Ask Dr. Pat · Menopause

Hot Flashes, Night Sweats and Sleep Disruption Before Menopause

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 50 years old, married and have no children. I still have regular and (usually) heavy menstrual periods. I am overweight but planning to work on this soon. I actually need to lose 40 pounds. I have a wonderful job in a big city, where I am a respected project manager in a stable firm but it is a job where I sit most of the day. I am the primary breadwinner in our family after my husband lost his good job in the 2008 recession and now works ten-hour days making much less money than before. I have worked for my company for fifteen years and would not consider changing jobs. We had to move further away from the city seven years ago and that is when the pounds began to creep on. We moved because our rental became a co-op and we couldn’t buy in. We also needed to be closer to the assisted living facility where my mother-in-law lives. I commute two hours to work, each way, on a bus, getting up at 5 a.m. and on the bus by 6 a.m. I get back on the bus, most of the time by 5:30 or 6:00 p.m. and usually have snacks on the ride home since I am hungry. We have dinner around 9 p.m., often something quick that my husband and I throw together and eat in front to the television, just because we need to chill out. I have a glass of red wine with dinner and maybe a few cookies at 10:30 p.m. and after I fall to sleep quickly. Many nights are totally disrupted from the hot flashes and night sweats. I get up to change clothes, throw cold water on my face and try to fall asleep again. However, once I wake up, I mostly  ruminate about the disaster facing me in the morning when I know I will be exhausted. I need my sleep or I cannot function. On the weekends, I sleep in until 10 a.m. to recover. I also have sweats and hot flashes at work with a telltale red face. Let’s face it, everyone can guess my age and they know that I am having menopausal symptoms. I am anxious with presentations now because I don’t know how to deal with these unpredictable symptoms.

I saw my gynecologist because I am certain that I am close to menopause and wanted hormone therapy to help me control these terrible hot flashes and night sweats that are ruining my sleep, destroying my energy, and interfering with my work life. She told me that I may have a few years to go before I am past menopause and that she did not want to give me hormone therapy at this time since I have regular and heavy periods. I asked her to do blood work for menopause markers. The tests she did showed that I have lots of estrogen. I hated the birth control pill so I didn’t ask for that. She said that she could give me an antidepressant that might help with the hot flashes but didn’t have much else to offer in our brief visit. I don’t want to take that kind of medication. I have always been the kind of person who just puts her shoulder to the grindstone and gets the job done, usually with a good attitude and gratitude. I have a good marriage and good health. But, I am feeling worn down now and it is affecting all areas of my life. What can I do to improve these symptoms, lose the weight, and prepare for that wonderful second half of life that you write about?



Dear Laura,

Your story and questions are so familiar to healthcare providers across the country who have an interest in menopause management. I am sorry that you are one of the thousands of women who have a long commute daily, which is such a stressful grind. But, as in many life transitions, there is little that you can do about the long commute and the stress that it causes. You had to move farther away from the urban area where your work, simply because you had no choice financially and your mother-in-law needed more oversight as well. This is a story that many of us understand.

There are two new primary problems in your life that I will discuss:

1. Management strategies for hot flashes and sweats at night and during the day, along with sleep disruption at night.
2. Forty-pound weight gain during the last seven years due to difficult life circumstances, poor food choices, no exercise and no self care.

This week, let’s focus on the hot flashes, night sweats and sleep disruption with its consequent daytime fatigue along with the management of hot flashes and sweating in the workplace. Your very real vasomotor symptoms (VMS) beginning during the late perimenopause are quite common. Your gynecologist, understandably, does not want to begin systemic hormone therapy at this point since you have high levels of estrogen and have heavy regular menstrual cycles. You can choose, of course, to use low dose systemic hormone therapy, if you have no contraindications to this treatment, as soon as your periods become very far apart and the menstrual flow is no longer heavy or you are one year without a period.

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  • Pamela Yew Schwartz January 17, 2019 at 12:36 pm

    30 years ago yesterday, Dr.
    Allen and I together, gave birth to my daughter, who has grown into this very special and wonderful woman. She has some of Dr. Allen’s characteristics of determination, fortitude and caring. Watching my daughter grow up has been a most profound and life affirming experience.  I want to thank Dr. Allen for bringing my daughter into the world and am most grateful to her for taking care of me these last 30 years.

  • Patricia Yarberry Allen MD January 14, 2019 at 11:13 pm

    Dear ABS,
    Thank you for reading and commenting!! Our goal in 2019 is to encourage the development of a virtual community. Your co-hort is in the sweetspot for our core mission: to inspire women 40 and over to become educated about the perimenopausal-menopausal transition, the options for management that allow each of you to move on and through this transition to make the second half of life your best half! Find friends to join you in comments to our posts so we can hear what interests you and continue to improve our going on 13 year old site!
    Thanks again for the thoughtful post
    Dr Pat

  • ABS January 14, 2019 at 8:52 am

    Dr. Pat, your knowledge coupled with empathy never ceases to amaze me. Thanks to women like you, I think my generation of urban women (mid to late 40’s) who are starting to experience menopause are more open and unguarded with girlfriends about the signs and symptoms. That said, as the writer notes, work situations or any interaction with males still carries some stigma. Thank you for helping share ways in which we can alleviate any negativity with a natural life event.