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18 Things Every Woman Should Know About Menopause

Hot flashes. Sleepless nights. Weight gain. Intense crabbiness. You don't have to struggle through symptoms. There's actually an art to surviving, even thriving, through the change. Here's what your mother, sister, best friend and doctor never told you.

Just like booking an Eat-Pray-Love solo trip abroad or visiting a plastic surgeon, bringing up the (formerly) "silent passage" is no longer taboo. Experts and real women revealed all about "second springs" for our by-the-decades survival guide. Read on to find out how to outwit, outplay and outlast the next chapter in your life.

In Your 30s: What's Happening to Me?
"By the time you reach 35, your fertility starts to gradually decline and it may become more challenging to get pregnant," says Alyssa Dweck, M.D., Family Circle Health Advisory Board Member and co-author of V Is for Vagina (Ulysses). Levels of the hormones estrogen and progesterone slowly decrease, as do the number and quality of eggs your ovaries release.

To-Do List
Become Your Healthiest Self. What you do now impacts how early menopause starts, how intense the symptoms are and how they affect your body. "Women who are in better physical shape before menopause are more likely to maintain a reasonable body weight and reduce their risk of disease after the change," says Dr. Dweck. So get into a good-health groove.

1. Bust Stress
Mini meltdowns will be happening. "Devise a go-to stress management technique to help alleviate menopause-related anxiety," advises Jennifer Landa, M.D., chief medical officer of the BodyLogicMD women's and men's health office in Orlando, Florida, and co-author of The Sex Drive Solution for Women (Atlantic). Try tai chi or yoga, or turn to technology by creating a peaceful playlist on your iPod and using sites like calm.com for guided relaxation

2. Drop Pounds
Carrying excess weight worsens menopause symptoms. Since your metabolism slows as you get older, find a physical activity you love now (biking, swimming, hiking) and eat healthfully to slim down and beat the "middle-aged spread."

3. Quit Smoking
Light up and your risk of early menopause rises by about 60%, according to a study in BMC Public Health. Quit at least 10 years before menopause and you'll be 87% less likely than current smokers to enter the change early.

4. Get Strong
Preserve your calorie-torching muscle mass, which decreases as you age, by strength training twice weekly. One big bonus: Resistance exercises also increase bone density to prevent osteoporosis.

5. Boost Nutrition
Phytochemicals, found in broccoli, kale and other cruciferous veggies, help your body keep hormones balanced. Ever-present B vitamins are involved in producing mood-regulating brain chemicals like serotonin. Build a healthy recipe repertoire now.

6. Wear SPF
Sun damage is the number one cause of fine lines and wrinkles, which worsen as estrogen levels drop during menopause, stymieing collagen production. Make wearing a broad-spectrum facial moisturizer with SPF 30 a daily habit.

7. Control Cholesterol
LDL ("bad") cholesterol jumps nearly 10% in the two years surrounding menopause. Eat right and exercise to keep it in a healthy range as you age.

The #1 Test You Need Now
"Have your ob/gyn run a baseline hormone panel, which is an easy blood, saliva or urine test that determines your optimal hormone levels," says Dr. Landa. If you decide to get hormone therapy later, your doc can use your results to put you on hormones specific to your ideal range instead of the range of an average woman,

In Your 40s: What's Happening to Me?
One of the first signs of perimenopause—a stage before menopause that can last up to 10 years—are changes in your menstrual cycle. Periods may become irregular, heavier or lighter, or you may skip some altogether. Fluctuations in progesterone and estrogen levels, as well as changes related to aging, contribute to different perimenopausal symptoms.

To-Do List
Know the Signs. Worried that you find yourself welling up during ASPCA commercials or staring at the ceiling unable to sleep at night? Both insomnia and mood swings are signs of perimenopause. Joint pain, heart palpitations and forgetfulness are also on the list. "Many women are frightened that these symptoms mean something's seriously wrong," says Dr. Dweck. "They have no idea why they're feeling this way." Overcome the fear and ease symptoms with lifestyle modifications.

1. Hot Flashes
One minute you're on fire (off with the sweater!), the next you're freezing (on with the sweater!). Spicy foods, caffeine, hot drinks, alcohol and stress (like that fight you keeping having with your teenage daughter) are all common triggers. Try to avoid them.

2. Increased Anxiety
Life changes (kid switching schools, moving to a new town) along with hormonal fluctuations are major sources of stress. Tap into om mode with relaxation techniques or exercise for frazzled moments. A recent study found that middle-aged women who engaged in 50 minutes of aerobic exercise four times per week for six months experienced reduced night sweats, fewer mood swings and less irritability compared with those who didn't. Plus, moderate exercise reduces levels of the stress chemicals cortisol and adrenaline.

3. Joint Pain
Although the cause is unclear, about 40% of women approaching menopause experience aching joints. "Ease the pain by taking omega-3 fish oil supplements with 500 to 1,000 mg of DHA and EPA [combined], which help reduce inflammation," explains Susan Dopart, M.S., R.D., author of A Recipe for Life by the Doctor's Dietitian (SGJ Publishing).

4. Sleepless Nights
About 60% of women report disturbed zzz's during perimenopause thanks in part to the decline of sleep-promoting progesterone (not to mention waiting up for your kids to make curfew). Good sleep hygiene is critical. Establish soothing bedtime habits: Take a bath, sip chamomile tea, turn off the TV one to two hours before bed. And for short-term use, consider OTC meds like Tylenol PM (drugstore.com, $5) or Benadryl (drugstore.com, $5), suggests Manhattan-based ob-gyn Tara Allmen, M.D., a nationally certified menopause practitioner.

5. Decreased Sex Drive
Lower levels of estrogen cause those "not tonight, honey" moments, notes Dr. Landa. Plus, changes in your body can further decrease sexual desire, as can stress and lack of sleep. Communicating with your spouse about your emotional and physical needs (like incorporating more foreplay to feel aroused) is key.

Rx Relief
Talk to your ob/gyn about these two prescriptions, which can ease symptoms:
1. Low-Dose Birth Control Pills: They're good for regulating hormones if you're a nonsmoker. "You can take active pills the entire month and skip the placebos. Most women can stay on them until they reach menopause, which a blood test can determine," says Dr. Allmen.

2. Lysteda: Many people think periods dwindle to a trickle as you age. Not true. "In reality, many women find they get heavier, which contributes to anemia," says menopause expert Donnica Moore, M.D. She prescribes Lysteda, a medication to treat heavy menstrual bleeding.

In Your 50s: What's Happening to Me?
The average woman hits menopause at age 51. Ovaries stop secreting estrogen and progesterone and ovulation ends. Once you've gone without menstruating for a year, consider yourself postmenopausal.

To-Do List
Conquer These Symptoms. A whopping 72% of women with menopausal issues aren't treated. Why? "Fears about hormonal therapy and confusion about the safety and effectiveness of other options keep women from seeking help," says Cynthia Stuenkel, M.D., clinical professor of medicine in the division of endocrinology and metabolism at the University of California-San Diego. But those aren't your only options.

While nearly 25% of women won't have bothersome symptoms, most of us will, and they last for four years on average. "It's not like menopause symptoms will kill you, but you don't have to suffer!" says Hilda Hutcherson, M.D., a clinical professor of obstetrics and gynecology at Columbia University Medical Center in New York City. The Endocrine Society developed the Menopause Map to help you navigate treatment choices. Also, experiment with solutions like the ones our experts recommend below.

1. Do Away with Hot Flashes and Night Sweats
When dressing in layers and waking up drenched in sweat get old, consider black cohosh. Popping high doses of the herb reduced the number of hot flashes by a third for women who took it for a year in one study, says Dr. Allmen. Try 20 mg of the brand Remifemin (drugstore.com, $21) twice a day. Not interested in cohosh? Try Poise's roll-on cooling gel (drugstores nationwide, $8).

2. Turn Off Tension
Daily pressures can crank up your worry meter, and anxiety makes you up to five times more vulnerable to hot flashes. Dr. Hutcherson notes that many of her patients respond well to acupuncture. "It addresses anxiety and stress as well as difficulty sleeping and hot flashes," she says.

3. Overcome Insomnia
Being pulled in a dozen different directions and can't wind down and catch some shut-eye? Consider prescription sleep aids like Ambien or Lunesta.

4. Sharpen a Foggy Brain
To reiterate: You're not losing your marbles. Fuzzy-headed happenings (where is my purse?) are a real phenomenon for menopausal women, according to research from the University of Rochester. Donnica Moore, M.D., advises patients to address sleep problems first: "Exhaustion is usually at the root of concentration and focus issues," she says.

5. Up Your Pleasure
Enjoying intimate moments is tricky when it hurts to have them. Painful sex is most likely caused by declining estrogen levels that lead to down-there dryness. Try moisturizers like Replens (drugstore.com, $17) and lubricants like KY Jelly (drugstore.com, $5) to enhance comfort.

6. Beat Irritability
Sufficient sleep helps (yes, we know; easier said than done), and some women find OTC meds such as Estroven (drugstore.com, $12) or Amberen (drugstore.com, $50) useful.

The Truth About Hormone Therapy
First we heard it raises your risk of heart attacks, blood clots, breast cancer and stroke. Then word was it's safe. Today the tide has turned back to hormone therapy (HT) as a viable option if you're suffering from moderate to severe symptoms, are younger than 59, aren't at an increased risk of heart disease or stroke and don't have a personal history of breast cancer. "It's safe overall for women within 10 years of the start of menopause," says Dr. Stuenkel. "The risks are real but they're small, and HT remains the best way to improve hot flashes, sleep disruption and vaginal symptoms." The U.S. Preventive Services Task Force recently concluded HT shouldn't be used to prevent chronic diseases like dementia. Short-term use at the lowest dose is the safest course.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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10/11/12 2:31 A

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What Is Depression?
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

The term depression is one you hear frequently. It's not unusual for people to say they're depressed by the weather, their jobs, their haircuts, their prospects for dinner, or the night's television lineup. But there's a world of difference between these passing feelings of disappointment, dissatisfaction, or sadness, and an ongoing state of major depression.
For all of the overwrought “depressions” you hear about every day, true depression is a real problem faced by hundreds of thousands of people in our society. According to the Journal of the American Medical Association, between 5 and 10 percent of the U.S. population experiences major depression, and nearly 25 percent of all women will suffer from depression at some point during their lives.

Major depression is an illness that prevents sufferers from working, eating, sleeping, studying, and enjoying a full, normal life and range of moods. Major depression typically results from changes in brain chemistry; therefore, even though it can occur once in a lifetime, many people who suffer from major depression experience it several times.

Menopause and Depression
Many studies have shown that women first experience depression when they're in their twenties, or even younger. And although menopause doesn't automatically signal the onset of depression, women who have suffered from depression earlier in life — or women who have had postpartum depression or even severe premenstrual syndrome (PMS) — are more likely to have recurring depression during perimenopause. Women who have a family history of depression also run more risk of suffering from depression during perimenopause.
Sometimes, depression itself can be a symptom or side effect of some major life event, such as a divorce, the death of a loved one, losing a job, or dealing with a severe or ongoing medical problem — all problems that can occur to women at midlife. But these sorts of event-triggered depressions may pass with time or resolve themselves quickly, without the need for special treatment or therapy. Sometimes, however, these events can lead to depression that deepens into a more systemic, major depression that women are unlikely to overcome without some form of treatment.

Another, less severe, type of depression is known as dysthymia. The symptoms of dysthymia are similar to those of major depression and may be chronic and long term, but they aren't disabling. Finally, bipolar disorder (manic-depressive illness) is another kind of depression. People suffering from a bipolar disorder experience extreme mood shifts that swing wildly between manic highs and depressed lows.

Know the Symptoms of Depression
Though transient feelings of sadness, despair, or a general dissatisfaction with life are common during perimenopause, if these feelings are long lasting or severe, they could be signaling the onset of depression. Insomnia, fatigue, hot flashes, and other perimenopausal symptoms can trigger minor mood disorders during perimenopause.

But major depression goes well beyond the typical reaction to these symptoms and is often the result of a biological or chemical imbalance that requires careful diagnosis and treatment. The National Institute of Mental Health provides a list of common symptoms of depression (though it notes that few people suffer all of them). Here are some of those symptoms:

• Feeling persistently sad, anxious, empty, hopeless, or pessimistic
• A strong sense of impending doom
• A loss of interest in hobbies or activities you once enjoyed (including sex)
• Feeling guilty, worthless, or helpless
• Losing energy and feeling fatigued and slowed down
• Suffering from insomnia, early morning awakening, or oversleeping
• Experiencing a dramatic change in appetite or weight
• Difficulty concentrating, remembering, or making decisions
• Thoughts of suicide and death, or suicide attempts
• Feeling restless and irritable
• Suffering from persistent physical symptoms (headache, pain, digestive disorders) that don't respond to treatment

Essential
If you suffer from low self-esteem, feel overwhelmed by stress, or have a persistently pessimistic attitude toward life, you might be at risk for developing depression. Scientists continue to study the causes of depression to determine whether these types of feelings are an indicator that you're prone to depression, or whether these feelings can actually trigger the illness.

The Causes of Depression
No one cause is at the source of every case of depression, but it usually is associated with a change in the brain's structure or functions. Sometimes a vulnerability to depression is genetically inherited, but depression can be brought on by physical changes resulting from stress, injury, an accident, or a serious emotional event.
If an individual feels at the mercy of a disease or illness, he or she can fall into depression. Severe illnesses such as heart attack, stroke, and cancer can lead to depression, as can progressive illnesses such as Parkinson's disease.

