Menopause is the time in a woman's life when menstruation stops. It's usually a gradual process. As you hit your forties, you produce estrogen less steadily, which causes your periods to become less regular. You will probably start having your periods more often -- every 21 to 25 days -- and they will most likely become lighter, except for occasional periods of heavy bleeding. Later on, you may begin missing periods or spotting. Eventually your periods will stop altogether.

Most women reach menopause between the ages of 45 and 55. The average age is 51. Don't toss out your birth control after your first hot flash, though, since you may continue to be fertile for a while. If you're under 50, it's a good idea to continue using contraception for 24 months after your last period; if you're over 50, continue for 12 months.

In addition to irregular menstrual periods, falling estrogen levels can cause a variety of other symptoms that can last anywhere from a few weeks to several years. Here are the most common:

•hot flashes, night sweats

•insomnia, fatigue

•mood swings, depression, anxiety, irritability, trouble concentrating

•vaginal dryness and inflammation (which may cause soreness or pain during sexual intercourse)

•loss of sexual desire

•joint pain, back pain, headaches

•pounding heartbeat, dizziness, tingling sensation

•thinning scalp hair, increased facial hair

•frequent urination or leakage

A hot flash is just what it sounds like: a sudden feeling of heat. Eight in ten women get them during menopause, usually during the first year or two. For some women, it's just a mild warming sensation; for others, the heat can be intense, leaving them drenched in sweat.

You don't have to make a special appointment for menopause unless you're having trouble with symptoms. However, be sure to see your physician if you have prolonged or unusually heavy bleeding, or if you suddenly have a period after going six months or more without one, since these could be symptoms of uterine cancer.

Evidence of serious side effects associated with hormone replacement therapy continues to mount, so this is a question you should review carefully with your doctor. As the name implies, hormone replacement therapy (HRT) replaces some of the estrogen (and usually the progesterone) that your body stops producing after menopause. Not only do low estrogen levels produce the symptoms of menopause, but, more importantly, they increase your risk of heart disease and osteoporosis (the "brittle bone" disease). Taking estrogen, either in a pill or through a skin patch, can relieve symptoms and strengthen your bones, reducing your risk of fractures. Some early studies suggested that HRT might prevent heart disease, but the most recent evidence suggests the opposite may be true. In a clinical trial sponsored by the National Heart, Lung and Blood Institute (NHLBI) involving over 16,000 women, HRT was found to increase the rate of coronary heart disease by 29 percent.

In fact the study, which was to run at least eight and a half years, was cut short after five years due to health risks experienced by study participants. Women who received HRT had twice the number of blood clots, a 41 percent increase in the rate of strokes, and a 26 percent increase in invasive breast cancer rates. The rate of cardiovascular disease increased by 22 percent.

And that's not all. In a sub-study of 4,500 women aged 65 and older in this same group, those on the HRT regimen were found to be twice as likely to develop Alzheimer's disease or another form of dementia within five years when compared to women who took a placebo. This part of the study, reported in the May 28, 2003 edition of the Journal of the American Medical Association, also found that the estrogen/progestin therapy was ineffective in preventing mild cognitive impairment, a dimming of cognitive function that is less severe than dementia and which sometimes occurs as we age.

The most recent indictment of HRT came in June 2003, when a follow-up study of the women in the NHLBI study found that not only were women more likely to develop breast cancer if they took the hormone pill, their tumors tended to be larger and more advanced than breast cancers that developed in women who took a placebo, or dummy pill. The study, which was reported in the June 25, 2003 edition of the Journal of the American Medical Association, also found that women on hormone therapy were more likely to have abnormal mammograms, even in the first year of treatment, than women taking a placebo.

Another study of 975 women conducted by the Fred Hutchinson Cancer Research Center reported in the same edition of JAMA found that the increased risk of breast cancer from estrogen/progestin hormone therapy remained the same whether the two hormones were taken at the same time or one after the other in the course of a month. This means that the increased breast cancer risk isn't limited to the brand of hormone pill used in the NHLBI study, but includes any pill that uses a combination of estrogen and progestin.

