Menopause is part of a gradual and natural process in which the ovaries produce less and less of the female hormones, estrogen and progesterone, and menstrual periods gradually disappear. For most women this process begins silently somewhere around 40 years of age when periods may become less regular. The average age women complete menopause is around 51. Some women experience menopause at younger ages due to premature ovarian failure, cancer therapy or surgical removal of both ovaries.

What are the signs of menopause?

Each woman experiences menopause differently. Changing hormone levels can cause a variety of symptoms that may last from a few months to a few years or longer. Some women have slight discomfort or worse. Others have little or no trouble. If any of these changes bother you, check with your doctor. The most common symptoms include:

• Change in periods — One of the first signs may be irregular periods; some may have a lighter flow than normal; others have a heavier flow and may bleed a lot for many days. They may come more often and last longer. There may be spotting between periods.
• Hot flashes — A hot flash is a sudden rush of heat in the upper part or all of your body.
• Problems with the vagina and bladder — Vaginal dryness can make sexual intercourse painful. Vaginal infections can become more common. Some women have more urinary tract infections or problems with holding urine.
• Sex — Some women find that their feelings about sex change with menopause. Some have vaginal dryness that makes sexual intercourse painful. Others feel freer after menopause, relieved that pregnancy is no longer a worry. Until you have had one full year without a period, you should still use birth control if you do not want to become pregnant. After menopause, a woman can still get sexually transmitted diseases and should make sure her partner uses a condom.
• Sleep problems — Some women find they have a hard time getting a good night's sleep. They may not fall asleep easily or may wake too early. They may need to get up to go to the bathroom and then not able to fall back to sleep. Hot flashes can interfere with sleep.
• Mood changes — There may be a relationship between changes in estrogen levels and a woman's mood. Shifts in mood also may also be caused by stress, family changes or feeling tired. Depression is not a symptom of menopause.

What about hormone replacement?

In menopause, your doctor might suggest taking estrogen and progesterone, know as hormone replacement therapy or HRT. HRT involves taking estrogen plus progestin. Estrogen alone, or ERT, is for women who have had their uterus removed. Estrogen plus progestin is for women with a uterus. Progestin, when used with estrogen, helps reduce the risk of uterine cancer. These hormones can be taken in a variety of forms such as pills, skin patches, creams or vaginal inserts, depending on a woman’s needs.

HRT or ERT may relieve menopause-related symptoms, such as hot flashes, and reduce bone loss; however, HRT has risks. It should not be used for long-term prevention of heart disease. Taking HRT increases, rather than reduces, the risk for heart disease and stroke. It also increases the risk of breast cancer and blood clots, but it appears to decrease the risk of colon cancer. Scientists are still studying the effects of HRT. Talk to your doctor about taking estrogen/progestin or about other treatments that may ease menopausal symptoms.

What about phytoestrogens?