The following information is provided by the:
New York Department of Health

Menopause is the time in a woman's life when her menstrual periods come to an end It occurs around the age of 50, although earlier for some women and later for others. For generations of women, the natural process of menopause has been surrounded by myths and old wives' tales.

Fortunately, today we know more about how menopause works and how to safely ease the symptoms of women who have a difficult time with it. And event though 75% of women have no or only mild problems with menopause, learning what might happen can help you view "the change" as a normal experience, rather than something to be dreaded.

The Role of Female Hormones

To understand menopause, you need to know about the menstrual cycle and the hormones estrogen and progesterone, which are produced by the ovaries In the first half of each menstrual cycle, the ovaries produce estrogen. The estrogen causes the uterus to build up a lining called the endometrium. In the middle of the cycle, the ovaries release an egg. This is called ovulation.

After ovulation, the ovaries produce progesterone and estrogen for the rest of the cycle. The progesterone prepares the endometrium for pregnancy. If pregnancy doesn't happen by the end of the menstrual cycle, the ovaries make less progesterone and estrogen, and the levels of thee hormones drop. This causes the built-up lining of the uterus to dissolve and flow out through the vagina as a menstrual period This cycle usually repeats itself regularly all throughout a woman's childbearing years until menopause.

Menopause

Usually between the ages of 45 and 55, a woman will start to notice that her menstrual cycles are less regular. This is because the ovaries become less likely to release an egg each month as a woman gets older. During some cycles the ovaries will produce less estrogen than usual, and your menstrual period may be lighter or shorter. During some cycles, no egg will be released, and you may skip a period. Or sometimes, if there is no egg, the ovaries do not produce progesterone, and this may make you have a longer, heavier period than usual.

These changes in the menstrual cycle can be worrisome, but they are not unhealthy. If you skip a period and are worried about being pregnant, you can have a pregnancy test either t your doctor's office or with a home test kit available at most pharmacies or grocery stores. If you have several cycles of heavy bleeding, you may want to check with your doctor; he or she may prescribe progesterone pills that will help lessen the bleeding.

If you experience very heavy bleeding, lengthy staining between periods, very frequent periods, or a resumed flow after six period-free months, check with your doctor. Occasionally, these are signs of a serious problem, such as endometrial cancer (cancer of the lining of the uterus).

It's useful to keep a record of your periods when they begin to become irregular. Write down the date your period begins, how long it lasts, the amount of flow and any associated symptoms. This will help you and your doctor get a better idea of what is happening with your hormones as you approach menopause.

Eventually, after several years of irregular cycles, your ovaries stop producing estrogen and your period stops completely. This is menopause. Once menstruation has stopped for six months, you will probably not have any more periods. However, if you are using birth control, you should continue to do so for at least one year after your last period.

What To Expect During Menopause

When the amount of estrogen in your body decreases, you may have some discomfort. Studies have shown that about 25% of women have no discomfort during menopause, 50% have mild symptoms, and 25% have severe symptoms.

Hot Flashes

Usually, the first symptom women notice when their estrogen level drops are "hot flashes". Many women describe them as a sudden wave of heat that sweeps from the chest to the neck and head. Hot flashes are due to an increased blood flow in the blood vessels of the skin. This extra surge of blood creates the wave of heat your feel.

A hot flash can range from a sense of mild warmth and a flush over the skin to a wave of heat that leaves you drenched with perspiration. Flashes can come singly or in a series, lasting from a few seconds to a few minutes. Sometimes, hot flashes can occur while you're sleeping, causing you to wake up in a sweat.

Many women are embarrassed by hot flashes, especially since it is hard to tell when they will occur. But even though you may feel flushed and sweaty, it usually isn't noticeable to others. Look in the mirror the next time you have a hot flash and you will probably be reassured.

What to Do When a Hot Flash Comes…

• Stay calm.
• Take a few deep breaths. Exhale deeply, too.
• Dress in layers so you can remove some clothing. Natural fibers like cotton may be more comfortable. Loosen any tight clothing.
• You may want to carry a folding fan to cool yourself.
• Drink something cool, or step outside if possible.

Caffeine, alcohol, very hot or spicy food, or sugar can trigger hot flashes in some women. You might want to keep track of when the hot flash occurs and see if any of these things seem to set them off. If so, cutting down or eliminating such foods may help.

Many of us were brought up to believe that menstruation was something to be hidden, and we find ourselves feeling ashamed of having hot flashes, too. Talking with other women who are going through menopause can help us get over these feelings. Don't be afraid to let people around you know when you're having a hot flash. There's no need to hide a normal body process that all women go through. If you are seriously bothered by hot flashes, talk with your doctor. There are treatments ) both non-hormonal and hormonal replacement therapy) that may make you more comfortable.

Changes in the Vaginal Area

Another common problem when estrogen levels drop is vaginal dryness and irritation. This can cause discomfort during intercourse. Often, this discomfort can be relieved with water-soluble creams (such as K-Y Jelly, Astroglide or Replens) which are available at pharmacies.

You may find you're more prone to vaginal and urinary infections. Vaginal fluids contain natural acids that help fight bacteria. However, as estrogen decreases, the amount of acid in the vagina also decreases, and the chances of infection increase. If you experience pain or burning with urination, see your doctor.

