Dr Sharon Malone says hot flashes can signal higher cardiovascular risk
"Women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues."
About this episode
Mel Robbins interviews Dr Sharon Malone, a US board-certified obstetrician-gynaecologist, for a wide-ranging explainer on women’s reproductive health from contraception through menopause. Malone argues that social media has fuelled fear about hormonal contraception and says birth control pills do not cause infertility; she also urges listeners not to treat cycle-tracking and other “natural” methods as reliable pregnancy prevention, particularly for people with irregular cycles. The discussion covers PCOS (which Malone says has been renamed by some to a broader metabolic label without changing diagnostic criteria), typical symptoms such as irregular periods, androgen excess and insulin resistance, and the limits of current understanding of underlying causes.
Malone outlines endometriosis as uterine-lining-like tissue growing outside the uterus, often missed on imaging and sometimes requiring laparoscopy to diagnose and treat; she says diagnostic delays can stretch for years and that the condition can contribute to infertility and painful sex. On fertility, she describes age-related decline accelerating after the mid-30s and encourages women to ask family members about menopause timing and reproductive history.
On menopause care, Malone characterises menopause as a long life stage affecting multiple systems, not a one-off event. She endorses hormone therapy as the most effective treatment for vasomotor symptoms and disputes the idea that it must be time-limited, while noting treatment should match symptoms and individual risk. She also addresses reported oestrogen patch shortages and alternatives, explains the difference between systemic and local vaginal oestrogen, and stresses resistance training and earlier attention to bone density around menopause.
Key takeaways
- Malone says hormonal contraception is safe for most young women and does not cause infertility; she warns against misinformation-driven avoidance.
- She describes cycle-tracking and other “natural” contraception methods as unreliable, especially with irregular cycles and because temperature rises after ovulation.
- Malone explains PCOS symptoms (irregular cycles, androgen excess, insulin resistance) and criticises renaming efforts that do not change criteria or treatment options.
- She says endometriosis can be underdiagnosed, may require laparoscopy to confirm, and can lead to chronic pain and infertility.
- On fertility, she says decline is modest in early 30s but accelerates from around 35; family history of menopause timing and gynaecological conditions can be a useful data point.
- Malone argues menopause symptoms, including hot flashes, should not be dismissed; she links severe symptoms and sleep disruption to later cardiovascular risk.
- She recommends earlier attention to bone health around menopause, plus resistance training and discussion of hormone therapy as a prevention tool for bone loss.