Financial problems, the death of a loved one, the loss of a job, a parent's illness, the departure of grown children, and other stressful changes to a daily routine also can push people into depression. Even a change of address or an abrupt change in a close circle of friends can trigger the onset of a depression that's been building over time. Finally, hormonal shifts, such as those women experience in pregnancy, perimenopause, and menopause, can also contribute to depression in women.

Considering all these triggers, you easily can see how some women might suffer from depression during perimenopause. Menopause itself doesn't cause depression, but the hormonal changes of perimenopause can join with other natural life events of middle age to contribute to a depressed state.

Take Action
Alert
As you approach menopause, consider your risks for depression. Do you have a family history of depression? Have you suffered from severe PMS or postpartum depression earlier in your life? If you have a predisposition, don't ignore feelings of depression that arise as you near the age of menopause. Talk to your doctor, therapist, or other health care professional about your concerns early.

Major depression is an illness, with many options for treatment. The sooner you get help, the more quickly and effectively you can overcome the physical and emotional side effects of this devastating condition. Many women can go through months of emotional turmoil thinking, “It's just a bad day,” then “What a bad week,” to “This month has been awful,” and still believe that they're just feeling temporarily down. Often, these women are taken aback when a friend, spouse, or relative expresses concerns over their moodiness, irritability, or remoteness.
If you or those around you suspect that your emotional behavior may signal a mood disorder, you need to seek a diagnosis and, if necessary, make behavioral changes or begin treatment. Your goal is to get your life back in balance, so you can regain your sense of confidence and purpose.

Rule Out Medical Causes
Mood swings, depression, and anxiety can all be triggered or made worse by medical problems. Thyroid disorders can sometimes result in depression, as can the use of some medications used to treat high blood pressure. Some weight-loss drugs can trigger a rise in anxiety levels or even panic attacks. Begin by talking with your gynecologist or general practitioner, who can review your medications and health history to uncover any potential medical causes for your mood disorders.

Your doctor or health care provider can also uncover contributing medical conditions, such as insomnia, sleep apnea, or extreme hormonal imbalances, which may contribute to your mood swings. If your doctor uncovers specific medical causes for your condition, he or she can adjust your medication, treat the contributing medical condition, or suggest other specific treatment options to address those issues.
Explore Your Treatment Options
When medical complications have been ruled out, you have several treatment options available to you for diminishing — or even eliminating — your mood disorder symptoms. The option that's best for you is determined, in part, by the severity of your problem and your personal and family medical history.

If you suffer from major depression, your doctor is likely to prescribe an antidepressant medication. Following is a quick list of some of the most commonly prescribed antidepressant and anti-anxiety medications:

• Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, sertraline, paroxetine, and citalopram (marketed as Prozac, Zoloft, Paxil, and Celexa). Though SSRIs can cause depressed sexual response and other side effects in certain individuals, they are non-addictive and work by helping your body make better use of the serotonin it naturally produces. Some of these medications are effective with anxiety as well.
Fact
Many doctors prescribe antidepressants in combination with hormone therapy for perimenopausal or menopausal women with severe depression. Though hormone therapy is rarely the first-course treatment for depression, it can alleviate symptoms such as hot flashes and insomnia that contribute to depression, and it offers other benefits for some menopausal women.
• Tricyclic antidepressants such as desipramine, amitriptyline, imipramine and others, have been used for many years to treat depression. While they do have some annoying side effects such as dry mouth, sleepiness, sensitivity to the sun, and low blood pressure, these medications can be very effective in treating depression. Since they interact with many other medications and may change blood sugar levels, you should tell your health provider about all other medications you are on, and any medical conditions you might have before starting these drugs.
• Anti-anxiety drugs, or anxiolytics — such as buspirone and alprazolam — can lessen the effects of depression, anxiety, and sleeplessness, and they also can treat the symptoms of PMDD that many perimenopausal women experience as they move closer to menopause. Anxiolytics can have a slightly sedative effect and can be addictive, so many doctors prescribe them for short periods of time only.

Essential
Learning to be optimistic can have real physical and emotional health benefits. Studies continue to point to the benefits of optimism, including increased feelings of well-being, better immune response, and quicker recovery from injury and disease. Best of all, it can be learned! So even if you aren't rosy by nature, you can learn techniques to have an optimistic outlook that will benefit your physical and emotional health.

Psychological counseling — psychotherapy — is a powerful treatment option for women experiencing excess anxiety, stress, or mood disturbance during perimenopause and menopause. Most studies have shown that counseling in conjunction with antidepressant medication offers more long-term and effective results than does a treatment using medication alone. Though you may not experience the benefits of psychotherapy immediately after you begin treatment, its effects can be long lasting and extensive.
The two types of psychotherapy you are most likely to receive for emotional problems associated with perimenopause are interpersonal therapy or cognitive behavioral therapy. Interpersonal therapy explores the relationships in your life and how they contribute to your emotional problems. This type of therapy also teaches you how you may use the strength and support you gain from your relationships to help deal with emotional issues.

Cognitive behavioral therapy examines your core thoughts and beliefs and how they determine your actions in response to life. If you have developed a pessimistic or negative attitude toward life, this type of therapy can help you see the world in a more balanced perspective and learn more effective ways of viewing and coping with challenges.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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10/4/12 1:48 A

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Anxietyby Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Anxiety is a natural, healthy response to certain realities of life — beginning a new job, meeting upcoming deadlines, passing examinations, and so on. But anxiety that interferes with your ability to function throughout your day and then sleep soundly through the night is definitely unhealthy. Anxiety can be a side effect of a more serious mood-destabilizing condition — depression.

The Symptoms of Anxiety
Anxiety can be associated with depression, or it can be a side effect of sleeplessness, excess fatigue, or unmanageable levels of stress. Many people suffering from anxiety describe it as overwhelming feelings of fear, nervousness, or the conviction that something dreadful is about to happen — though they often can't pinpoint what that something may be. When these feelings begin to interfere with normal, everyday functioning, they may signal an anxiety disorder. Some other symptoms of anxiety include:
• An unshakable feeling of fear, dread, or worry that lasts for more than three days
• Chest pain, racing heart, or fast breathing
• Stomach pain, cramps, or diarrhea
• Hand wringing, pacing, or other repetitive nervous movement

Essential
Two important skills for decreasing stress are setting priorities and delegating. Take a look at responsibilities and decide which ones are truly essential. Women tend to think they have to do everything, without considering what is essential and what is optional. Once you have set priorities, delegate. Doing these things at the first sign of stress can save you from a real meltdown later on.

Anxiety Can Lead to More Serious Conditions
Anxiety that goes unchecked can develop into anxiety disorders. These disorders include social phobias, such as agoraphobia (fear of going out in public), specific phobias (such as fear of dogs or spiders), or obsessive behaviors (such as obsessive hand washing or repeatedly checking door locks or appliance switches).

Women in perimenopause sometimes report the occurrence of panic attacks — overwhelming feelings of intense fear or impending doom that occur suddenly and repeatedly. Symptoms include shortness of breath, choking sensations, heart pounding or palpitations, and the sensation of losing control. If you have episodes that sound like this, talk to your health professional or a counselor. There are effective treatments for panic disorder.

Alert
Some of the symptoms of anxiety such as a feeling of doom, shortness of breath, heart palpitations, nausea, and clamminess could also be typically female symptoms of a heart attack. Don't minimize these events, but use them as a chance to rule out physical causes. Discuss them with your medical care provider, and ask whether you should have a cardiac evaluation.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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10/3/12 9:49 P

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Looking Stress in the Eyeby
Kate Bracy Kalb, R.N., M.S., A.R.N.P
.
Stress is a fact of life for everyone, and women approaching the age of menopause certainly aren't immune to its effects. In fact, women in perimenopause may be more susceptible to the health-damaging side effects of stress than they had been previously.
Women in midlife can be faced with career and financial issues, body-image changes, emerging health problems, divorce, widowhood, struggles with teenage children, and increasing responsibilities for aging parents. The added stress of adjusting to hormonal fluctuations, hot flashes, weight gain, or other potential side effects of perimenopause can make the burden of stress even harder to bear.

Fact
Your stress may be connected to a medical condition or to the medication or treatment program you're using to combat one. Your doctor or health care provider may be able to adjust your medication or offer additional treatment options that can help you reduce and manage any health-related stressors you're encountering.

Some of the most common symptoms of stress include headaches, sleeplessness, indigestion, forgetfulness, an inability to concentrate, and ongoing feelings of anger and unhappiness. Stress can leave you feeling drained of all good feeling, and it can lead to overeating, drinking too much alcohol, or intensifying other unhealthy stress habits such as cigarette smoking. If you experience any of these symptoms of stress, you may have a real, health-threatening problem and can take action to determine its sources and potential solutions. Unless you find ways to eliminate or manage stress, you won't be successful in combating the mood-related problems you may experience during perimenopause.

Managing Stress
You can't avoid all sources of stress, but you may be able to find workarounds for many of them. If a hectic work and family schedule is depleting your energy and stressing you out, what can you trim from your list of daily activities? Can you ask a partner for help in managing household tasks or running errands? Can you afford to hire a service to do laundry, pick up and deliver dry cleaning, or take over major cleaning jobs around the house? If you have children, can you ask them to step up and take more responsibility for their own needs, or to help out more around the house? If aging parents are presenting increasing demands on your time, can you get any type of community support assistance, such as meal deliveries or the services of a visiting nurse?

Alert
Stress can trigger the biological changes that accompany depression, and it appears that hormonal shifts can trigger those changes, too. That's why women with a family or personal history of depression must be particularly careful to monitor and manage stress as they approach the age of menopause.

Getting Handle on Work Stressors
Evaluate your job and work habits to try to spot stress fixes there, as well. Can you ask your boss for flexible work times, so you can schedule your commute when traffic is less hectic, or even arrange to work at home one day a week? Can you find someone to carpool with? If you commute by train, can you do some of your work on a laptop computer and save time at the office? If you have problems with a coworker, can you schedule a meeting to try to resolve the issues, or at least to lessen the tension? Can a personal organizer, meeting scheduler program, or other software help you save time and cut down on unnecessary panic and last-minute emergencies?

Once you've pinpointed and reduced the stressors that you can, find ways to cope with the stress you can't avoid. Exercise regularly, spend time engaged in leisure activities you enjoy, eat a healthy diet, and go easy on your mind and body — don't expect to perform every task perfectly and on time.

The first key to addressing stress is to admit that stress is a real health risk — one you simply cannot overlook. Stress will wear you out, age your body and mind, drain your spirit, and cause lasting health problems. Though you may feel that you're stuck with the stressful situations you currently endure, you do have options available to you. Talk to your doctor, a therapist, a counselor, a friend, a minister, or a trusted family member, and ask for help in finding ways to manage stress.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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10/1/12 1:55 A

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Menopause and Emotions
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Fluctuating hormones can cause emotional shifting. As anyone who has experienced premenstrual swings can understand, the effect of variable hormones on a woman's emotional stability can be unpredictable and unnerving. It's not just that your mood and behavior shift, but it's how they shift and how fast they shift that can leave you wondering what hit you.

“I'm Feeling Hormonal”
Women are used to the jokes and comments that people make about “that time of the month.” Medical professionals are still studying and exploring the many ways hormones affect neurological processes, and in turn how women feel emotionally. It is usually the steroid hormones like estrogen, progesterone, and testosterone that get the attention around reproductive changes like menarche, puberty, and menopause. But there are many other hormones that change during these times and interact with brain functions, and these changes can cause strong emotional and behavior reactions.

Don't Kill the Messengers
Hormones are essentially chemical messengers designed to enter the bloodstream and serve some specific purpose. Since they have many different purposes such as reproduction, growth, or regulating the metabolism, it is not surprising that one of the areas they act on is the brain and its functions. So when one “family” of hormones changes, as when estrogen begins to decrease, it has a larger effect as other chemical messengers shift to keep things in balance. In the process of all this shifting around, some messages can get a little scrambled. If those scrambled messages alter your neurological processes, you may experience unfamiliar or unwanted emotional states.

Most of these changes are temporary if they are adjustments to your perimenopausal metabolism. But temporary or not, they can be upsetting and stressful if they show up as episodes of sadness, or rage, or even irritability. Some women experience many emotional variations during this phase, and some glide through without noticing much difference at all.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Mood Swings
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Researchers believe that the fluctuating levels of estrogen and progesterone many women experience during this time contribute to mood swings and other emotional symptoms, though there are no clear conclusions about how this happens.

Doctors know, however, that estrogen is directly related to our body's production of serotonin — an important chemical that works in the brain to regulate moods. As estrogen levels shift, so does the brain's supply of serotonin — and therefore, moods can shift, as well.

But body chemistry isn't the only thing that can trigger midlife mood decay. Women who are dealing with changing roles at home or at work or changing levels of energy, or who feel less fit or less healthy, may suffer from emotional upheavals and imbalances. Coming to grips with your emotional upsets by recognizing symptoms and tracking them to their source can be a first step toward solving the problem.

Which Comes First?
Just as mood swings in perimenopause can have both physical and emotional consequences, the causes of those mood swings can be both physical and emotional. First, consider that many of the symptoms of perimenopause can cause emotional distress. Hot flashes can lead to sleeplessness, fatigue, irritability, and anxiety. Those factors alone can make you feel angry, isolated, and under siege — and may contribute to occasional moodiness and transient depression. It is sometimes hard to sort out whether your moods swing because of other symptoms, or those symptoms come from your unpredictable reactions.

