Preparing to talk to your doctor about hot flashes is a bit like preparing for a job interview. But instead of giving thought to your greatest strengths and weaknesses, plan to do some soul-searching on where you stand regarding hormone-replacement therapy. And get ready to explain how hot flashes are disrupting your quality of life.
“Probably the most important thing a woman can do is connect with herself about ‘what am I willing to do?’” said Nanette Santoro, M.D., professor, a member of the Board of Trustees of the North American Menopause Society and E. Stewart Taylor Chair in Obstetrics and Gynecology at the University of Colorado School of Medicine in Aurora, Colorado.
Whether you’re open to all your options, or opposed to estrogen therapies or antidepressants that can mitigate the frequency and severity of hot flashes, knowing your comfort zone can most efficiently steer the conversation.
“Because there are a lot of natural things that can be done, once hormones come up that’s a barrier a lot of women are not willing to cross,” said Mary Ann Meyer Jones, M.D., F.A.C.O.G., an obstetrician and gynecologist in practice at Prima Bella Women’s Health in Valparaiso, Indiana.
In addition to preparing a list of questions for her doctor, a woman preparing to get into the hot flash hot seat should expect that her doctor will ask her: “Are hot flashes the only things bothering you? Do you have other symptoms? What other medical conditions (‘comorbidities’ in medical lingo) do you have?”
“You can feel kind of like a limp dish rag,” said Santoro of the rollercoaster ride of the hot flash followed by chills. “Having that happen a lot of times a day gets on your nerves.”
Jones and Santoro agree that an appointment dedicated solely to a discussion of hot flashes or the larger menopause landscape is recommended. Don’t try to squeeze the conversation in at your annual exam.
If you do prefer to squeeze it in, at least let the scheduling staff know you’d like a longer-than-usual appointment. Santoro explains that every doctor’s office has a standard appointment length of 15 minutes.
“For that type of discussion it’s bad to be in a hurry,” she said. “That may cost more, but that should come out in the coding that you had a longer than typical visit.”
Women might also want to question their doctors on the out-of-pocket cost of any medications being debated, because it’s typically accepted that estrogen therapy will have an end point.
Jones finds that insurance companies are increasingly refusing to cover the cost of estrogen therapy for her older patients. She said a woman left paying her own estrogen bill could be out $60 to $100 per month.
Does it matter if the doctor you’re trying to discuss hot flashes with is of an age and gender to likely have experienced them personally? Even female physicians will say, probably not.
“I think that most people get the same training,” said Santoro. “I think the doctor’s mindset is more important. If the doctor’s fixed on one treatment that can be a bad thing. You don’t want to go to a one-trick pony.”
Why might a doctor fixate on one specific treatment? “Hormones tend to galvanize people,” Santoro said. Even highly-trained specialists can develop biases.
Some questions to ask your doctor, or to ask yourself in advance of your appointment and relay to your doctor:
- What are my options?
- What is my pattern of hot flashes and how are they disrupting my life?
- What is my general attitude toward hormones?
Once you’ve talked to your doctor and come up with a treatment plan don’t assume the conversation is over. “I will usually rediscuss every year with my patients,” Santoro said. “For some women, they stop it [estrogen therapy] and the symptoms don’t come back. I usually try an annual wean.”
When is a good time to launch the conversation with your doctor? Jones and Santoro say that women know. They tend to be patients at the end of their proverbial ropes.
“Sometimes you’re starting to not be very nice to your family because you’re not sleeping,” said Jones.
“Women really need to know that they deserve relief and the treatments are relatively safe despite a lot of the scary reports,” added Santoro. “They can’t have this [the hot flash meltdown] happening in a board room. They can’t have it looking like they’re losing their composure.”
Mary Ann Meyer Jones, M.D., F.A.C.O.G., via telephone interview July 6, 2015.
Nanette Santoro, M.D., via telephone interview July 6, 2015.
Reviewed July 9, 2015
by Michele Blacksberg RN
Edited by Jody Smith