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.


It’s “hot town, summer in the city” again, and those of us who are urban dwellers face not only increasing temperatures from global warming but the retention of that heat by asphalt and tall buildings. Unless there is a thunderstorm to cool things down, we can only hope that our electric grid doesn’t fail from overuse or union strikes. 

Women who are in the throes of a symptomatic menopause with hot flashes and night sweats are even more affected by the heat and humidity. They have sleep disruption and are exhaused during the day; that makes it even more difficult for them to function in a hot and humid environment.

What could be worse than hot flashes in this heat? Menopause specialists are besieged these days with women who were just barely functioning in early June and now are finally overcome with the high and humid temperatures throughout much of the United States over the last few weeks.

Patients have lost patience. They don’t want to hear about cold water and cold cloths. They tell me that nothing is working to control the hot flashes and sweats; the flushing of the face and chest that lasts now for what seems like hours, when it used to be just a few seconds.

So there is a rush on for medical relief of menopausal symptoms. When the internal temperature button won’t reset properly, women have sleep disruption from these night sweats, daytime fatigue, and the consequences of this cascade: irritability, volatility, fuzzy thinking—and, yes, occasionally, feeling hopeless. It is hard for women who are suffering these symptoms in this weather to integrate the message of “This is just temporary; it will pass. They want relief—now.

But for a decade, doctors and patients have been loath to turn to hormone therapy to end this misery. In July 2002, the National Institutes of Health caused a media firestorm with its premature announcement of the dire consequences of hormone use for all women. The National Heart, Lung, and Blood Institute abruptly stopped a major clinical trial—known as the Women’s Health Initiative (WHI)—of  the risks and benefits of combined estrogen and progestin in healthy menopausal women “due to an increased risk of invasive breast cancer.”

In the years since that study was suspended, however, careful evaluation of the age and health of the women randomly chosen to participate in the trial has convinced many physicians and scientists who are specialists in women’s health and menopause management that the older cohort of the women who made up this study group do not represent the group of women whose quality of life is seriously affected by the hormonal disruptions of menopause.  Many of those who have reviewed the many sub-studies of the WHI trial believe that women who want relief of  their menopausal symptoms are not the women studied in this billion-dollar trial. (Indeed, the NIH’s press release acknowledged, “The study did not address the short-term risks and benefits of hormones for the treatment of menopausal symptoms.”)

Women who have no genetic predispostion to clotting disorders, premature cardiovascular disease,  breast or endometrial cancer, and are symptomatic in the early part of their menopausal transition are now thought to have a safety profile that justifies the choice to use systemic hormone therapy for management of menopausal symptoms. Early onset and short-term use of estrogen and progesterone do seem to increase the safety profile.

So there is hope for women in the menopausal transition who are hot hot hot in the summer and need to improve their temperature-control mechanisms when menopause is the cause and the heat and humidity don’t help!

I believe that doctors should listen to their patients and help them with symptom management and symptom relief. We need to counsel patients about the risk of short-term use and avoid giving these drugs to women at risk of serious side effects. But the public and many doctors act as if low-dose short-term systemic hormone therapy has a risk profile like that of heroin.

 It’s TIME for some balance here, people!

P.S. If you are one of the many women whose doctor has discouraged you from choosing some form of hormone therapy for relief of your symptoms, find a doctor who understands that you need to function for this period of hormonal transition. Gynecologists who have a special interest in menopause can help you choose a low-dose estradiol and progesterone formulation that is approved by the Food & Drug Administration and can help you find the dose and route of delivery that works for you.

 Avoid “anti-aging” doctors who test your saliva for hormone levels and change your hormone dose based on numbers. Use the lowest dose available at first and recognize that the goal of this systemic delivery of hormones is to make life manageable, not to take away all symptoms.

Then enjoy the return of an internal thermostat that works again, and manage the heat wave like everyone else with common sense—lots of water and sports drinks; simple, cool foods; and clothing that moves and is made from natural fabrics. When the time comes to take a break from hormone therapy, time the process of weaning from the hormones so it happens 18 months from now. The cooler weather will make the transition off hormone therapy easier. Some women need treatment longer, but many can manage after brief hormone therapy.

Photo by Liz Kasameyer via Flickr.

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  • Jill July 18, 2012 at 2:05 pm

    Dr Pat could you please explain why using HRT should only make life manageable and not take away all symptoms.It seems that this would not be acceptable in any other endocrine disorder.