Fact
Mood swings are characterized by strong and sometimes rapidly changing emotional events. Women approaching menopause may report anxiety and panic attacks, bouts of sadness, or unexplained surges of elation. These emotional swings tend to be erratic and transient, not long-lived facts of life for perimenopausal women.

Tracking Your Mood Swings
Mood shifts are relatively mild changes in mood that can quickly take a woman from feelings of joy to anger, fatigue, or despair. The triggers for these responses can be unpredictable — and sometimes seemingly inconsequential. Perimenopausal women who report mood swings cite a wide range of stimuli for these events.

If you're swinging, you can be moved to tears by a song on the radio or the color of the light as evening falls over your backyard. You can become incredibly angry when a coworker asks for clarification of a point you made in a memo, when children or a partner fail to take care of their household responsibilities, or when you forget to stop and pick up the dry cleaning on your way home. Mood swings can sometimes be no more than a typical response, but more intensely felt.

You may be reacting to some source of irritation, unhappiness, discomfort, fear, love, joy, or longing. As estrogen levels rise and fall, serotonin levels can rise and fall, too, taking your mood right along with them. Mood swings can also be a response to a medical condition or chemical imbalance in your body — one, that might be treatable through counseling, medication, or other therapy. Your mood swings can teach you a lot about who you are, what issues and changes you're dealing with, and where you want to go during this transition in your life.

You can expect some mood swings in your life, but many women in perimenopause develop mood swings that interfere with their daily living. Frequent or severe mood swings can create problems with family, coworkers, and friends. They can cause missed workdays, discourage participation in social functions or enjoyable activities, or create feelings of alienation, exhaustion, fear, and a lack of control. If mood swings are severe or frequent enough to get in the way of your full — and fulfilling — life, take action to bring them under control.

Essential
To get a handle on your mood swings, try tracking them for a month. Use a 1–5 scale, where 1 = happy and on track, and 5 = extremely negative, angry or sad. Record your mood at given times during the day or any times you notice changes. After recording for a month, look over your “mood map” and see if there are any patterns. Then talk to your health care provider about what might help.


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Menopause and Emotions
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Fluctuating hormones can cause emotional shifting. As anyone who has experienced premenstrual swings can understand, the effect of variable hormones on a woman's emotional stability can be unpredictable and unnerving. It's not just that your mood and behavior shift, but it's how they shift and how fast they shift that can leave you wondering what hit you.

“I'm Feeling Hormonal”
Women are used to the jokes and comments that people make about “that time of the month.” Medical professionals are still studying and exploring the many ways hormones affect neurological processes, and in turn how women feel emotionally. It is usually the steroid hormones like estrogen, progesterone, and testosterone that get the attention around reproductive changes like menarche, puberty, and menopause. But there are many other hormones that change during these times and interact with brain functions, and these changes can cause strong emotional and behavior reactions.

Don't Kill the Messengers
Hormones are essentially chemical messengers designed to enter the bloodstream and serve some specific purpose. Since they have many different purposes such as reproduction, growth, or regulating the metabolism, it is not surprising that one of the areas they act on is the brain and its functions. So when one “family” of hormones changes, as when estrogen begins to decrease, it has a larger effect as other chemical messengers shift to keep things in balance. In the process of all this shifting around, some messages can get a little scrambled. If those scrambled messages alter your neurological processes, you may experience unfamiliar or unwanted emotional states.

Most of these changes are temporary if they are adjustments to your perimenopausal metabolism. But temporary or not, they can be upsetting and stressful if they show up as episodes of sadness, or rage, or even irritability. Some women experience many emotional variations during this phase, and some glide through without noticing much difference at all.


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Other Neurological Symptoms
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Because hormones can have such wide-ranging effects on the brain and nervous system, women report many symptoms that are not always found on the “typical signs of menopause” lists. But if they are, in fact, due to the changing levels of estrogen, these troublesome symptoms will be temporary and disappear as your body adjusts to new hormone levels.

Tinnitus
Tinnitus is defined as “ringing in the ears,” but it has also been described as whooshing, roaring, chirping, pulsing, and screeching. It can be any persistent noise that a person hears, but that is not generated outside the body. While women sometimes begin to notice it with the onset of perimenopause, it has also been associated with other hormone shifts such as puberty and pregnancy. It is not clear how much of this symptom is related to the change in hormone levels, and how much is the result of getting older. By the age of sixty-five, a third of women will report that they have tinnitus at least now and then.

Alert
Be aware that although often benign, tinnitus can also signal a serious medical condition such as heart disease or thyroid problem. It can also be a side effect of medications including hormone therapy, antidepressants, and pain medications. Be sure to report it to your health care practitioner when discussing your symptoms.
One cause may be otosclerosis, which is a stiffening or hardening of the bones in the ear and can lead to loss of hearing. Tinnitus has also been reported as a side effect of menopausal hormone therapy, and has been related to fluid retention. There is no well-defined treatment for tinnitus, but here are some things you can do to help reduce it:

• Avoid loud sounds or excessively noisy environments.
• Decrease your intake of sodium/salt.
• Avoid stimulants such as caffeine and nicotine.
• Have your blood pressure checked to be sure it is within normal range.
• Get adequate exercise to increase blood flow to all of your body.
• Get enough sleep.
• Use “white noise” machines to make tinnitus less bothersome when trying to fall asleep.
• Practice relaxation or biofeedback exercises to reduce stress.
• Avoid aspirin or other pain medications in the non-steroidal anti-inflammatory (NSAID) family such as ibuprofen and naproxen.

Tingling/Burning and Other Paresthesias
A paresthesia is a skin sensation without an apparent physical cause. These sensations are reported by women in perimenopause, and can be unsettling. They take many forms, and may be described as numbness, pricking, burning, tingling, creepy crawly, pins and needles, or electric shocks; some women describe feeling “cobwebby” or feeling that they have “ants under the skin.” It is thought that they are the result of vasomotor instability, the same mechanism that brings you hot flashes. In fact, some women get a paresthesia just before a hot flash, as a sort of warning. Paresthesia may also be caused by the hyperventilation that some women experience with panic or anxiety attacks. Whatever the cause, they are usually transitory, and seem to improve after actual menopause occurs.

Some women experience facial paresthesias that signal a oncoming migraine headache. Most paresthesias are more emotionally disturbing than physically dangerous. But since multiple sclerosis and some neurological conditions have this as a symptom, you should report it to your medical provider.

You're Not Crazy!
This chapter has described many neurological and cognitive symptoms that occur during menopause. As with all menopausal symptoms, these are interrelated with your health and lifestyle, and must be considered as part of the larger picture of perimenopause. Your emotional health, physical health, and life situation all influence how your symptoms will express themselves. Realize that these symptoms change as you go through the perimenopause and that you are not “going crazy.” As with adolescence, your shift in hormones may cause changes that, although hard to keep up with, are perfectly normal.


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Dizziness
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Although it is not known exactly why, many women find that they have episodes of dizziness during the perimenopause. The dizziness can range from just a slight sensation of “room spinning” to debilitating nausea or vertigo that affects your ability to walk.
There are several causes that might account for dizziness at this time of life. In most cases, it is likely to be one of the following:

• Hyperventilation. Stress or anxiety can trigger shallow breathing, which can cause your arteries to constrict. This loss of blood to your brain and extremities can make you light-headed and can cause your hands and feet feel to be numb. Taking long, slow, deep breaths may reduce the dizziness.

Fact
Dizziness can be a side effect of many medications, including antidepressants, blood pressure medicines, heartburn medications, sedatives, antihistamines, and decongestants. If you are taking any of these medications, check with your pharmacist or health care provider to see if dizziness is a side effect.
• Low blood sugar levels. If you are dieting rigorously, or just busy and not paying attention to mealtimes, you may have a drop in blood sugar that makes you feel light-headed. If this is common for you, schedule frequent snacks containing some protein with complex carbohydrates — such as cheese and whole-wheat crackers.
• Hypotension. If you notice dizziness when you stand up quickly, it's possible that you are having a drop in blood pressure when you stand. Change positions slowly, and increase your water intake, since being dehydrated can make your blood pressure even lower.

More Serious Possibilities
Although dizziness is common in the perimenopause, it can also be caused by serious conditions that need to be evaluated. Stroke, Parkinson's disease, cancerous tumors, vestibular disorders, and multiple sclerosis are all conditions that may have dizziness as a symptom. If you have dizziness that came on suddenly, impacts your ability to perform day-to-day activities, has other neurological symptoms along with it, or persists for weeks, see your health care provider about possible causes.


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Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Headaches
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Headaches are a common perimenopausal symptom. Some women will experience migraine headaches for the first time during this period, or a worsening of a long-standing migraine condition. Others will notice an increase in tension headaches. Whether it is migraine or tension, a headache can seriously limit your productivity and well-being.

Migraine Headaches
Migraine headaches are vascular, and are caused by blood vessels in the head enlarging, and then nerves around the blood vessels releasing chemicals that cause inflammation and pain. This migraine event usually triggers the “sympathetic” nervous system, the so-called “fight or flight” response, and thereby may cause nausea, vomiting, and diarrhea.

Since migraine headaches are sensitive to hormone shifts, women tend to have more of them during times when hormones fluctuate, such as the premenstruum, pregnancy, and menopause. They can be little more than a nuisance, or they can be debilitating events that put you out of commission for days at a time.

Fact
As many as 20 percent of migraine headaches are immediately preceded by an “aura” or sensory change. The aura may be a visual change such as flashing lights or a blind spot in the visual field, a “pins and needles” sensation on one side, or even a strange taste or sound. This aura is sometimes enough of a heads-up that medication can be started in time to diminish the headache.

Some women experience an advanced warning other than an aura that comes days or hours before the headache. It may take any of a number of forms, including:
Irritability, sadness. Euphoria. Sleepiness. Yawning, food cravings
People with this sort of migraine learn to heed the warning and seek treatment before the headache hits. Often there are triggers for migraine headaches, including foods (aged cheese, coffee, chocolate, pickled items, and others), changes in sleep patterns (too much or too little), stress, artificial sweeteners such as aspartame, fasting, odors, alcohol, food additives such as monosodium glutamate (MSG), bright and flashing lights, and others. Sometimes avoiding triggers is effective in reducing the headaches significantly.

There are many ways to treat migraine headaches, some of them requiring prescription and some available over the counter. Combining caffeine with common pain medications is effective for some. Others find that they need to try prescription medications such as triptans or ergot formulas. Talking to your health care provider is important to determine which medications are best for you, and which will not interact badly with other medications you may be taking.

Non-medication approaches for migraine headaches include relaxation techniques and biofeedback. Ice can be effective in aborting headaches, and getting sufficient sleep is also important in preventing migraine attacks.

Essential
If you notice an increase in migraine headaches with menopause, see your health care provider. He or she can help you choose prevention and treatment options, and can sort out whether this change is related to a more serious medical condition, such as stroke or neurological disease.

Non-Migraine Headaches
A non-migraine headache is usually called a “tension headache.” As with migraines, these are more common in women than men, and often begin in middle adulthood. Tension headaches, as the name implies, seem to result in the muscular tension in the neck and shoulders. As life, work and family become increasingly stressful, women notice more severe and more frequent tension headaches. Tension headaches may be associated with anxiety or depression, and are often treated successfully.

Treatment of tension headaches may be with common pain medications such as ibuprofen or acetaminophen, or with relaxation techniques and biofeedback, or some combination of the two. The most effective approach also is one that reduces the stress that causes the headache to begin with (more about stress management in Chapter 8). Some women find that chiropractic care, acupuncture, and/or massage can significantly reduce the number or severity of their tension headaches.

Alert
A headache that comes on suddenly after the age of fifty can be a sign of serious illness. If you are a regular headache sufferer who notices a change in your headache pattern; if you have never had headaches and suddenly begin to have them; if your headache lasts for more than a day; or if your headache is not relieved with simple pain relievers, see your medical provider right away.


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Understanding and Treating Sleep Problems
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Hormonal imbalances aren't the only cause of sleep disruption for women in perimenopause and menopause. Depression and anxiety are common contributors to sleeplessness. Remember, these problems feed each other. The less rested you are, the more powerful your negative feelings become, and the less able you are to see your way through them. Stress — an enemy of women at any age — can also severely inhibit your ability to enjoy deep, restful sleep. A late-night trip to the bathroom, for example, may be followed by hours of sleeplessness brought on by stress-induced worry. If you awaken due to pain, or have a tendency to “snap” awake at 4 a.m. for no good reason, and lie in bed worrying about vague concerns or relatively inconsequential issues until the alarm goes off at 7 A.M., stress is playing a role in your sleep disturbance. All of these triggers can combine to create a powerful enemy of your good health as you approach and pass through menopause.

Acknowledging that sleep disturbance is part of this overall pattern is an important first step in any treatment. The next step is to talk with health professional about these problems and their solution.

Your sleep problems may have nothing to do with stress, anxiety, or tension, but could have physical sources. One in four women over fifty, for example, suffers from sleep apnea, a sleep disorder in which the sleeper stops breathing for frequent, short periods throughout the night. Snoring and daytime sleepiness are clues that you might be suffering from sleep apnea. Snoring can increase with weight gain — particularly when you gain weight around your neck. If you have a problem with daytime sleepiness and your partner complains that your snoring is becoming louder, see your doctor. Sleep apnea is associated with other medical problems, including high blood pressure and cardiovascular disease, so it isn't something to blow off (so to speak).

More women than men suffer pain-related sleep problems. Pain from arthritis, migraine headaches, tension, chronic fatigue syndrome, and fibromyalgia have been linked to sleep disruption in women. Pain can make falling asleep and staying asleep more difficult, but many people fail to report (or recognize) sleeplessness as a problem. If pain is interrupting your sleep, ask your health care professional about pain management options.

