ughhhh…..I too wonder when it will end….it’s been 4 years now of non-stop hot flashes. Weight gain is also a struggle, but I am very active and have the luxury of being retired so I can usually have a small nap in the afternoon to catch up a bit on my sleep. I think I need to be more disciplined with the meditative breathing. I am unable to take hormone therapy as I have a history of DVT’s. Anyways, that’s my story.

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  • jackie sinclair May 8, 2016 at 11:24 pm

    your page has been most helpful i’m 64yrs.old and finally decided and determine to stop taking premarin after being on it 15yrs.Ihave been off of it since feb 21,2016.life has been hard ever since,the hotflashes have taken over 24-7!!

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  • Rose April 21, 2013 at 2:06 am

    I had to laugh at the initial question. I’m 48 and last November I had an ovary removed and also an ablation …since then, the changes in my body are just outright wrong! Prior to this year, I would look forward to winter just so I can wear my flannels and comfy warm jammies. This year? Lo’ and behold, if I could, I would open the windows (winter), turn off the heater and be happy as a clam!! If you knew me, you’d know anything under 75 degrees is cold!
    My husband asked me to describe it so here it goes: First you are wakened from a deep sleep with a sense of sheesh, what’s going on?. Then you start feeling the heat, first your chest. God forbids you’re wearing a bra at that moment! Then your neck and hair: in my case, my hair curls up when it gets wet, so guess what? I go to sleep with straight hair and wake up with a bunch of curls! Then, here it goes, the moment I dread: it feels like a bag of popcorn must feel inside a microwave during the popping part!! That is the only way I can describe it. Off come the covers, the socks, and then bamm! you freezing again and if you’re lucky, you go to sleep again, exhausted!
    I mean, you kidding me? my mama did not warn me about this!
    With a smile on my face, I hope this brings humor to a not so humorous situation!

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  • Betty May 19, 2012 at 12:35 pm

    Pat, Thank you for your advice regarding my going off HRT at 65 and then having heart palpitations return. I had my doc do what you recommend: EKG and thyroid panel — normal. I wore an “episode” heart monitor for two weeks, and like when you take your car to the mechanic, no palpitations. She concluded that my heart’s okay. Since the monitor, I’ve had a couple of palpitations, quick, not scary like the one I wrote you about. I am having hot flashes, but they’re not as severe as before I went on HRT. Again, I so appreciate your quick and caring response! Betty

    Betty

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  • Kim May 12, 2012 at 6:03 am

    I have been having hotflashes for the past year and they seem to be getting worse instead of better. When I get one, I don’t just get hot and sweaty, my head and body feel terrible on the inside..my head gets this squeezing pressure that makes me feel like I am being pushed down into the ground. My nights are very disruptive causing lots of sleep loss and therefore my days are worthless as well. Before all of this I was very active, doing powerwalks, aerobics, some jogging, weightworking but now I am just a lump on a log sitting inside with no energy. I started using vitamine B12 recommended for energy but I got so wound up inside that I couldn’t sleep from that either. Now I am using Famosan from Dr. Vogel and that seems to reduce the number of hotflashes but even so they do increase at night. Sometimes, when I get a hotflash and all the squeesing pressure in my head occurs, I feel like just putting a gun to my head to end it all because I don’t think I can take anymore of it.

    Reply
  • Dr Pat Allen April 16, 2012 at 12:12 pm

    Dear Betty,

    Have your GP do a thyroid blood panel and an EKG, the in-office heart rhythm strip. If that is normal, see a cardiologist and have an evaluation. The cardiologist may order an echo-cardiogram to see if there is prolapse of the mitral valve in the heart which is often associated with palpitations or irregular heart rhythms. In addition a 24 hour holter monitor for continuous monitoring of the heart rate can be done.
    Do let us know the results.
    At your age (over 60), you certainly have more risk than reward in the continued use of systemic hormone therapy.

    Best,

    Dr. Pat

    Reply
  • Betty April 16, 2012 at 9:49 am

    When heart palpitations happen, how do you know if they are menopause-related or a-fib? I’m over 60 and recently stopped HRT (low dose patch) — and my heart rhythm has been going out once or twice a day, as it did when menopause started at 51.

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  • Alie November 2, 2011 at 1:40 pm

    Thank you for that informative article, it has made the most sense to me out of all the articles I have read on the subject. It makes sense to work with our bodies in addressing this issue. Wonderful advise!

    Alie. Edmonton, Alberta.

    Reply
  • Chris Lombardi April 14, 2010 at 2:15 pm

    Elizabeth J. Coleman, President of Professional Stress Management Solutions, Limited (www.prostressmgmt.com), wrote to us a week after Dr. Allen published this, and Dr. Allen believes it can be invaluable to WVFC readers. We thank Dr. Coleman for the observations:

    Dr. Pat is right on in her suggestions. I would like particularly to second the use of breathing exercises to deal with the physical symptoms and resulting stress of menopause. According to WebMD, James Carmody, PhD, of the University of Massachusetts Medical School, says the results of a small study suggest mindfulness-based stress-reduction programs that include meditation may help women manage menopausal symptoms. And that makes sense if you think about it. There are an increasing number of studies showing the beneficial effect of mindful meditation on symptoms of illness and on our reaction to stressful circumstances. One definition of stress is wanting things to be different than they are, and hot flashes are a good example. They can be extremely unpleasant and disruptive but a woman may find that if she doesn’t fight the symptoms (not try to alleviate the condition but fight them), she feels a little better. And mindfulness, which is the intentional regulation of our attention, such as in meditation, allows us to be present to what’s going on, to be with it. By breathing with the experience rather than combating it, you might observe that it ebbs and flows a little more than you thought. Mindful breathing can help you remember that there’s more right with you than wrong with you, and may let you observe the situation a little bit dispassionately just for a moment. One tip: when you’re doing the breathing exercises Dr. Pat recommends, if your mind wanders back to the unpleasantness of the hot flashes (or to anything else), gently but firmly bring it back to your breath. You might slowly try increasing the time you do the exercise to five minutes as well, and see if that is helpful.

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  • Tara Dillard March 9, 2010 at 7:29 am

    Terrible attitude into the future, “Each generation of women…”

    Ha. If men had menopausal symptoms it would be 1 generation to solution. Maybe less. Could they handle a full month?

    Garden & Be Well, XO Tara Dillard

    Reply
  • Anita March 5, 2010 at 6:29 pm

    One more thing…if you have hot flashes at night…sometimes called night sweats, try wicking pajamas. They help to keep you cool and dry at night.

    Reply
  • abbe weinerman-kalfus March 5, 2010 at 1:32 pm

    Dr. Pat gives some excellent recommendations when struggling with menopausal symptoms. For the past year, I have been suffering with all the symptoms stated in the article. I vacillated for months as to whether I should get drug support. When I just could not bear it anymore, I begged my doctor to prescribe SOMETHING to help me get through this. My doctor finally gave me the prescription for the patch. She clearly and emphatically recited all the risks involved. Once I had the prescription in my hands, I further explored the hormone route as the risks really concerned me. I decided to wait it out a little longer. I informed my doctor that I was on the fence. My doctor told me to stay on the fence for as long as needed. This was about six weeks ago. While we all know that everyone’s journey with menopause is unique, I am happy to report that my flashes have basically diminished. Is this temporary? Am I done? Probably not, but I am glad that I made the decision not to go on hormones. That option is always there for me. Patience does go a long way.

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