Health · Menopause

When Hot Flashes Meet the Heat of Summer

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.

This past weekend, a “heat dome” hovered over the middle part of the country from the Great Lakes to the East Coast with temperatures feeling close if not over 100 degrees. As a result, about 157 million people were under heat warnings and heat advisories.

What could be worse than hot flashes in this heat?

Menopause specialists are besieged these days with women who were just barely functioning in the early days of summer and now are finally overcome with the high and humid temperatures throughout much of the United States over the last few days.

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 flushed 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.

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 like low-dose short-term systemic hormone therapy has a risk profile like that of heroin. Time for some balance here, people.

So 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 and 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 next 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 in the fall, say 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.

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  • Susan July 23, 2019 at 7:46 am

    The subway, July 22. Interview ready in a full suit. No air conditioning in the subway car and 90 outside. I was hot and then, like clockwork, Hot. Flash. I have been having 18 per day. We all complain that NYC office buildings are way too cold in the summer. My boss insists on 65 degrees. For the first time I am grateful. My trusted doctor and gynecologist and my physician agreed it was time to begin the estrogen/progesterone cocktail. Still waiting for it to ‘kick in’; but, trust me Dr. Pat – I hear you. I am so very lucky that my doctors agreed the treatment would be helpful for me. I am hopeful for a good night of sleep – I hope it comes soon. I can’t believe more of us haven’t joined the conversation thread. This is important stuff. Thank you Dr. Pat.