Fact
Rapid Eye Movement (REM) sleep is the most active sleep state — the one in which dreams occur. Scientists divide non-REM sleep (about 80 percent of total sleep) into four stages. In each stage, brain waves grow larger and slower. After the fourth stage, the deepest period of sleep, the brain waves reverse the pattern; sleep progresses toward its lightest stage, REM sleep. Typically, the cycle takes about ninety minutes.

Travel can wreak havoc with sleep quality and quantity, too. Many menopausal and perimenopausal women are in professional positions that require them to travel frequently. Hopping from time zone to time zone, spending long hours in airports and on planes, and sleeping in one hotel after another can seriously damage the quality and quantity of anyone's sleep. If you're already dealing with fluctuating hormones and subsequent hot flashes, night sweats, and periodic anxiety attacks, this kind of disruption can make your sleep problems even more severe.

Alert
If you or your partner is a heavy snorer, or have other risk factors for sleep apnea, your symptoms could cause sleep problems for both of you. Sleep apnea is a serious condition and can contribute to overweight and heart disease. Your primary care physician can refer you to a sleep study medical center that can help diagnose the problem and recommend treatment.

IsYour Lifestyle Keeping You Awake?
Simple lifestyle choices may be at the root of many sleep disturbances. Although you may be following the same practices you've followed for years, as your body changes in perimenopause and menopause, you may have to become more protective of your body's natural ability to sleep. Here are some of the most common daily habits that can interfere with good, restful sleep:

• Alcohol. You may think a nightcap will help you sleep, but it probably won't. Drinking alcohol right before bedtime may help you fall asleep, but it's also likely to wake you up hours before you're ready to rise. Avoid alcohol for at least two to four hours before heading for bed.
• Caffeine. Caffeine can stimulate your brain and make it difficult for you to go to sleep and stay asleep. Limit the amount of caffeine you consume during the day, and confine that consumption to the morning or early afternoon hours. Or cut out the caffeine altogether.
• Exercising at night. Yes, exercise is essential for good health, but it's a powerful mind and body stimulant. Exercise regularly to help put your body on a natural schedule, but don't exercise in the two to three hours before bedtime.
• Smoking. Nicotine is a stimulant. As you already know, your good health requires that you quit altogether. If you continue to smoke, however, stop at least two to three hours before bedtime.
• Your sleep environment. If your partner snores; if your cat or dog walks all over you through the night; if your room is too hot, too cold, too noisy, or too bright, you won't sleep well. Keep the sleeping room temperature between 65 and 70 degrees. Use light-blocking window shades or wear a sleep mask. And finally, consider sleeping apart from disruptive sleep partners of any species (a difficult step, but perhaps essential).

Putting Sleep Disorders to Rest
You can't control your body's evolution, and you probably aren't willing to tell your boss, “No travel until after menopause,” so what can you do? The most important way to promote and protect healthy sleep patterns is to pay attention to sleep problems when they arise and then take action to resolve them. If the lifestyle changes suggested in the preceding section don't alleviate your sleep problems, seek professional help. Although polls report that many people describe sleep problems as common experiences, many of those same people will say that they don't suffer from sleep disorders. You may think that missing an hour or two of sleep now and then isn't a problem, but if you aren't getting enough sleep — and that means at least eight hours a day for most adults — your physical and emotional health will suffer.

Prescription Medications
You and your medical provider may decide that your insomnia is serious enough to warrant trying medication. There are a number of choices, depending on your history and the severity of your insomnia. Some of the choices are:

• Hypnotic-Sedatives. These valium-like medications help with falling and staying asleep. Older types can be habit forming, while newer “non-benzodiazapine” hypnotics seem to be as effective without being habit forming. None of these are recommended for long-term use.
• Sedating antidepressants. These are usually the “tricyclic” antidepressants. While they do have some uncomfortable side effects, they are sometimes chosen because they also help with pain management, and may be a good choice for treating depression and insomnia at the same time.
• Over-the-counter sedatives. These are typically some form of antihistamine, and may be useful for occasional insomnia, but their “hangover” effects of sleepiness and motor impairment need to be evaluated for their impact on your ability to function well the day after using them.

So, if you have trouble falling asleep or are awakening frequently during the night, and none of the lifestyle changes you've made have helped, talk to a health care professional. You have a number of options for resolving sleep problems, including changing your diet or exercise schedule, medications, hormone therapy, relaxation techniques, biofeedback, and psychological counseling. Though sleep disturbances may be a short episode in your passage to menopause, you shouldn't allow them to get the upper hand — for any length of time. Protect your sleep so that you can protect your health.


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Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Insomnia and Its Role in Menopause
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Insomnia is a typical symptom of perimenopause, and it plays an active cause-and-effect role in other perimenopausal conditions. Night sweats and panic attacks, for example, can contribute to insomnia. Long-term insomnia can contribute to heightened anxiety and feelings of fatigue, moodiness, and irritability. When women don't get enough rest, they can have difficulty with concentration, focus, and memory, and their overall physical and mental health can suffer.

Insomnia — a condition characterized by an inadequate amount or poor quality of sleep occurring three or more nights a week — isn't a concern just of menopausal women. As a nation, the United States appears to have entered a time of greater sleeplessness than ever before. The National Sleep Foundation (NSF) (an independent, nonprofit organization) released the results of its own national sleep survey in 2003, revealing that 71 percent of American adults between the ages of 55 and 74 report some sort of sleep problem, and most say they were able to get more sleep in the past (as little as five years earlier) than at the time of the survey.

Menopausal women are at particular risk for insomnia. In a 2006 Harris poll, women suffering from insomnia reported that this was the symptom of menopause that bothered them the most, with 72 percent of participants experiencing it frequently (at least once per week), and 59 percent losing on average three or more hours of sleep each night. The vast majority of these women, 88 percent, said they have more fatigue during the day, 62 percent said they are more irritable, and 44 percent said they cannot do their job as well.

Hormonal Imbalances and Sleeplessness
Remember when you were a teenager and could — if allowed — sleep past noon? For most women approaching menopause, that capacity for endless sleep is only a distant memory. Throughout her adult life, a woman's hormonal balance affects her ability to sleep. Many women experience sleep disturbances during menstruation, pregnancy, and in perimenopause and menopause.

Women who experience PMS often report sleeping difficulties during that same late phase of the menstrual cycle (days 22 through 28). The physical symptoms of PMS include bloating, headache, moodiness, and cramping — all of which can contribute to sleeplessness. But women with PMS report a range of sleep problems in addition to insomnia, including hypersomnia (sleeping too much) and daytime sleepiness. As women who have a history of PMS approach menopause, those symptoms can become even more severe.

Essential
Women who are healthy sleepers spend 15 to 20 percent of their sleeping hours in deep sleep. Some research has suggested that women who have PMS may spend only 5 percent of their sleeping hours in deep sleep all month long.
Many sleep problems in perimenopause are caused by other symptoms of diminishing hormones, including hot flashes and night sweats. Though these problems may not diminish the length of a woman's sleep cycle, they can disrupt sleep frequently enough to cause fatigue and sleepiness throughout the following day. In the NSF poll, women reported that hot flashes contributed to their sleep disturbances at least five days a month.
Many doctors recommend hormone therapy or alternative treatments to combat many of the symptoms of perimenopause and menopause, including sleeplessness.

Alert
Six in ten adults in the United States say they experience frequent sleep problems. In the National Sleep Survey of 2001, a high percentage of those with certain health problems common to perimenopause experienced sleep problems, including depression (83 percent), nighttime heartburn (82 percent), and hypertension (79 percent).


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Managing Cognitive and Neurological Changes

NEXT TO HOT FLASHES, the menopause symptoms that bother women the most are the ones involving their brains. If you find your memory seems to be lapsing or you have some trouble concentrating, it can be unsettling or even alarming. Women ask themselves, “Am I going crazy? Do I have Alzheimer's? And where are those car keys anyway?” This chapter will cover neurological symptoms and some treatments that may offer you that much needed relief.

My Mind — Where Did It Go?by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

If you're nearing age fifty and you haven't yet begun to experience periodic memory lapses, consider yourself lucky. The busier and more stressful life becomes, the easier it is to misplace items, forget an associate's name, lose track of the point you were about to make, and remember the title of that movie. As one fifty-something friend once said, “It takes three middle-aged people to tell any one story.” Multiple events challenge the memory at middle age and many of them still are not fully understood. Though many women wonder if they're showing the first signs of Alzheimer's, the vast majority of memory loss problems are natural — and sometimes transient — responses to the effects of age, menopausal hormone changes, stress, and a busy, changing life.

Memory Problems
Many women report an increase in forgetfulness and memory loss, as well as decreased mental clarity, during perimenopause. Because hormones tend to fluctuate dramatically during this period, estrogen deficiency used to be the culprit most often blamed for changes in memory functions. But studies such as the Seattle Midlife Women's Health Study, conducted by the University of Washington in 2000, dispute that notion. In that study, researchers found that neither the age nor the perimenopausal stage of the women studied were linked to any diminishment of the women's mental functions. In fact, the study found that younger women and women undergoing hormone therapy were more likely than midlife women to report problems with memory loss.

Fact
Alzheimer's disease is more common in women than in men, and it strikes women at an earlier age. The symptoms, which include memory loss, diminished language and motor skills, and an inability to recognize people or objects, appear gradually and worsen with age. If you are increasingly dependent on others for your decisions, or are losing the ability to do everyday tasks, you can ask your health care provider to perform diagnostic tests to see if you have early Alzheimer's disease.

The Seattle study found that physical health, emotional factors, and stress accounted for almost half of the memory loss noted in participants. Depression and high levels of stress played a key role in short-term memory degradation. Among participants in the study, only 24 percent of memory loss was attributed to the physical effects of aging.

Most medical and scientific authorities agree that age results in subtle changes in anyone's ability to think clearly and quickly, but that doesn't link memory loss to menopause; causes for these mental lapses are tied more closely to the brain than the ovaries. First, the human brain shrinks after age fifty, due to a loss of water content. That shrinkage doesn't necessarily impair memory, of course, but a loss of volume in the frontal lobes can. Some neuroscientists say that the frontal lobes can shrink as much as 30 percent between the ages of fifty and ninety. Because the frontal lobes are so important to complex thinking, losses in that area of the brain can impair your ability to reason things out, maintain attention span, multitask, and use your best judgment.

Essential
Although you don't have to fear that your brain will shrink up like a walnut when you hit fifty, real physical changes can begin at this time, and you may begin to feel their impact on your short-term memory, attention span, and other thinking processes. Chapter 18 offers some simple techniques for keeping your mental edge as you move toward and through menopause.

And the brain's hippocampus can lose some of its capabilities with age, too. This part of the brain is responsible for creating, storing, and retrieving memory, and scientists now think it can lose a portion of those abilities with age. A slowing of mental processes accounts for many of the cognitive changes that you perceive with age. In other words, the information is all there and your brain can retrieve it — that retrieval process just takes longer than it used to. Metabolic changes and a diminished number of brain signal transmitters (called dendrites) on your brain cells (neurons) contribute to the slowdown.

Difficulty Concentrating
The inability to focus is also common in perimenopause, and may be due to normal aging of the brain or may be a temporary shift as your hormones change. There are several causes of decreased concentration, any or all of which may explain why you keep reading that paragraph over and over and can't seem to focus on the story you are reading.

Concentration, like memory, is a cognitive task that relies on brain chemicals and brain structures that are sensitive to hormonal changes. If you have a history of premenstrual syndrome (PMS) and found that you could not concentrate as well just before your period, you may be more prone to this symptom in menopause. As estrogen decreases, some women have fewer of the neurotransmitters such as serotonin to carry messages in the brain. And normal aging of the brain means that in middle age people become less able to turn off the “daydreaming” area of the brain, making it easier to be distracted and harder to pay attention.

As frustrating as it is to lose concentration, the news is not all bad. As your body adjusts to new levels of hormones, some of your ability to concentrate will return. And research is discovering that the human brain is much more adaptable than previously thought. When we lose abilities in one section of the brain, we seem to be able to rebuild those abilities using another part of the brain. The secret seems to lie, in part, with keeping your body and attitude healthy so that you have the right building materials to make those changes.

Fact
The level of stress hormones in your body can seriously alter your memory and concentration. Other factors such as loss of sleep, alcohol use, and vitamin B12 deficiency — all common during this life stage — are more common reasons for cognitive trouble than low estrogen.


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Other Physical Changes Associated with Menopause
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

After menopause, estrogen and progesterone levels plummet. Although other parts of your body continue to produce some hormones, they cannot compensate fully for the loss of ovarian hormone production. The specific role of these hormones is treated in Chapter 11. Some of the major postmenopausal side effects are increased bone loss and your skin tissues becoming thinner and less elastic. Your organs and joints respond to diminishing hormones as well as to the wear and tear of living.

Catching Up with Men — Not Always a Good Thing
After menopause, women are just as likely to develop heart disease as men are. Your cardiovascular system misses those hormones, too, with their beneficial impact on HDL cholesterol and their inhibiting effect on LDL cholesterol. With the loss of protective hormones, your arteries become more susceptible to plaque buildup, and begin to narrow and lose elasticity. As a result, estrogen loss can contribute to heart disease.

