Some women sail through their mid- to late 40s and 50s without a second thought about menopausal symptoms. For others, hormonal changes can make midlife less than "prime time." Most women can tell if they are approaching menopause because their menstrual periods start to change. This transitional time is often called perimenopause and typically lasts for about five years.

Hormonal fluctuations cause irregular menstrual patterns and other changes associated with menopause, including:

  • hot flashes
  • vaginal dryness
  • urinary tract infections
  • night sweats
  • insomnia
  • headaches
  • heart palpitations
  • mood changes
  • anxiety and irritability
  • memory lapses and diminished concentration

Most women experience only mild symptoms just prior to and following menopause.

Irregular menstrual periods are common as you get closer to menopause, but they also can be a symptom of gynecologic cancer or other conditions that may need medical attention. Remember, you can still get pregnant during the transition to menopause, even if your menstrual cycle is irregular, so continue to use birth control. Be sure to mention any menstrual problems during regular checkups or schedule an appointment to discuss them. Bleeding after menopause should be reported and evaluated right away.

Menopause itself is one event โ€” 12 consecutive months with no menstrual period and no other biological or physiological cause for the end of your periods.

Postmenopausal Hormone therapy ( commonly referred to as hormone replacement therapy or HRT) has been widely used for short-term management of uncomfortable menopausal symptoms such as vaginal dryness and hot flashes, and as a long-term strategy for preventing diseases common in postmenopausal women (related to estrogen decline) such as osteoporosis. For many years, estrogen had been widely recommended to postmenopausal women as a way to prevent heart disease.

The safety of hormone therapy (often administered as combination of estrogen and progestin hormones) as well as estrogen-alone therapy for short- and long-term use is now under intense scrutiny by the Federal government. Concerns were triggered by major studies of postmenopausal hormone therapy published in 2002 that identified significant risks associated with its use. One of those studies, part of the Women's Health Initiative (WHI) โ€” one of the largest studies of women's health ever undertaken and still underway โ€” investigated the use of combination estrogen-progestin hormone therapy for the prevention of coronary heart disease on healthy women between the ages of 50 to 79 years. The study found that not only did combination hormone therapy NOT prevent heart disease, it could potentially contribute to its development.

In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen #151 risks illuminated by a section of the WHI study, which was abruptly halted when the risks were identified.

Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time. Women taking estrogen products are cautioned to have yearly breast exams, perform monthly breast self-exams and receive periodic mammograms.