Ask Dr. Pat · Health · Menopause

Ask Dr. Pat: In Her 40s: Menopausal Symptoms After an Endometrial Ablation

Dear Rose,

It was time for a checkup! You mentioned that you had a D&C and an ablation along with the removal of an ovary at 47 for a benign ovarian cyst and very heavy bleeding. Once the pathologist provides reassurance that the heavy bleeding was not caused by abnormal tissue removed during the D&C and no other growths are found in the endometrial cavity, an ablation was a good option to consider for the control of very heavy bleeding in the menopausal transition. Thousands of women had hysterectomies for uncontrollable heavy bleeding every year prior to the development of endometrial ablation techniques.

Women often have no bleeding at all after an ablation, causing confusion for them when they try to determine if or when they are in menopause. Your gynecologist did the right things by evaluating your total health with appropriate screening tests for your history of previous cysts and an ablation. She also did the right thing by doing blood tests for thyroid, estrogen, and the pituitary hormones that stimulate the ovaries to produce estrogen and progesterone. Since the estrogen level from your blood test was still normal, then non-hormonal management for your most significant symptom, hot flashes and sweats that are worse at night, would be a better choice for now.

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 may follow these sleepless nights and most of this caused by significant temperature disruption.

What you need first is an action plan, or more precisely 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.

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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 wet washcloth in it. You’ll use these 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 meditative breathing exercises before going to sleep. Remember to use this simple meditation exercise 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 can focus on returning to sleep calmly.

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.

Next Page: Intervention for management of menopausal symptoms

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  • Patricia Yarberry Allen, M.D. June 20, 2016 at 10:11 pm


    Thanks so much for reading and joining in the conversation. Sorry that you have been avoiding the medical community, but I do urge you to keep preventive care on your to do list.

    Dr. Pat

  • Mickey June 20, 2016 at 3:24 pm

    Thank you so much, Dr. Pat. Non-medical, non-drug intervention. Excellent. I’m so past menopause. However, here’s the individual thing. I think I’m still have occasional hot flashes. Not serious sweating ones, but I don’t know. And I don’t have a primary care physician much less a gynecologist. Avoiding the medical community with all my strength. Sorry. Just can’t figure out how to meet the right ones here in Tucson. My favorite doctor retired years ago. Empathy and knowledge is what I seek but since I’m on Medicare, it’s a roll of the dice. Now I need cataract surgery and the medical cost is keeping me from scheduling it. I need new tires first! ha, ha. Thanks again. Too much coffee. How I do run on. We thank you again and again for your excellent words.