Boning Up on Osteoporosis
Another important side effect of plummeting hormones is a rapid advance of the bone loss that began in your forties. In the first five years that follow menopause, women can lose as much as one-fourth of their bone density — a potentially deadly development. Bone fractures that develop as a result of osteoporosis can have life-threatening consequences. This bone loss slows down for most women within a decade or so of menopause, but without supplements or MHT, it continues throughout a woman's life. There are ways to minimize this bone loss and the dangers it brings.

More Postmenopausal Changes
During your fifties and early sixties — the decades immediately following menopause — your body undergoes some inevitable changes resulting from the natural aging process. Your body is unique, and so are your family medical history, your lifestyle, and your individual health program. In general, here are the types of changes many women experience in the years that follow menopause:
• Hearing loss can set in, due to the ear canal tissue's becoming thinner and drier. Many people have no hearing loss until they are in their sixties, but almost one-third of women over sixty-five report hearing problems. Keep this loss to a minimum by protecting your ears from loud noises. Wear earplugs when you mow the lawn and avoid sitting close to loud stereos and televisions. And get annual hearing checkups, so you know when your hearing loss reaches the you-need-a-hearing-aid stage.
• Joints lose cartilage with age and connective tissue becomes less flexible and resilient, making arthritis and other types of joint pain more common in aging women. Exercise and weight control are critical factors in maintaining healthy joints.
• Lungs become less elastic as we hit our mid-fifties, which can contribute to shallower breathing and, therefore, less oxygen in our bloodstream. Get plenty of aerobic exercise to keep your lungs pumping. If you're still smoking, quit now!
• The brain loses mass and shrinks slightly with each passing year. As a result, women can face impaired cognitive functions as early as age seventy. Keep your body and mind active — participate in a regular aerobic exercise program, work crossword puzzles, learn to use the computer, visit with family and friends, read the newspaper, and travel. Life's pleasures are also your best weapon in keeping your mind alert and agile.
• Digestion slows down as you reach your sixties, and food moves at a slower pace through your intestines. As a result, many postmenopausal women report problems with constipation. Eat plenty of whole grains, fresh fruit, and vegetables, and drink plenty of water to combat this change in your digestive function and, you guessed it, exercise.

Living for the Rest of Your Life
These changes contribute to the challenges you face in maintaining your strength and health as you move through the postmenopausal years of your life. Though aging is inevitable, you have tremendous control over its effects. Menopause is great training for learning how to age because it demands that you pay attention to your body, make decisions, and take actions that can protect and nurture it throughout the many years ahead. Learning how to take control of your health and choices is worth the effort because menopause also can usher in a time of great freedom, personal exploration, and growth. How you manage the symptoms of perimenopause and the realities of aging that follow will determine your own postmenopausal experience. The remaining chapters of this book take a closer look at all the health issues that surround menopause, and offer simple, effective, ideas for managing your health and combating these issues — now and for the rest of your life.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Weight Gain
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Your body's metabolism changes as you move into middle age. As you age, your body burns calories much more slowly (some studies say by as much as 4 to 5 percent) as each decade passes. So, instead of burning off the calories that you eat, your body converts them into fat. You may feel as though you aren't eating any more, and may actually feel you are eating less, but your body's furnace just needs less fuel to perform the same functions.
Although you may think you are always on your feet and very active, many people slow down a bit as they move into middle age — running fewer errands, doing less physical work around the house, and so on. All of these factors contribute to unwanted weight gain during peri-menopause and after menopause.

Beating the Odds
As if a slowing metabolism isn't enough of a challenge, there are other conditions of aging and menopause that may make weight gain more likely. First of all, you may be more sedentary as you get older. Your job may require being confined to a desk, or without kids to chase around you may find yourself sitting on the couch watching TV. This is not a pattern that helps you burn calories. And if you develop diabetes or have painful conditions like arthritis or joint pain, you will be even more reluctant to move around, thus slowing your metabolism even more.
Although it may seem discouraging to consider all the reasons that make it difficult to lose or maintain weight, it is also the perfect opportunity to take a hard look at how you want to live the next years of your life. This may be just the time that you finally decide to become more active and eat healthy foods, since you can't count on a young metabolism to take care of those extra calories. Diet and exercise are discussed later in this book, but weight gain is a physical symptom of menopause that you can address directly with enough support and information.

Is It All in My Genes?
Weight problems are so common in this country that you cannot pass a grocery checkout or newsstand without seeing numerous articles on weight loss (usually in the same magazines with recipes for cake!). Most people have an ambivalent relationship with food, using it to comfort, nourish, and reward themselves. At the same time, they aspire to be as willowy as the models they see on the covers of those same magazines. Your body weight is a combination of food habits, genetic makeup, and activity levels. It's true that you inherit many influences on your weight, such as tendencies to gain or not, how we process and burn calories, and likelihood of getting obesity-related diseases. You can't change your genetic makeup any more than you can change your eye color. But you do have control over what and how much you eat, how much you move, and your attitude toward fitness. Those “changeable” factors are the focus of later chapters, and they are your best bets for getting and keeping a healthy weight.

Fact
If you find yourself gaining weight as you get older, you are not alone. About a third of adults in the United States are clinically “obese,” and another third are “overweight.” The percentage of obese adults has nearly doubled in the last twenty-five years. Use the supportive programs and information that have resulted from this epidemic to avoid becoming one of the statistics.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Other Physical Changes Associated with Menopause
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

After menopause, estrogen and progesterone levels plummet. Although other parts of your body continue to produce some hormones, they cannot compensate fully for the loss of ovarian hormone production. The specific role of these hormones is treated in Chapter 11. Some of the major postmenopausal side effects are increased bone loss and your skin tissues becoming thinner and less elastic. Your organs and joints respond to diminishing hormones as well as to the wear and tear of living.

Catching Up with Men — Not Always a Good Thing
After menopause, women are just as likely to develop heart disease as men are. Your cardiovascular system misses those hormones, too, with their beneficial impact on HDL cholesterol and their inhibiting effect on LDL cholesterol. With the loss of protective hormones, your arteries become more susceptible to plaque buildup, and begin to narrow and lose elasticity. As a result, estrogen loss can contribute to heart disease.

Boning Up on Osteoporosis
Another important side effect of plummeting hormones is a rapid advance of the bone loss that began in your forties. In the first five years that follow menopause, women can lose as much as one-fourth of their bone density — a potentially deadly development. Bone fractures that develop as a result of osteoporosis can have life-threatening consequences. This bone loss slows down for most women within a decade or so of menopause, but without supplements or MHT, it continues throughout a woman's life. There are ways to minimize this bone loss and the dangers it brings, and you will learn about them in Chapter 15.

More Postmenopausal Changes
During your fifties and early sixties — the decades immediately following menopause — your body undergoes some inevitable changes resulting from the natural aging process. Your body is unique, and so are your family medical history, your lifestyle, and your individual health program. In general, here are the types of changes many women experience in the years that follow menopause:

• Hearing loss can set in, due to the ear canal tissue's becoming thinner and drier. Many people have no hearing loss until they are in their sixties, but almost one-third of women over sixty-five report hearing problems. Keep this loss to a minimum by protecting your ears from loud noises. Wear earplugs when you mow the lawn and avoid sitting close to loud stereos and televisions. And get annual hearing checkups, so you know when your hearing loss reaches the you-need-a-hearing-aid stage.
• Joints lose cartilage with age and connective tissue becomes less flexible and resilient, making arthritis and other types of joint pain more common in aging women. Exercise and weight control are critical factors in maintaining healthy joints.

• Lungs become less elastic as we hit our mid-fifties, which can contribute to shallower breathing and, therefore, less oxygen in our bloodstream. Get plenty of aerobic exercise to keep your lungs pumping. If you're still smoking, quit now!
• The brain loses mass and shrinks slightly with each passing year. As a result, women can face impaired cognitive functions as early as age seventy. Keep your body and mind active — participate in a regular aerobic exercise program, work crossword puzzles, learn to use the computer, visit with family and friends, read the newspaper, and travel. Life's pleasures are also your best weapon in keeping your mind alert and agile.

• Digestion slows down as you reach your sixties, and food moves at a slower pace through your intestines. As a result, many postmenopausal women report problems with constipation. Eat plenty of whole grains, fresh fruit, and vegetables, and drink plenty of water to combat this change in your digestive function and, you guessed it, exercise.

Living for the Rest of Your Life
These changes contribute to the challenges you face in maintaining your strength and health as you move through the postmenopausal years of your life. Though aging is inevitable, you have tremendous control over its effects. Menopause is great training for learning how to age because it demands that you pay attention to your body, make decisions, and take actions that can protect and nurture it throughout the many years ahead.

Learning how to take control of your health and choices is worth the effort because menopause also can usher in a time of great freedom, personal exploration, and growth. How you manage the symptoms of perimenopause and the realities of aging that follow will determine your own postmenopausal experience. The remaining chapters of this book take a closer look at all the health issues that surround menopause, and offer simple, effective, ideas for managing your health and combating these issues — now and for the rest of your life.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Weight Gain
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Your body's metabolism changes as you move into middle age. As you age, your body burns calories much more slowly (some studies say by as much as 4 to 5 percent) as each decade passes. So, instead of burning off the calories that you eat, your body converts them into fat. You may feel as though you aren't eating any more, and may actually feel you are eating less, but your body's furnace just needs less fuel to perform the same functions.

Although you may think you are always on your feet and very active, many people slow down a bit as they move into middle age — running fewer errands, doing less physical work around the house, and so on. All of these factors contribute to unwanted weight gain during peri-menopause and after menopause.

Beating the Odds
As if a slowing metabolism isn't enough of a challenge, there are other conditions of aging and menopause that may make weight gain more likely. First of all, you may be more sedentary as you get older. Your job may require being confined to a desk, or without kids to chase around you may find yourself sitting on the couch watching TV. This is not a pattern that helps you burn calories. And if you develop diabetes or have painful conditions like arthritis or joint pain, you will be even more reluctant to move around, thus slowing your metabolism even more.

Although it may seem discouraging to consider all the reasons that make it difficult to lose or maintain weight, it is also the perfect opportunity to take a hard look at how you want to live the next years of your life. This may be just the time that you finally decide to become more active and eat healthy foods, since you can't count on a young metabolism to take care of those extra calories. Diet and exercise are discussed later in this book, but weight gain is a physical symptom of menopause that you can address directly with enough support and information.

Is It All in My Genes?
Weight problems are so common in this country that you cannot pass a grocery checkout or newsstand without seeing numerous articles on weight loss (usually in the same magazines with recipes for cake!). Most people have an ambivalent relationship with food, using it to comfort, nourish, and reward themselves. At the same time, they aspire to be as willowy as the models they see on the covers of those same magazines. Your body weight is a combination of food habits, genetic makeup, and activity levels. It's true that you inherit many influences on your weight, such as tendencies to gain or not, how we process and burn calories, and likelihood of getting obesity-related diseases. You can't change your genetic makeup any more than you can change your eye color. But you do have control over what and how much you eat, how much you move, and your attitude toward fitness. Those “changeable” factors are the focus of later chapters, and they are your best bets for getting and keeping a healthy weight.

Fact
If you find yourself gaining weight as you get older, you are not alone. About a third of adults in the United States are clinically “obese,” and another third are “overweight.” The percentage of obese adults has nearly doubled in the last twenty-five years. Use the supportive programs and information that have resulted from this epidemic to avoid becoming one of the statistics.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Involuntary Urine Release
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Many women are subject to urinary tract infections (UTIs) on and off throughout their adult lives. But this problem can worsen during peri-menopause. Estrogen contributes to the growth and nourishment of all cells and tissues. Because your body produces lower levels of estrogen during the years leading to menopause, the tissues lining the urinary tract can grow thin and more prone to bacterial infection and inflammation. That same lack of estrogen-induced nourishment can weaken the muscles that surround your bladder and urethra. As a result, you experience more UTIs and other urinary tract disorders, a weaker bladder, and less control over urine release.

The most common kinds of urinary tract disorders women experience during perimenopause are stress urinary incontinence, urge incontinence, and UTIs. These disorders can have similar symptoms, but their causes and treatments are very different.
Urinary Tract Infections
Urinary tract infections are caused by bacteria in the urinary tract. The symptoms of UTI include feeling as though you need to urinate all the time, even when your bladder is empty; a burning sensation during urination; and — infrequently — small amounts of blood in your urine. Urinary tract infections can seem to fade, then return again. It's important to remember that, as with any bacterial infections, a full-blown UTI won't go away without antibiotic treatment. If left unchecked, the bacteria that cause a simple bladder infection can spread to the kidneys, causing a much more serious infection called pyelonephritis.

Fact
Many urinary tract disorders have similar symptoms, but require different treatments. If you suffer from burning or too frequent urination, involuntary urine release, or a constant full bladder feeling, see your doctor for an accurate diagnosis and treatment.

Urge Incontinence
Urge incontinence is the result of a bladder spasm that forces urine out, even when the bladder is not completely full. These involuntary muscle contractions cause the bladder to release urine in varying amounts. Even though the woman may not feel as though her bladder is full and she needs to urinate, the sight, sound, or even thought of water or urination can cause the sudden reflex need to urinate and an accompanying release of urine.

Stress Incontinence
Stress urinary incontinence is another cause of periodic involuntary urine release. Unlike urge incontinence that can result from the mere thought of emptying the bladder, stress incontinence usually has a specific triggering event, such as a sneeze or cough. Some women release small amounts of urine when they bend over, laugh, or exercise.
Stress urinary incontinence is caused by weakened sphincter muscles, which surround the urethra, and can occur in women of any age. Women who have given birth, regardless of the type of delivery, often experience this disorder many years before they approach menopause. But during menopause, weakening sphincter muscles can contribute to the onset of stress urinary incontinence, even in women who have never had a pregnancy. Obesity and chronic lung conditions that produce a lot of coughing, such as emphysema or cigarette smoking, can also cause or aggravate the condition.