Because estrogen replacement alone has been linked with an increased risk of ovarian and uterine cancer, most HRT today combines estrogen and progestin -- a synthetic form of progesterone that lowers your risk of ovarian cancer.

Your doctor will probably advise you against HRT if you've had breast cancer or some other cancer, blood clots, fibroids, or certain liver or gallbladder disorders, since the hormones can exacerbate these conditions. It can also produce PMS-like symptoms such as nausea, headache, bloating, and breast tenderness, and cause spotting and a return of period-like monthly bleeding. Because all the new information about HRT can be confusing, check with your doctor to make sure you are fully informed about the potential risks and benefits of HRT before making a decision.

Early optimism about the value of some alternative therapies has waned a bit. Some research suggested that soy might relieve hot flashes, but studies of its effectiveness have been inconsistent. A Japanese study of over 1100 women, published in the American Journal of Epidemiology, found that those who included soy in their diets had fewer hot flashes, though studies done in the U.S. found no such benefit. However, we do know that soy can increase bone density, so some experts speculate that it could help women avoid bone loss.

Black cohosh, another traditional remedy for hot flashes, looked promising when German studies in the 1980's suggested it helped relieve hot flashes and other menopausal symptoms. However, a study of 85 subjects by researchers at Columbia University found it was not much more effective than a placebo, or dummy solution, in relieving such symptoms.

So, are there any alternatives to HRT that do work? Perhaps. Researchers are finding that some antidepressants have an unexpected benefit -- they relieve hot flashes. A Mayo Clinic study of 191 women found that the antidepressant venlafaxine (Effexor) in dosages of 75 or 150 mg reduced hot flashes by more than half -- and a lower dose was still effective, cutting hot flashes by about a third. Another antidepressant, paroxetine hydrochloride (Paxil), showed promising results in a preliminary study of 27 women -- on average, hot flashes were reduced by more than half. Of course, these medications can have side effects ranging from such symptoms as nausea, increased blood pressure, and dry mouth (Effexor) to drowsiness and decreased libido (Paxil). They may also interact with other medications, so be sure your doctor is aware of all medications you're taking when you discuss these drug options.

What else can you do to relieve menopausal symptoms? Do what you can to reduce stress: Get more exercise, join a support group, or try meditation. Emotional strain can throw your hormones out of balance and make menopause a bumpier road. Cut back on caffeine and alcohol, too, which can raise your body temperature and trigger a hot flash.

For vaginal dryness, it may seem counterintuitive, but consider having more sex! Frequent sexual activity -- either alone or with a partner -- can keep your vagina's natural lubrication going. If dryness is making intercourse painful, an over-the-counter lubricant such as K-Y Jelly or Astroglide can do wonders.

To lower your risk of osteoporosis, exercise regularly. Weight-bearing exercise (such as walking or running) builds your bones and reduces your risk of developing osteoporosis. Make sure you get 1,200 milligrams of calcium a day. After age 50, women (and men) need more calcium in their diets -- and remember that vitamin D is important in helping your body absorb calcium. According to the most recent recommendations, if you're age 51 to 70, you need 400 International Units (IU) of vitamin D a day -- 600 IU if you're over 70.

-- Kate Lee is a former associate editor at Consumer Health Interactive and researcher at Time Inc. Health. She is currently a senior editor at BabyCenter.

References

First published September 3, 1998
Last updated May 6, 2008
Copyright © 1999 Consumer Health Interactive and OneBody, Inc.

• If you have severe symptoms, make an appointment with your doctor. • Try to get some aerobic exercise every day, and work in some weight training every week. Exercise can help lift your mood, and weight training will help keep your bones strong. • Check out a yoga class, particularly if you’re suffering from menopause-related stress. • Consider finding a support group. Sharing your experiences with other women who are going through the same thing can be more helpful than you think. • Limit your caffeine and alcohol intake and lose extra pounds, if possible -– this may help lessen the severity of hot flashes.

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