Ask Dr. Pat · Health · Menopause

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

An intervention for management of menopausal symptoms based on cognitive behavioral therapy (CBT) has been studied over the last decade and we are now getting information about how this can be used for patients in the real world. CBT is short-term treatment that teaches clients specific skills. This form of therapy focuses on the ways that a person’s thoughts (cognition), emotions, and behaviors are connected and affect one another. In this form of therapy, the therapist helps the client discover that she is capable of choosing positive thoughts and behaviors. Since this therapy is short term, the clients actively participate in and out of sessions. Homework assignments often are included in this therapy, for the skills that are taught in these therapies require practice. Treatment is goal-oriented to resolve present-day problems. Therapy involves working step by step to achieve goals.

No one can tell you how long the hot flashes will continue. It is not uncommon to have hot flashes for several years before the last menstrual period, the time of medical menopause, then for a few years after this.

RELATED: Age at Menopause and Depression

Rose, if all of these methods do not help you to manage your temperature disturbance enough to function well, than return to your gynecologist in three months and ask for a pelvic exam. If the genital tissue is pale and thin, then you don’t need another blood test.  This is a clinical sign of prolonged low estrogen.   If you are told that your clinical findings are consistent with your other menopausal symptoms and if your quality of life is poor, you may want to discuss with your doctor the use of a very low estrogen patch, estradiol 0.014 mg, along with progesterone 100 mg taken by mouth at night. This is a good dose of hormone therapy to begin with since your estrogen levels may still be rising and falling, but you may have no progesterone produced due to loss of ovulation. This combination of low-dose hormone therapy and the other suggestions discussed in my response to your question are very likely to allow you to manage your symptoms. If your doctor and you decide that you will begin hormone therapy, than you should re-evaluate its use at regular intervals.

The longer we are away from the impressive Women’s Health Initiative that ended in July 2002, causing most doctors to stop prescribing hormone replacement therapy and most women to abruptly stop hormone treatment, the more we realize that the right treatment plan for women in the menopausal transition needs to be an individual one. Women without symptoms should not be given hormone therapy to prevent something. Women with symptoms should have the option for hormone therapy if there are no medical contraindications to its use.

Rose, menopause is a universal experience, but it’s one that each woman experiences uniquely.  Some women find they cannot function without drug support during this time. Others are able to manage their symptoms through non-medical means. It’s important to find both a doctor who is interested in menopause and to look for information from other sources that may be helpful. I suggest that you look for mentors and role models who are a decade or so older and ask them what worked. Seek out women who are functioning well, and find out what choices they made.  Our community here at  is here to provide information and support as well.

Dr. Pat

RELATED: Ask Dr. Pat: Is It “Just Menopause?”
Eleanor Mann, Melanie J. Smith, Jennifer Hellier, Janet A. Balabanovic, Hisham Hamed, Elizabeth A Grunfeld, and Myra S Hunter. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol: 2012 Mar, 13(3): 309-318.
MGH Center for Women’s Mental Health. Managing Sleep Problems in Menopausal Women: What Are the Options? (MENOS 2). Menopausal Symptoms, Sleep Disorders.
Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society Vol. 22, No. 11.
Writing Group for the Women’s Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA, July 17, 2002, Vol. 288, No. 3.
Quentin Regestein, Joan Friebely, Isaac Schiff. How self-reported hot flashes may relate to affect, cognitive performance and sleep. Maturitas, Vol. 81, Issue 4, p449–455, Published online: May 20 2015.

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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.