There are several approaches that seem to improve this condition, including:
A specific strengthening exercise called the Kegel exercise
Physical therapy with biofeedback and pessaries — small devices worn in the vagina to support the weakened urethral muscles
Surgery
Weight loss
Quitting smoking
If you begin to notice stress urinary incontinence when you cough or laugh, talk to your health care provider about these treatments.

Essential
A number of therapies can help end many urinary tract disorders. Biofeedback, pelvic floor muscle exercises (known as Kegel exercises), and medication are just some treatment possibilities. Weight loss and bladder retraining can be successful tools in fighting incontinence, too. Talk with your doctor to learn more.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Heart Palpitations
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.
Heart palpitations are very common during perimenopause and are usually a bit startling the first couple of times they occur. Your heart may feel like it is racing, slowing, irregular, or just “thrashing around in there.” It may accompany or precede a hot flash, and is probably responding to the same hormone fluctuations that make the rest of your vascular system a little unstable during this time. Because cardiac problems sometimes start in midlife, you will want to check with your health care provider if you have palpitations frequently or if they are painful or dramatic.

It's Not Love, It's the Coffee
Remember when a rapidly beating heart meant you were excited to see a new love? Menopausal palpitations can feel like that, but the most likely cause is either anxiety or stimulants. It's hard to say whether women feel anxious because their hearts are beating fast, or their hearts beat fast because they are anxious. If you find yourself feeling anxious or having panic episodes, talk to your health care provider or mental health counselor. There are relaxation exercises, biofeedback techniques, and medications that can help you through anxious moments or events.

And if you are a habitual stimulant user you may notice that heart palpitations may occur when you use alcohol, caffeine, diet pills, or decongestants. Even if you are used to these substances, they may set off an episode of palpitating because you're more sensitive to small changes, just as spicy food can trigger a hot flash.

Other medical conditions may have palpitations as a symptom, which is why it's a good idea to check out any changes in your heartbeat. If you are anemic, dehydrated, or have high blood sugar or an overactive thyroid, you may notice heart palpitations. Any of these conditions should be evaluated to be sure they are not serious health problems.

Is It a Heart Attack?
That, of course, is the fear when your heart starts acting erratically. Although cardiac disease is rarely the cause of heart palpitations in perimenopause, it is possible that you are experiencing cardiac symptoms. Heart attack symptoms are different for women than for men, and it is important not to dismiss ongoing heart irregularities without having them evaluated.
Like other transient symptoms of the perimenopause, palpitations usually go away on their own after a few months. If you find that exercise or certain situations trigger them, learn to stop what you are doing and breathe in a slow, regular way until your heartbeat returns to normal. This, too, shall pass.

Alert
Although heart palpitations are common during perimenopause and are almost always benign, they can also signal more serious problems. If you have dizziness, fainting, tightness in the neck or chest, abdominal pain, or nausea with the palpitations, or if your heart rate is over 120 beats a minute, go to the emergency room or urgent care to be checked.


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Heavy Bleeding
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

As if unpredictable periods weren't enough, some women find that their periods become very heavy during perimenopause. This may be rather benign, and just a bit more bleeding than you have been always had; or it can mean significant blood loss, or be a sign of something serious. You may want to start counting the pads or tampons you use in a day and keep a note of it on your calendar, in case you need that information to discuss heavy bleeding with your health care provider.

Uterine Fibroids
As you've learned, unusual bleeding can have a number of causes, but two relatively common benign causes are fibroids and polyps. Uterine fibroids are benign growths of muscle tissue that develop within the wall of the uterus, on the uterine lining, or on the outside of the uterus. Also called leiomyomas, fibroids are extremely common and by age fifty as many as 80 percent of women have them. Fibroids within the uterine lining can cause abnormal bleeding because of the way they distort the lining and prevent it from shedding normally. Fibroids vary tremendously in size, from undetectable to the size of a grapefruit, or larger. Their size alone can cause problems, such as pelvic pressure, bloating, urinary frequency, or pain during intercourse. If you have unusually heavy or midcycle bleeding, your doctor probably will check for the presence of fibroids.

If your symptoms are found to be from fibroids, rather than from hormone fluctuations or other causes, your health care provider will probably recommend treating you. Treatment options for fibroids also vary, depending on the size of the tumors; whether you want to retain your fertility (not usually an issue during perimenopause, but it might be); and what resources are available in your area. Among the accepted treatments for uterine fibroids are the following:

• “Wait and Watch.” Because these are benign growths, some health providers prefer to wait and monitor fibroids. This is acceptable if symptoms are not seriously affecting your life and health. Since fibroids usually shrink after menopause, this may be a good choice for women in perimenopause who are not having serious symptoms.
• Embolization. Fibroid tumors are dependent on the blood supply that develops around them, and in this procedure a specially trained radiologist injects a plastic or gelatin substance into the blood vessel through a small incision in the leg. A tube is inserted into the uterine artery, where particles are deposited on both sides of the artery, stopping the blood supply to the fibroid. It is relatively safe and can be done on an outpatient basis. Embolization is not usually recommended for women who want to remain fertile, since a pregnancy requires excellent blood supply to the uterus.

• Medications. There are several medication approaches to treating fibroids. You may be advised to take iron to treat anemia if you have been bleeding heavily. Or your doctor may prescribe non-steroidal anti-inflammatory medications (NSAIDs, such as ibuprofen, naproxen, etc.) for pain and inflammation and to decrease prostaglandin activity — this can decrease total menstrual blood loss by up to 50 percent. Oral contraceptives are used to decrease the bleeding, but they do not reduce the size of the fibroids. Because fibroids respond to a reduction of female hormones, sometimes androgens (“male” hormones) or a class of medications called gonadotropin-releasing hormone agonists may be used to reduce the action of estrogen and progesterone, thereby shrinking the tumors.

• Myomectomy. This is the surgical removal of the tumor itself, and is one choice for women who want to keep their uterus and are having significant symptoms of pain or bleeding. This treatment may be done by abdominal surgery or by laparoscope, and carries all the usual risks of those types of surgery.
• Myolysis. This treatment means using an electric current or liquid nitrogen to destroy the fibroid tissue. Done through a laparoscope, it seems to present fewer risks than abdominal surgery, but its safety and effectiveness are still being studied. It is not recommended for very large fibroids or for women who want to eventually become pregnant, since scarring and adhesions often follow the procedure.

Alert
There is often cramping with fibroid embolization, and the pain may become severe as the fibroid tissue “dies” after the blood supply is cut off. This process of tissue death also increases the chance of infection. Although serious infection is rare, it can lead to hysterectomy. Be sure to explore the risks of this procedure before you decide to pursue it.
• Focused Ultrasound Surgery (FUS). FUS is the use of ultrasound to destroy fibroid tissue, and is done using a special magnetic resonance imaging (MRI) machine to locate and target the tumor. It is not yet well studied, but has promise as a less invasive form of surgery and is already being used for other procedures.
• Hysterectomy. Surgical removal of the uterus is the only certain way to eliminate fibroids and the symptoms they cause. It is major surgery, however, and has its own set of risks and benefits, which must be considered before accepting it as the treatment of choice.
If you are diagnosed with fibroids and they are causing problems, discuss the options with your health care provider. He or she can help you weigh the seriousness of your symptoms with the risks and benefits of treatments.

Fact
Uterine fibroids can cause bleeding serious enough to make you anemic. If you find during your period that you are changing a maxi-pad or super tampon more than eight times in eight hours, or if you have clots that last over eight hours, make an appointment with your health care provider to be evaluated for these benign but troublesome tumors.

Polyps
Uterine polyps are smaller benign growths on the lining of the uterus. Science and medicine have yet to explain why polyps develop in some women, and not in others. Polyps bleed, just like fibroids, but because they are typically small, they're unlikely to cause the amount of blood loss associated with fibroids. When a health care provider diagnoses polyps (usually through an ultrasound test or a biopsy sample), he or she can remove them through a simple outpatient procedure in which the doctor snips the polyps from the uterine lining. This procedure usually involves a hysteroscopy — a sophisticated dilation and curettage (D and C) procedure where a small (one-eighth-inch) camera lens and instrument port are inserted into the cervix to locate the polyps and remove all of them at that time. Although pain is usually minimal, you may receive mild sedation or anesthesia during the procedure, and some pain medication afterward.


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Irregular Periods
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Since the very earliest sign of perimenopause is often a change in the regularity of your menstrual cycle, it's a good place to start on the list of physical menopausal changes. You may be one of those women who notice a change not only in the timing of your period, but also in the amount of flow. Sometimes heavier periods become so over several months or years, until one day you realize that your life revolves around having pads and tampons in every purse and coat pocket, and you begin to plan your vacations and activities around that time of the month. That is, if you can predict that time of the month.

What's Going On?
What causes cycle irregularity during perimenopause? Once again, the culprit behind the majority of irregular periods is hormonal fluctuations. In fact, hormone fluctuations can cause a variety of irregularities in your periods. As you enter perimenopause, you probably ovulate less frequently. Because all hormone releases are triggered by others, an unusual fluctuation in one hormone can set off a series of unusual fluctuations in others, as your body tries to spur on or hold back the hormone in flux. For that reason, you might have a six-week cycle, followed by a four-week cycle, followed by a six-week cycle with unusually light flow, and so on. (A cycle is the length of time from the first day of one menstrual period to the first day of the next.) Your body is going through a series of starts and stalls as it attempts to adjust to fluctuating levels of hormones in your bloodstream. Because you ovulate less frequently during this time, your body's estrogen levels often are unchecked by progesterone. As a result, your uterine lining can develop abnormal cell changes that lead to unusually heavy bleeding or midcycle spotting.

Hyperplasia
A common cause of abnormal bleeding is a precancerous condition of the lining of the uterus called endometrial hyperplasia. This excessive growth of the uterine lining can result from having unbalanced estrogen. If diagnosed when still in its early stages, it can be treated medically. Untreated endometrial hyperplasia can develop into endometrial cancer. It's a good idea to report any changes in bleeding patterns to your health care provider.


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Mind-Body Exercises
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Many women have found that they can limit the number and severity of hot flashes using mind-body practices such as yoga, meditation, visualization, and deep breathing. It is worth noting that in many menopause studies placebo works as well as many of the remedies being studied. This is a strong indicator that expectations — and your mind — have a profound effect on your body's responses. Stress, anxiety, and fatigue can contribute to the onset and severity of hot flashes; these techniques help calm the mind, relax your muscles and nerves, and keep you feeling rested and at ease. Even when hot flashes do occur, regular practice of these techniques can help you recover more quickly from their effects. And these relaxation techniques and mind-body exercises work to combat a number of other menopausal symptoms, including mood swings, sleeplessness, muscle loss, joint aches, and reduced cognitive functions.

Take a Deep Breath
Use deep breathing to calm a raging hot flash; practice it regularly to help avoid the onset of hot flashes throughout the day and night. Deep, paced breathing is a strong tool for calming the body and the mind — and it's an incredibly easy technique to use. If you feel a hot flash coming on, begin taking deep, slow breaths through your nose. Breathe in to expand your lungs as far as you can, then hold the breath there for a few seconds before you slowly release it. Let your belly swell out and your chest expand as you breathe in, so your body is fully “inflating” with the breath. When you exhale, empty your lungs completely. Take at least three full, deep breaths and try to remain calm.

Make It a Daily Habit
A daily program of meditation and relaxation is a powerful tool for keeping your body calm, focused, and strong throughout the day. Its stress-relieving benefits can help ward off hot flashes and other stress-related symptoms of menopause. A ten-minute relaxation session fits easily into your morning and evening schedule, and it's simple to do. Sit or lie down in a quiet place with your eyes closed. Consciously relax every muscle in your body, beginning with your feet and continuing the relaxation up toward your head. Concentrate on a single word or object that has personal meaning for you; if other ideas, worries, or mental chatter enter your mind, dismiss them and return to the thought of your focus word. After ten minutes, open your eyes, remain seated, and take three deep breaths before continuing with your day.

Essential
Use visualization techniques to help cool a hot flash. When you feel a hot flash begin to develop, close your eyes and envision being in a cool, breezy location. Think of the warmth as a liquid, and imagine that you can channel it to flow from your body. Envision the heat draining out through your hands and feet; then imagine that a cool layer of snow is falling on your head, shoulders, and arms.

Yoga: Not Just for Youngsters!
Yoga is an excellent practice for increasing flexibility, building muscle strength and endurance, and eliminating the negative effects of stress on your body. Practicing yoga stretches for twenty to thirty minutes three times a week can help reduce the negative effects of stress on your body, as it stretches your muscles, improves your balance, and encourages deep, full breathing. Regular yoga practice can also help reduce insomnia, so you fall asleep faster and stay asleep longer.

As you find your way through menopause, use your symptoms — including hot flashes — to increase your self-awareness. Talk to your health care provider, and try a combination of medicinal and mind-body suggestions until you find what best suits your symptoms and lifestyle. At the very least, you can reframe your hot flashes as “power surges” and keep a sense of humor about this temporary, if bothersome, phase.


The New You — Managing Physical Changes

Many of the physical signs can be managed to improve your quality of life and make the transition more comfortable. This chapter will take a look at the physical symptoms described earlier and will offer options for making the most of your “new” self.