Bone Changes: Osteoporosis

Estrogen loss can sometimes hasten the development of osteoporosis, a condition in which bones become thin and brittle and break easily. Smaller women and those with a family history of osteoporosis are at special risk.

Prevention is the best way to avoid this condition. You can reduce your risk of developing osteoporosis by maintaining a good weight, limiting alcohol use, getting regular weight-bearing exercise (like walking), not smoking, and increasing your calcium intake through the foods you eat or calcium supplements. Before menopause, women need around 1000 mg of calcium each day; after menopause the recommended daily intake of calcium is around 1000 mg of calcium if a woman is on estrogen replacement therapy (ERT) and 1500 mg of calcium if she is not on ERT. (A glass of skim milk has 300 mg of calcium; one ounce of cheese has around 200 mg.)

Other Physical Changes

Other physical changes can happen during menopause. Most of these changes are part of the normal aging process, not part of menopause, although they often occur at the same time in your life. You may gain weight. Your skin may become drier and develop brown spots. Hair patterns may change, including growth of some facial hair. Cholesterol levels tend to increase with age, making regular checkups with your doctor important.

Estrogen/Hormone Replacement Therapy: Is It Right for You?

Because the loss of estrogen can affect many body functions, many women consider estrogen replacement therapy as they enter menopause. ERT can be effective in stopping the bone loss of osteoporosis It also helps prevent vaginal dryness and decreases the risk of vaginal and bladder infections. A number of studies have shown a lower incidence of heart disease in women using ERT. There are several forms of estrogen that may be prescribed - pills, a skin patch, vaginal cream, or long-term implants.

ERT is not for everyone. Many women continue to make enough estrogen after menopause and don't need estrogen replacement. Your doctor may recommend a test to check your estrogen level If you are not producing any estrogen, you may benefit from ERT.

However, there are questions that you need to ask about ERT. Fibrocystic breast disease, fibroid tumors of the uterus, endometriosis, and endometrial hyperplasia are all stimulated by estrogen; if you have had problems with any of these conditions, ERT may make them worse. ERT should not be used if a woman has a history or a strong family history of liver disease, blood clotting problems, breast cancer or endometrial cancer.

Estrogen replacement has also been associated with an increased risk of endometrial cancer when estrogen alone is used; when progesterone is added to the estrogen, this risk is greatly reduced.

If you decide to try estrogen, your doctor may prescribe a low dosage of estrogen and progesterone together. (This is sometimes called hormone replacement therapy, or HRT.) The progesterone helps balance the effects of estrogen and reduces the risk of endometrial cancer.

It may take awhile to find the right hormone dosage, since everyone's body reacts differently to medications. Some women find that they only need ERT or HRT for a few months to relieve symptoms; others find that they need replacement medication for a longer time, particularly if it is being used to prevent or slow osteoporosis.

There are alternatives to ERT and HRT, including non-hormonal medications that can help minimize hot flashes. Many women prefer not to take any medication at all and let their bodies adjust to a lower estrogen level naturally. Talk with your doctor and decide together what is right for you.

Taking Care of Your Health

If you've taken good care of yourself all along, you don't need to do anything special during or after menopause. But if you've never taken the time to eat well, exercise, or have regular health checkups, menopause is a good time to get into the habit of doing these things. Preventive care - stopping health problems before they start - is more important than ever as we grow older. Here are some things that are helpful to good health:

• Have a complete physical exam, including a check of your blood pressure, a breast exam, and a pelvic exam every year.
• After the age of 50, have a mammogram every year. If the cost is a problem for you, call the New York State Health Department at (518) 474-1222 to learn about low-cost or free mammograms.
• Practice breast self-examination every month. Your doctor or nurse can show you how.
• Have a Pap test every year for at least three years. If all tests are negative, your doctor may suggest less frequent Pap tests (usually every other year). Some doctors prefer to test every year.
• Eat nutrient-dense foods - foods that give you a lot of nutrition in proportion to the calories they contain. Fruits, vegetables, breads, cereals, lean meats, fish, and low-fat dairy products are all good choices.
• High-fat diets have been linked with an increased risk of heart disease. Try to keep the proportion of fat in your diet to less than 30% of the total calories. Nutrition labeling on most packaged foods will tell you the number of calories and the number of fat calories in one serving. Divide the number of fat calories by the total number of calories to get the percentage of fat in that particular food. If you do this for a few days, you will get a pretty good idea how much fat your diet contains.
• Exercise has many benefits for menopausal women. It helps control weight, it gives you more energy by conditioning our heart and lungs, and it keeps your bones strong. The key to sticking with an exercise program is to find something you like to do. Waling, swimming, dancing, bowling, gardening, yoga - whatever keeps you moving is good for you. If you haven't exercised much before, start slowly and gradually increase your activity level. Trying a variety of activities is often helpful in maintaining your exercise program.

Not too long ago, few women lived beyond their childbearing years. Today, however, a healthy woman of 50 has an average life expectancy of 81 years - more than a third of her life before her! And that third can be the most vital, active and enriching part of a woman's life. During your menopause, take a new look at yourself. It's your chance for another beginning.

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