Patient’s night sweats, hot flashes persist for more than two decades

I am 72 years old and otherwise fairly healthy, but I am writing to you in desperation. I have talked with every doctor I have had in the past 15 years, and no one has been able to help. I have had severe hot flashes for more than 20 years, and I am miserable. The first eight years consisted of night sweats when I drenched the bed nightly. Then they suddenly switched to the daytime, and I somehow managed to deal with them throughout the last years of my career as a school psychologist.

Since that time, they have gotten increasingly worse, so much so that I have ridden my closets of everything but summer clothing, although I live in northwestern Pennsylvania. In the summer, I cannot go to a neighbour’s ball game or a picnic. I am literally drenched within minutes of going outside. Even in winter, I can often walk outside with a light jacket.

I was on hormones for 10 years, which made no difference. I can no longer take them anyway, as I am now taking Eliquis. I have also tried every over-the-counter medicine there is, as well as clonidine.

At this point, I don’t know if I actually have hot flashes or if something else is happening. No doctor I have ever spoken with has suggested something else. Is there anything I can try? Is there another type of doctor I can go to? I have spoken with two gynecologists, three primary care physicians, two cardiologists, a neurologist and a pulmonologist.

My medications include Eliquis, clonidine, atenolol, rosuvastatin, Lyrica, omeprazole and venlafaxine. Thoughts?

When nine doctors have been unable to help, it is prudent to try to think a little bit outside of the box. So, the first place I’d start with is questioning whether you have hot flashes at all. Estrogen is very effective for most women, so if estrogen did nothing for you, it’s suggestive that maybe these aren’t menopausal symptoms.

Night sweats can be caused by a long list of conditions. Cancers, especially lymphomas, are unfortunately high on the list, but after 22 years, any cancer should have progressed to the point where it would be quite obvious. There are some chronic infections, especially tuberculosis, but less-common ones as well, including other mycobacteria, HIV and hepatitis C. I’d be astounded if none of your physicians looked for these, and again, it would be odd for you to have had no other symptoms over such a long time.

Other endocrine disorders, especially elevated thyroid levels, are possible and must have been looked for, but pheochromocytoma and carcinoid syndrome remain distant possibilities that might have been overlooked. Blood and urine tests start the evaluation for these unusual conditions.

Some drugs can also cause this symptom. In the list you have mentioned, atenolol is one that can rarely cause night sweats and hot flashes. It might be worth asking your doctor for an alternative.

I have one other suggestion, which is a new and highly effective treatment for menopausal hot flashes called fezolinetant. My early experience with this drug has been remarkably successful. Your primary care doctor or gynecologist could prescribe this, and you will know very quickly if it works for you.