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Herbs, Botanicals, and Other Alternatives
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

It's important to approach any alternative treatment option with open eyes and healthy skepticism. Botanical extracts, herbal supplements, and nutraceutical compounds aren't inspected or approved by the FDA, so they haven't passed the rigorous testing process of prescription medications, and they haven't undergone a scientifically controlled process of long-term, in-depth study. Read Chapter 12, “Alternatives to MHT,” for a full discussion of this issue, and be aware that you can't just stroll down the aisle of your local health food store and choose a safe, effective, natural cure for any of your hormonal symptoms based on the claims of the label.

The Search for Herbal Treatments
Doctors and scientists around the world continue to evaluate the effectiveness of some of the most popular alternative treatments for the symptoms of menopause because many women use them. While a great deal remains to be learned about the safety, effectiveness, and long-term value of these treatment options, some of the alternative treatments most commonly used for the relief of hot flashes include:
• Soy products. Soy products, including whole soy foods, soy protein capsules, and isoflavone extracts, offer some relief from mild hot flashes, according to the results of some studies. Soy proteins are available in soy milk, tofu, tempeh, and roasted soy nuts. Because researchers haven't determined how phytoestrogens in soy interact with cancerous cells, however, these products aren't recommended for women seeking nonhormonal relief from menopause symptoms due to a history of cancer. Studies typically show that while women do experience lessening of hot flashes when they increase soy intake, it is not significantly more than the relief they experience when taking placebo.
• Vitamin E. Some women have reported that taking vitamin E offered them relief from hot flashes. In studies where participants took a regulated daily dose of 800 international units of vitamin E, the women did experience some minor relief (on the order of one less hot flash per day), and the vitamin caused no negative side effects. Right now, no study supports the idea that you can achieve significant relief from hot flashes by taking vitamin E, but studies continue in this area.

Is Black Cohosh the Answer?
Black cohosh is a plant in the buttercup family whose root is used in the treatment of menopausal symptoms. It is popular in Europe as a treatment for premenstrual syndrome and a number of menopausal symptoms. Though some products containing extracts of black cohosh carry labels that claim they can reduce hot flashes by as much as 25 percent, many medical experts feel that data to verify the herb's effectiveness is lacking. Studies have shown mixed results, but a rigorous double-blind study done in 2006 reported that black cohosh had no more effect on hot flashes than placebo, even when combined with other herbal therapies. Although many women report some improvement with the use of this herb, studies still do not support its use for hot flashes.

Fact
Research has not yet determined whether black cohosh is safe for women with breast cancer and other estrogen-sensitive cancers. If you suspect you may be pregnant, avoid taking black cohosh; it may cause miscarriage or premature birth.
When considering whether to try this herbal treatment, remember that it does have a number of negative side effects, including nausea and dizziness. When using black cohosh for the treatment of perimenopause or menopause symptoms, you should limit the total treatment time to no more than six months.


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Nonhormonal Medications
by Kate Bracy Kalb, R.N., M.S., A.R.N.P
.
Though some medical experts readily prescribe some form of hormone therapy for the relief of vasomotor symptoms, these treatments aren't appropriate for all women. Women with active endometrial or breast cancers, for example, usually must avoid hormone therapy during cancer treatment. Medical professionals rarely prescribe hormone therapy for women with a personal or family history of blood clotting, liver disease, or other conditions that can be triggered or exacerbated by hormone treatments.

Medications That Can Help
To provide relief from hot flashes for women who cannot take estrogen, medical professionals can prescribe other medications that have been shown to offer some relief from hot flashes. The following list mentions some of these prescription medications for alleviating hot flashes:
• Clonidine hydrochloride reduces the responsiveness of the body's vascular system, and has been used for some time in the treatment of high blood pressure. A low dose is used and it may take three to four weeks to begin to see improvement in symptoms; blood pressure must also be monitored. Clonidine does have some negative side effects and can disrupt the sleep of some women. Other side effects reported include dizziness and dry mouth.
• Methyldopa is another antihypertensive (high blood pressure medication) sometimes used to relieve vasomotor symptoms. Though methyldopa has been shown to reduce the number of hot flashes women experience during the day, it can cause dry mouth, dizziness, and headaches.
• Selective serotonin reuptake inhibitors (SSRIs), including paroxetine, fluoxetine, and venlafaxine, are also used to lessen vasomotor symptoms, although they are not approved by the Food and Drug Administration (FDA) for that purpose. In higher doses, these drugs are used to treat depression. Some tests have shown that relatively low doses of these drugs can reduce the frequency and severity of hot flashes anywhere from 19 to 60 percent, depending upon the specific drug and dosage strategy. Side effects of these drugs include dry mouth, nausea, and anxiety.
• Bellergal, a drug that combines very low dosages of belladonna and phenobarbital, is an FDA-approved medication for the treatment of menopausal symptoms. This drug has been used for decades in the short-term treatment of hot flashes, with varying success. Bellergal can have a number of unpleasant side effects, including constipation, dry mouth, and dizziness.
• Gabapentin is an anti-seizure medication that is sometimes prescribed for the treatment of hot flashes. In studies, 70 percent of women reported that they had a noticeable improvement in their symptoms. The long-term effects are not yet known, but one study showed gabapentin to be as effective as estrogen in reducing hot flashes, when compared to placebo. Side effects, which are lower if the medication is taken with meals, may include fatigue, dizziness, swelling of hands and feet, and skin rash.

Alert
Many of the nonhormonal treatments for hot flashes and other menopause symptoms are controversial, and their effectiveness, safety, and possible side effects and interactions with other medications remain the subject of ongoing studies.

What's Best for You?
If hot flashes are making your life miserable, there are treatments that can help. You have to decide whether your symptoms are serious enough to need medical intervention and prescription medications. Short-term treatment for the relief of hot flashes is very common, but your own unique risks and family history need to be considered. Be honest with your care provider about the severity of your hot flashes so that together you can decide what, if any, medication would work best for you. If you think you'd like to try some non-prescription medications to treat your symptoms, ask your health care provider for suggestions. The following section discusses some of the common ones.


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Hormonal Treatments for Hot Flash
Reliefby Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Though medical science continues to study the connection between hormone depletion and hot flashes, hormone therapy — involving estrogen and/or progesterone — is the most effective medical treatment for vasomotor symptoms known today. According to the American College of Obstetricians and Gynecologists, 80 to 90 percent of women taking prescribed estrogen find relief from hot flashes.

Estrogen Therapy
While it's true that estrogen offers a number of other health benefits for women experiencing symptoms of perimenopause and menopause, including protection against osteoporosis and colorectal cancer, there are also risks in using it. It is not as commonly prescribed as it was in years past, and may be seen as a second choice solution, after you have tried some of the nonhormonal remedies. You and your health care provider can decide if your menopausal symptoms, including hot flashes, are worth the risk of using estrogen therapy. Your personal and family health history can help you make a decision about using hormone therapy, and your health provider can help you sort it all out.

Estrogen is not recommended for women with a personal history of recently diagnosed endometrial cancer. For these women, progestins — such as medroxyprogesterone or megestrol acetate — have been shown to offer relief from hot flashes. Some studies have shown progestins to decrease hot flashes by as much as 70 to 90 percent.

Fact
Estrogen is a highly effective tool for combating symptoms of peri-menopause and menopause, but it's not suitable for all women. See Chapter 11 for more information about the benefits and potential risks of hormone therapies.

Progesterone Therapy
Another hormone-based treatment for hot flashes is progesterone cream. This cream, available by prescription, is rubbed on the skin, and the progesterone is slowly absorbed into the woman's system. Though some studies have shown that progesterone cream can offer significant relief from hot flashes, it can be accompanied by some negative side effects, including vaginal bleeding and PMS symptoms.

Again, your doctor or health care professional can help you decide whether or not hormone-based treatments are your best choice for reducing or eliminating hot flashes. If together you decide that hormones aren't right for you, you can choose from other treatment options, including other medications and hormone alternatives, discussed in the sections that follow.


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Techniques for Turning Down the Heat
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

A number of treatment options to help you lessen — or even eliminate — hot flashes caused by the onset of menopause are discussed later in this chapter. But you have a variety of first-defense techniques available to you that don't require any special medication or therapeutic program.

Start with the Obvious
When you first begin to notice that hot flashes are part of your life, you can try to diminish them. Try these simple techniques to avoid hot flashes or minimize their severity:
• Avoid triggering foods and drinks. Spicy foods — foods heavy in capsaicin, the heat-inducing chemical in cayenne and other hot peppers — can trigger hot flashes. Caffeine and alcohol are also common triggers.
• Drink plenty of water during the day — at least thirty-two ounces, more if possible. Keep a glass of ice water with you at work and during meetings and set a thermal-lined drink container of ice water on your nightstand, ready to help cool down raging flashes.
• Get at least thirty minutes of exercise every day. Exercise, including stretching, aerobic, and weight-bearing activities, has been shown to cut down on the frequency of hot flashes, and may even help limit their length and severity.
• Wear layers of moisture-absorbing clothing.When a hot flash strikes, you can take off one or more layers of clothing to help cool your skin temperature quickly. Cotton fabrics are particularly helpful in allowing adequate air to reach the skin, and they're good at absorbing perspiration.
• Keep your thermostat turned down — seventy degrees or lower during the day, and sixty-five degrees or lower at night. Lower temperatures can help ward off hot flashes.
• Manage stress to the best of your ability. Avoid stress if you can, but be prepared for stressful situations you can't sidestep. Deep breathing exercises, meditation, yoga, and visualization are all helpful techniques for boosting your ability to remain calm and centered throughout your day.

Essential
If a hot flash strikes, you may get some quick relief by running cold water over your hands, wrists, and inner elbow. A cold cloth on your forehead or the back of your neck can help, too; if you're at home, step into a cold shower and let the water run over you until the heat wave passes.

Don't Be Discouraged
If you take all the steps listed above, and still find yourself doused in sweat several times a day, don't despair. Continue to do the common sense things that will reduce hot flashes, but also consider talking to your health care provider about what other treatments might work. You will be able to say that you've tried the simple things, and your symptoms are serious enough that you need something more. And remember that sometimes tricks that don't work one day are magic the next. Finding the combination that works for you is as much art as science.


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Coping with Hot Flashes

WHEN WOMEN TALK about the bothersome aspects of menopause, hot flashes are the symptom they cite — and complain about — most often. Though hot flashes fade over time, severe symptoms can disrupt both the waking and sleeping hours of your busy life for several years. Fortunately, there are many ways to relieve or reduce hot flashes, but you need to choose carefully — and be sure to consult with your health care professional. Hot flashes are considered a “vasomotor” symptom. This means they are the result of a change in your body's ability to regulate the opening and closing of blood vessels. About 75 percent of all women passing through the stages of menopause will experience hot flashes during some part of the transition. Though hot flashes are a common symptom of menopause, in many cases they are a minor inconvenience rather than an alarming problem. Hot flashes (sometimes called hot flushes) often begin with an increase in heart rate and a slight feeling of warmth, usually occurring in the face, neck, and shoulders.

A Range of Symptoms
Women describe hot flashes differently, depending upon how frequent or how dramatic their symptoms are. Mild or moderate hot flashes may last anywhere from one to fifteen minutes and cause feelings of mild warmth, accompanied by light perspiration and a slightly dry mouth. After the flash passes, the skin may feel slightly clammy. Mild hot flashes pass with little or no impact on general feelings of well-being.

Severe hot flashes can last from thirty seconds to thirty minutes and cause the skin temperature to rise dramatically. The face, neck, and throat can become flushed and red, and the body can break out in heavy perspiration. A woman experiencing a severe hot flash can have difficulty breathing, and the hot flash can trigger panic attacks and anxiety. Afterward, the woman may be left with a headache, some nausea, and a general feeling of anxiety and exhaustion.

If hot flashes are severe or long lasting, they can have a negative impact on your health and well-being. Hot flashes that occur at night — often known as night sweats — can interrupt sleep and lead to daytime fatigue, exhaustion, and decreased mental abilities. The fear of breaking into a clothes-drenching sweat at work or during social events can lead to anxiety and even depression. When hot flashes ruin your sleep or prevent you from performing well during the day, it's time to take action.

What's Happening When You Have a Hot Flash?
Hot flashes are connected to changes in your estrogen levels, though the specific cause and effect relationship is still under study. Recent studies seem to point to a narrower “thermoneutral zone” in some women, meaning that their range of comfortable temperature becomes narrower. It is a lowering of the “sweat threshold” and your body is prompted to sweat with even small rises in body temperature.

Declining levels of estrogen set the stage for hot flashes and the actual hot flashes are the result of this sudden resetting of the body's thermostat. If your brain senses that your body is even a bit too hot — for any reason, including increased blood flow to the brain, a high ambient temperature, or even the ingestion of hot, spicy foods — it sends out a signal that your body needs to cool off, now! In response, your pituitary gland sends out luteinizing hormone (LH), which causes the blood vessels near your skin's surface to dilate to release heat through your skin. This heat-releasing action makes your skin temperature (and your body temperature) rise, followed by an increase in perspiration. The perspiration helps to cool the skin, which can result in a clammy feeling. If you've perspired heavily, you may be left damp and even chilly. Your body temperature drops and your blood vessels constrict. If you are damp and cold, you may begin to shiver. That's the hot flash in action.

Common Hot Flash Triggers
Estrogen levels alone do not predict hot flashes and other factors can cause them or contribute to their severity. Many women find, for example, that they have hot flashes during periods of anxiety and nervousness; other studies have found that some prescription blood pressure medications and anti-anxiety medications may also cause hot flashes. Hot flashes may be your body's reaction to certain foods or beverages or even the temperature of the air around you — some women report their hot flashes are more severe and last longer when they occur during hot weather or in a hot room.

