Crisis Management of Hot Flashes and Flushes Without Hormone Therapy

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 have a big job in PR and crisis management. There is constant chaos and the clients always have to be happy or we lose the accounts. I am 47 years old and have been in this industry with great success since I graduated from college. I have always been an optimistic woman who is known for efficient problem solving, client management, and great contacts. I now have a problem that I can’t solve and hope you can help. I am going through what I understand is peri-menopause. My periods are infrequent and I have unpredictable hot flashes. I feel the heat coming on, my face gets red, I start to sweat, my heart begins to race, and I lose my train of thought. I know that everyone can see me hot, red, sweating and not functioning well. I can’t take hormones because I had a blood clot with a pregnancy due to a genetic risk for blood clots. My daughter is off to college and doing well and my husband and I have been good at equal contributions to our home/work life.

I have already tried non-hormonal medications including three different antidepressants that are touted as being effective for hot flashes. They did nothing to control my flushing and sweating but did make me feel emotionally flat and tired. I took a blood pressure medication, Clonidine, that didn’t help. I have tried botanicals and soy, acupuncture, and herbs from an alternative health practitioner. Since I work in the “image is everything” business, I have to look cool, unflappable, and constantly competent. I certainly don’t fit this image now. I am seriously concerned that I could lose my job if I don’t find some medicine to fix these flushes. What else is available?



Dear Sandy,

Hot flashes are the most frequent symptom of menopause and peri-menopause. More than two-thirds of North American women who are heading into menopause have hot flashes. Estrogen is the most effective treatment for hot flashes but this drug is contraindicated in women like you who have had a blood clot and a genetic risk for more blood clots.

Many women want to understand what a hot flash is and why it occurs. Scientists and physicians continue to work on refining the answers to these common questions; but currently we can describe your collection of symptoms as vasomotor symptoms (VMS), the most common symptom of the menopausal transition. Common terms that describe VMS are hot flashes/flushes and night sweats.

A hot flash is a quick feeling of heat and sometimes a red, flushed face and sweating. The exact cause of hot flashes is not known, but they may be related to changes in circulation. Hot flashes happen when the blood vessels near the skin’s surface dilate to cool, making you break out in a sweat. Some women have a rapid heart rate or chills. Hot flashes with sweating can also happen at night. These are called night sweats and may make it harder to sleep.

A hot flush is a hot flash plus redness in the face and neck.

Women have sought treatment for vasomotor symptoms associated with menopause for decades. Research has yet to find the causes of VMS but there is active investigation into the biological processes involved in hormone-dependent temperature regulation. We do know that changes in ovarian hormone levels during menopause have an impact on multiple components involved in temperature regulation including neurotransmitters (brain chemicals) implicated in this thermoregulatory dysfunction.

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