Ask Dr. Pat · Menopause

Hot Flashes, Night Sweats and Sleep Disruption Before Menopause

Learn and use paced breathing to enhance your response to hot flashes/flushes and sweats.
Hormone levels affect our body temperature control mechanisms so that our bodies try to cool down by having a hot flush in response to small changes in our bodies and in our surroundings that previously would have gone unnoticed. Stress decreases the threshold for flushing since the adrenal glands begin to produce those “fight or flight” hormones and chemicals in stressful situations. Relaxation and paced breathing can be used to calm down your body’s physical and emotional reactions. Paced breathing is slow, even breathing from your stomach. The diaphragm is located just below the lungs and forms a barrier between the lungs and the stomach. Breathing from the stomach or below the diaphragm increases lung capacity, so that we get more oxygen, and it also has a significant calming effect. If practiced regularly, paced or diaphragmatic breathing can help you relax. You can practice by keeping the chest and shoulders still, pushing the stomach out as you breathe in, and taking slow, deep breaths. Putting one hand on your chest and one hand on your stomach helps as you get used to this way of breathing. The hand on your chest should stay fairly still and the hand on your stomach should rise and fall as you breathe. It might be easier to practice this lying down at first. Once you get used to it, you will be able to use this breathing for a few minutes during the day to reduce stress and to feel calm. Letting your shoulders relax and focusing on your breathing for a few minutes can give you time to pause and think how you want to react in a stressful situation.

Dress for the “transition.”
Wear loose-fitting clothes made of natural, light fabrics, such as cotton, when seasonally appropriate. Continue to dress for all those important meetings with your image in mind. Just add some clothing with lighter layers so it is easier to remove a layer if you have a hot flush.

Avoid hot flash stimulants.
These include coffee, hot drinks, some spicy foods, alcohol, abrupt changes in temperature, and rushing. Allow extra time for travel and the unavoidable challenges of your particular job so that you can avoid rushing. Carry a thermos of ice water and drink small sips before stressful meetings and when you feel a hot flush beginning. Keep a diary of hot flushes and note what is happening just before the flush. By doing this, you might be able to identify your hot flush triggers, and by making small practical changes, you can gain more control over them.

Women with the highest levels of distress in reaction to hot flushes tend to ‘catastrophize’ about the hot flush, i.e. think the worst. They are more self-critical within the situation, especially about their appearance. Notice what goes through your mind when you have a hot flush, so that you can identify your typical thoughts and any overly negative thinking, and write them down. You shared, “I am seriously concerned that I could lose my job if I don’t find some medicine to fix these flushes.” You were always admired for your skills and contacts and ability to fix problems. Now you fear that hot flashes and some sweats will cause you to lose your job. Really? I assume that everyone is aware that you have worked at your company for fifteen years. Your reputation for being competent, optimistic and a problem solver are exactly what your company and clients are looking for.

These menopausal symptoms are manageable. You are now in the second half of life. Make it the best half by changing the way you think so you can change the way you feel. Use this change in hormonal production as a “life-notice” that it is time to begin an exercise routine, learn meditation techniques, refine your eating habits,limit alcohol intake, improve your sleep and continue to work on personal relationships.

Next week’s post will address the second issue in your question to Ask Dr. Pat: Forty-pound weight gain over the last seven years in the menopausal transition due to difficult life circumstances, poor food choices, no exercise and no self care.




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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.