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Welcome to Menopause

Welcome to the rest of your life! Menopause, according to the doctors, is that six months to one year after you have your last period. This time of life is defined by exactly what the word means: the cessation of your monthly flow. But that's not the whole story.

The physical and emotional changes caused by menopause — and the dramatic change in the hormones circulating in your body and connecting to receptors from your brain to the bend in your big toe — will continue for the rest of your life.

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It starts out innocently enough. During perimenopause, which can begin as early as age 38 and continue until menopause, you get a hint or two of what's coming. Your periods may become irregular, and even vary between shorter and scantier or longer and heavier flows. You may have a few hot flashes, or night sweats, completely soaking your pajamas and sheets.

The ability of your hypothalamus (a wedge-shaped tiny gland deep in the brain) to naturally and easily regulate body temperature seems to falter. Since that gland also triggers your thyroid's secretion of the hormones that regulate metabolism, you could watch yourself gain weight without even varying from your diet or exercise regimen by one iota. And you might feel extremely tired from time to time.

What's happening is that your ovaries are beginning to feel the effects of age. Not only do you not have as many eggs as you had before, but the follicles that contain them don't work as efficiently as they once did.

Even if an egg matures, it may not actually be expelled from that follicle, leaving you with cysts and an incomplete cycle. Since you ovulate less frequently, that cuts back on your production of the hormones estrogen, progesterone and androgen (testosterone).

But frequently what's not happening in perimenopause is the luteal phase of the cycle when the egg moves from the sac to the fallopian tube and down into the uterus to be fertilized. It's this phase that gives you the right amount of the hormone progesterone, which usually balances your fluctuating levels of estrogen.

While all this is going on in your pelvis, the hypothalamus and pituitary glands in your brain are simply refusing to believe it. They send out signals of increasing intensity, in the form of follicle stimulating hormone (FSH) and luteinizing hormone (LH), to tell your ovaries what to do. 

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Generally what those brain signals produce is a jump in estrogen as your ovaries gear up to mature an egg. As a result, lower estrogen levels don't really occur until six months to one year before true menopause. Before that, estrogen levels may rise very high and then drop precipitously.

At menopause, your cycles have finally stopped. You do continue to produce some estrogen from the lining of your ovaries and your adrenal glands, and some testosterone as well. But the amount and power of this kind of estrogen is far less than the estradiol produced by your ovaries during your reproductive years. When you haven't had a period for a year, you're officially postmenopausal.

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Signs of Menopause

This loss of hormones is no small matter. Estrogen affects the entire body. Not all women react the same way to the wild fluctuations in hormone levels during menopause, but here are some common experiences and long-term health concerns of women going through menopause.

Hot Flashes. The most common problem related to menopause is the "hot flash" or "hot flush." Women feel really warm or even hot, and they may flush or perspire. Their heart rate may increase as well. Hot flashes come and go for usually three to five years, but they can end much sooner or go on much longer.

Taking estrogen usually stops hot flashes cold, but they may return if a woman goes off the medication too quickly. Alternative methods for alleviating hot flashes include increasing intake of soy foods and flaxseeds and supplementing with black cohosh in standardized extract form.

Insomnia. Some women have trouble sleeping, and, let's face it, trouble being awake too after getting too little sleep for month after month. You may feel irritable or depressed. Exercise, stress management, and eating a healthy diet are all recommended.

Lack of libido. Many women find that their sex drive diminishes with menopause. Physical changes in the vagina during menopause due to the drop in estrogen, which kept tissues plump and lubricated, and the huge decrease in naturally produced androgens, which spiked your sex drive, may leave you wishing you'd never heard of sex.

Estrogen creams and an estrogen ring worn in the vagina can help prevent the thinning and dryness of the vagina and vulva that make intercourse uncomfortable. Testosterone, in very small doses, may increase sex drive. (But be careful. Some women are very sensitive to testosterone and your testosterone/estrogen balance has already been skewed by the severe drop in estrogen. If you're sensitive to testosterone, you may develop acne, facial hair and thinning or loss of the hair on your head.)

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Bladder problems. Women may need to urinate more often and more urgently than before menopause. They may also leak urine when coughing or sneezing. The problem starts when estrogen levels drop and the lining of the urethra and bladder wall thins and pelvic muscles weaken. Kegel exercises strengthen the muscles, and certain supplements and devices may help stop the leaking.

Heart disease. At menopause, women's cholesterol levels increase, and they are more likely to develop clogged arteries and to have a heart attack. Exercising, eating a low-fat, largely vegetarian diet and managing stress all help keep the heart healthy. Doctors have long thought that taking estrogen protects against heart disease, but this claim is now coming under question. Medications are also available for women who have heart disease or high cholesterol.

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Osteoporosis. Estrogen is one of two female hormones that help keep bones, including the spine, healthy. So after menopause many women are at risk of developing osteoporosis, or fragile, brittle bones.

Here's the skinny on osteoporosis. Bone is living tissue. For many years, your bones continue to fill out, using the minerals you take in through your diet or in supplements (especially calcium, vitamin D and vitamin K) to achieve maximum bone mass. But bone mass peaks in your mid-30s.

After that, if you lead a relatively normal life, you'll maintain bone mass for a while. (Excessive dieting, or use of caffeine or alcohol, for instance, can deprive your body of the minerals needed for bone mass maintenance and you may begin to lose bone early.)

Normally, during the first five years after menopause, bone mass is reduced by three percent per year. Doing weight-bearing exercises and eating a healthful diet high in green leafy vegetables and vegetables high in calcium like broccoli can help to maintain bone mass and prevent osteoporosis.

Taking estrogen helps also, but the benefit disappears when a woman stops taking the medication. Drugs designed specifically to prevent osteoporosis are also available. Get a bone density test if you are concerned you are at risk for this disease. Women who are at greatest risk are short, slender, fair-skinned, blonde, blue-eyed, and have a family history of osteoporosis. You may also be at risk if you had an early or surgical menopause.

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