Menopause represent a major turning point in a woman's life--the end of her reproductive years. Some women look forward to it while others dread it. Most women experience menopause between the ages of 45 and 54 and will spend more than one-third of their life post-menopausal. Overall, the serious health problems that occur after menopause are the long-term increased health risks for heart disease and osteoporosis as the protective effect of estrogen disappears. Heart disease is the leading cause of death in women and is responsible for half of all deaths among women after age 50. In addition, one in three post-menopausal women develops osteoporosis which causes millions of fractures and thousands of deaths to each year.

Symptoms

Most the physical changes that women experience just prior to menopause are due to the dramatic decline in estrogen. The cessation of estrogen causes many physical symptoms that can make your body feel uncomfortably different. Hormonal changes can also cause premenstrual-like (PMS) symptoms including mood swings, irritability, and anxiety.

• Hot flashes typically begin early in perimenopause. About 75 to 85% of women experience hot flashes but their frequency can vary from dozens each day to only a few a day. They usually last for 2 years or less. A hot flash is a feeling of warmth in the upper chest, neck, and face followed by excessive perspiration and some chilling. Hot flashes can be triggered by caffeine, alcohol, stress and hot weather. Hot flashes are related to the decline in estrogen levels which disrupts the body's thermoregulatory system. Night sweats are also due to these changing hormone levels. Some women experience such severe sweats that they must change their sheets and bedclothes several times a night. This can seriously disrupt sleep patterns.
  
  
• Insomnia is a very common perimenopausal symptom related to hot flashes and hormonal changes. As estrogen levels drop there are also decreased levels of serotonin which may exacerbate insomnia. Many women sleep poorly and do not awaken feeling rested. Sleep deprivation may lead to nervousness, irritability, fatigue, forgetfulness and problems with concentration. As estrogen declines there are also decreased levels of serotonin which may exacerbate insomnia.
  
  
• Depression. Women who have two or more of the physical symptoms of menopause (e.g. hot flashes, vaginal dryness) are four times more likely to be depressed as women who have no more than one symptom. Those who feel bad physically and are anxious about their health are more likely to be depressed. Some women are more vulnerable to depression during perimenopause because it may symbolize getting old and being sexually undesirable. Overall, depression that occurs during the menopausal years is more often triggered by other life events such as the stress of being a caregiver for parents or adjusting to children leaving home.

Treatment

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) is the replacement of the female estrogen hormones estrogen and progesterone after menopause. Progesterone is given to reduce the risk of endometrial replacement (i.e. uterine) cancer. HRT can significantly reduce the risk of heart disease and osteopososis and may also therapy or reduce the risk of Alzheimer's disease by about 50 percent. HRT causes a 30 to 50 percent reduction in "all hormone cause" mortality. However, HRT remains somewhat controversial because of concerns about its long-term safety and replacement efficacy. A major issue has been the relationship between estrogen and breast cancer. Many women decide not to use HRT because they fear breast cancer. Although HRT is a personal decision, evidence shows that for most women the benefits outweight the risks. Yet, only 15-20 percent of women decide to take HRT.

HRT is usually taken orally, although sometimes skin patches or vaginal creams are used. Many women resume their monthly period once they start on HRT but this decreases with time. Progestin can cause side effects such as breast tenderness, bloating, abdominal cramping, anxiety, irritability, and depression that can discourage women from staying on HRT. Some of these symptoms have been eliminated by development of low-dose HRT. Most women currently take cyclic HRT in which they take estrogen continually and progestin only for the first 12 days of each month. Women who have had a hysterectomy do not neet to take progesterone so they use estrogen alone (ERT).

Another hormonal approach to menopause are the "selective estrogen receptor modulators." These "designer estrogens" such as raloxifene (e.g., Evista) are effective in protecting agains osteoporosis and heart disease, but do not increase risk for breast or uterine cancer. However, raloxifene does not relieve symptoms such as hot flashes.

Some women use alternative therapies based on herbs and other botanicals. One of the best known alternatives is phytoestrogens which may have effects similar to estrogen. Phytoestrogens occur naturally in soy products (e.g. tempeh, soy beans, miso, tofu), garbanzo beans, and other legumes, bean sprouts and sunflower seads. Women with high phytoestrogen intake report fewer menopausal symptoms. Clinical trials are needed to evaluate claims of effectiveness.