Alert
If you suffer from severe hot flashes, it's not unusual to have feelings of nausea, headache, and weakness afterward — especially when hot flashes last for more than fifteen minutes. If your feelings of intense heat last for longer than an hour, it may be something more serious, and you should tell your doctor or other health care professional.

How Many, How Bad, How Long?
Although many women don't seem to notice hot flashes until after menopause has occurred, many others begin having them during peri-menopause, with forty-eight being an average age for the onset of hot flashes. In general, women who experience hot flashes start having them at least one year before menopause, and continue having them for one to six years.
The American College of Obstetricians and Gynecologists's publication Managing Menopause lists the findings of one study in which 501 women were asked about the frequency and severity of their hot flashes. Of those participating in the study, 87 percent reported having one or more flashes per day; of those experiencing multiple daily hot flashes, the numbers of incidents per day ranged from five to fifty, with one-third of the women reporting more than ten. Another study reported a lower frequency of hot flashes — participants had an average of only three or four flashes a day.


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Other Perimenopausal Changes You May Notice
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Recognizing the unique experience each of us has as we age, most of us can expect to experience other physical changes during — and perhaps as a result of — the physical changes of perimenopause. If perimenopause occurs during a woman's forties, for example, here are some of the changes her body might be undergoing:

1) Muscles may lose mass more easily and become harder to tone during your forties, so your old workout plan may not be enough to maintain the strength and body weight you enjoyed in your thirties. You may need a new workout program during this time; see Chapter 17.
2) Bones can start to lose calcium as estrogen levels recede and the body becomes less efficient at absorbing calcium from food. You may need to adjust your diet to include more vitamin D and calcium, or consider taking supplements. See Chapter 15 for more information.
3) Eyes become less efficient as the lenses lose elasticity and their controlling muscles weaken, making focusing close-up more difficult. Estrogen helps keep eyes and muscles elastic, so diminishing levels of estrogen contribute to this degeneration.
4) Skin and hair can begin to thin in response to lowered levels of estrogen; most people start to get some gray hair in their forties. Estrogen also helps maintain the collagen content (the basic protein bridgework) of your skin, thus keeping it youthful and elastic. Your strong ally in the battle against this aging factor is a healthy diet and lots and lots of water.
5) Metabolism slows down during your forties, so weight gain can creep up on you. Typical dieting methods are unlikely to work as well for you at this age, so maintaining or losing weight may require additional exercise and calorie cutting.
6) Propensities for certain conditions such as diabetes and asthma can accelerate during this time, due to changing hormone levels, lowered resistance to stress and infections, and other factors of aging. Medical checkups and health maintenance are more essential than ever at this point.

Don't be put off by this list; yes, the perimenopause may be an introduction to the beginning of the aging process and the toll it takes on your body's systems. But there's never been a time when medicine and health care, public information, and healthy life practices have been better able to contribute to everyone's pursuit of a healthy, active middle age. You have more control than any generation that's preceded you in how quickly or slowly your body loses ground to the aging process. You can learn ways to manage the effects of perimenopause and its role in the aging process.

Essential
If you've been casual about your health until you hit forty (which most people are), now is a perfect time to get serious about preparing for a long, healthy life ahead. Diet, exercise, lifestyle changes, and regular medical checkups are your strongest agents for maintaining a strong, healthy body.

Stay on Top of Your Symptoms
This chapter has outlined a wide range of symptoms that can appear during the years preceding menopause. But it's important to remember that you may experience none, some, or all of these symptoms — or others that aren't even listed. To be certain that you are doing all you can to maintain peak health during this important time of transition, pay close attention to your body, and don't ignore the messages it sends you. Many of the symptoms that initially seem par for the course for middle age may be symptoms of problems requiring serious and quick medical treatment. So don't ignore any ongoing problem because you think it's just “the change.” Work closely with your health care provider to make sure that your body gets any and all of the help that it needs to stay strong, fit, and healthy.


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Neurological and Cognitive Changes
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

As your hormone levels change, your brain function may show signs of faltering. This can be a frustrating and unsettling side effect of the menopausal process, and sometimes it's best to relax and realize it can also be normal.

Difficulty Concentrating
If you're approaching fifty, and it seems as though you aren't quite as sharp mentally as you used to be, it's probably because you aren't. Though fuzzy thinking, forgetfulness, difficulty concentrating, and memory problems are common complaints of perimenopausal and menopausal women, these issues are linked as closely with the aging process as they are to changing ovarian functions. Today, doctors and health care professionals recognize that certain cognitive problems are due to depleted estrogen levels and other changes in the aging brain.

How does this fuzzy thinking manifest itself? In ways you've probably experienced most of your life, for example, losing your car keys, forgetting what you were about to say, recognizing a face but failing to recall the name, searching fruitlessly for the right word, being easily distracted, or losing your train of thought.

As women reach the age of menopause (around age 50), however, they can suffer an increase in these sorts of problems. You may have heard people refer to these lapses as “senior moments,” and if you're approaching the age of menopause you're likely to be experiencing them yourself.
While you can't stop your brain's odometer from registering the passing years, you can slow down and repair many of the issues that contribute to fuzzy thinking and other cognitive roadblocks.

Memory Loss
As your estrogen rises and falls during perimenopause, memory may be impacted. This is usually transitory and will improve once the body adjusts to new lower levels of hormones. It is a symptom that women can find annoying, or even alarming, if they are worried about dementia. Although some memory loss is very common with aging, especially short-term memory, these initial memory lapses should not be a cause for alarm unless they are serious enough to affect day-to-day activities. Stress can make memory problems worse, so take that into account when you are assessing whether this is a problem for you.

Alert
If your heart palpitations are severe or produce significant discomfort or side effects, you need to talk to your doctor or health care provider about them. Some palpitations are a warning sign of an impending heart attack. Pay attention to the number and frequency of your palpitations, and be prepared to discuss these and your heart history when you talk with your doctor.

Insomnia
Interruptions in normal sleep patternsare common complaints of perimenopausal and postmenopausal women. During the years approaching menopause, many women find that they wake once or twice during the night and then have a difficult time returning to sleep. Other times, women find that it takes longer for them to fall asleep when they go to bed at night or that they awaken an hour or two earlier than they used to. Whatever form it takes, insomnia leaves women feeling tired, irritable, and out of touch with their surroundings.
Fortunately, many women find that insomnia is a transient problem that may last no more than a few months. For others, insomnia during perimenopause may be so severe that it hampers their performance and sense of well-being during the day. There are a number ofoptions for minimizing insomnia when it strikes. As always, if your symptoms become severe, consult your doctor or health care professional. You can combat insomnia, so don't allow it to drag you down during this important transition phase.

Migraines and Other Headaches
Some medical experts will tell you that migraine headaches aren't truly a symptom of menopause. Nevertheless, many women who have never experienced a migraine in their lives begin having them during perimenopause. These hormonally related migraines are often experienced by younger women in the first few days of their periods, or during pregnancy. In both cases, fluctuations in your body's estrogen levels seem to be a cause.
Though both sexes suffer from migraines, women are three times more likely to have them. Migraines are intensely painful headaches thought to be associated with constricted blood vessels in the brain. Women who suffer migraines describe them as pounding headaches that can cause nausea, vomiting, and a strong sensitivity to light, noise, and odors.
Some migraine sufferers — about 20 percent — report a certain premonition, or aura, for several minutes before the actual pain begins. This aura can include flashing lights, certain odors, changes in their vision, or numbness in a hand, arm, or leg. Migraines usually last four or more hours, and they can last as long as a week.

Migraines aren't the only kind of headaches that seem to accompany perimenopause. In general, women report having more frequent and severe headaches during this time. These are usually simple stress or muscle tension headaches, and are often relieved by over-the-counter analgesics such as aspirin and acetaminophen.


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Emotional and Psychological Changes
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Women report various emotional and psychological shifts during peri-menopause. Sometimes their partners or families complain about this symptom. As with other perimenopausal symptoms, these changes can be temporary, but they can also be unnerving.

Mood Swings
The good news about mood swings is that you may never experience them during perimenopause. Still, mood swings are a common complaint of perimenopausal women, and among women who cite symptoms in perimenopause, nearly 50 percent say mood swings are among the symptoms that bother them the most.
Whether you think of them as moodiness, temporary depression, or simply the blues, mood swings can be minor “speed bumps” in your day — or they can leave you feeling totally down and out. The experiences are as individual as the women who have them, but mood swings tend to take the form of intensified emotional reactions.

Sometimes, the swing can take you high, and you feel a particularly strong delight in everything around you — the weather, a movie, your dinner companion. Other times, however, mood swings can take you on a wild roller-coaster ride of emotions, such as intense sorrow, despair, love, anger, anxiety, general depression, or fear.
A typical anger response during a mood swing can leave your heart pounding, your face flushed, and your head throbbing. Mood swings can trigger bouts of crying and cause deep, dark feelings of hopelessness. Then, however dramatic they might be, mood swings may pass rather quickly, leaving you feeling a bit shaken and confused by the emotional ride.

Alert
Although it is tempting to drink alcohol when feeling anxious, it is a very bad idea for menopausal women. Not only does it cause insomnia and trigger hot flashes, according to the North American Menopause Society, women who drink heavily have a higher death rate from alcohol abuse, and are at a higher risk for stroke, liver disease, and cancer.
Though mood swings seem to be emotional responses, they can, in fact, be a direct physical response to the changing hormonal levels in your bloodstream. In fact, many perimenopausal women experience mood swings along with other common symptoms of premenstrual syndrome (PMS), even when those women have never before suffered from PMS symptoms.
Those symptoms include a wide range of physical and emotional markers, including gastrointestinal distress, headaches, pains in muscles and joints, fatigue, heart pounding, hot flashes, exaggerated sensitivity to sounds and smells, agitation, and insomnia.

Depression
Depression is a serious condition that should not be confused with brief episodes of feeling sad or overwhelmed. It is not a normal part of perimenopause, although many women use “depressed” to describe their quickly changing moods or tendency to cry easily. Chapter 8 discusses depression and its treatment in greater detail. If you find yourself feeling hopeless, desperate, or sad for long periods of time, see your health care provider or counselor to determine if this is part of adjusting to new hormone levels or something more serious.

Fact
Most health care professionals agree that certain lifestyle habits contribute to insomnia at any time in your life. Get regular exercise and try not to consume any alcohol, sugar, caffeine, or rich foods within the two to three hours before bedtime.

Changes in Libido
Few things are more individual than libido. Everyone has a unique attitude toward sex and sexuality, and we all differ in our sexual habits and desires. While this undeniable (and delightful!) individuality may seem to contradict any generalizations about how sexual desire can change during menopause, many women do experience some types of changes during this time.

Many studies — including those of the famous Alfred Kinsey — indicate that both men and women can experience gradually declining sexual desire as they age. Pay special attention to the “can” in that last sentence. While not everyone undergoes a noticeable change in libido during menopause, many women report changes in their level of sexual desire. Some say they have more interest in sex and enjoy it more, while others say their desires have diminished, and still others say they find sex increasingly unappealing — even painful.


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Physical Changes
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

Your body will tell you when you are entering perimenopause. You may not listen to it at first, or you may try to dismiss physical symptoms as “getting a bug” or some other familiar event. But once it gets your attention, you can tune in to your body and manage some of the physical changes before they get the best of you. Here are some common changes to watch for.

Hot Flashes (Including Night Sweats)
Along with irregularities in menses, hot flashes have to earn the dubious honor of being one of the symptoms most commonly reported by women during perimenopause. Nearly 75 percent of women who report perimenopausal symptoms list hot flashes among them. Hot flashes can come at any time of the day or night, but when they occur during sleep, they're usually referred to as night sweats.
Hot flashes can be mild or severe, but in general, they involve a fast-spreading sensation of warmth in your neck, shoulders, and face that may last a few seconds or as long as thirty minutes or more. This sensation may begin at the top of your scalp, behind your ears, on your chest, or even across your nose.
Hot flashes don't have to limit themselves to your head and shoulders; many women have also reported flashes occurring across the breasts, below the breasts, or all over the body. Hot flashes are so common and bothersome that an entire section is devoted entirely to managing them.

Irregular and/or Heavy Periods
Changes in your period are usually the very first sign that the perimenopause has arrived. Even if your periods have always been as regular as clockwork, you can expect some irregularities to occur in the years preceding menopause. The levels of estrogen and progesterone produced in your body can flag and surge, contributing to unusually light or skipped periods, or periods that flow for weeks at a time. Some women experience spotting — or even phases of heavy bleeding — for a few days between periods. In other words, you may find that irregularity becomes the norm in your perimenopausal cycles.

Alert
If periods come less than 21 days apart, last more than a week, are unusually heavy, and maintain these irregularities for more than two cycles, make an appointment with your doctor or health care professional for a gynecological checkup.
Having said that heavy periods and ongoing irregular bleeding are not uncommon during perimenopause, it's also important to have them checked out by your health care provider. Heavy bleeding or bleeding that continues for a long time can be more than an inconvenience. Nonstop heavy bleeding can leave you tired, weak, and anemic — a prime candidate for getting a cold, flu, or infections.
Even more importantly, heavy bleeding may have nothing to do with simple hormonal ebbs and flows. Heavy bleeding could be a sign of abnormal tissue in the uterus, precancerous conditions, or even endometrial cancer. Don't take chances that your period irregularities are just part of the change. If your irregularities are dramatic, see your health care professional.

Fact
According to some studies, your menstrual cycles may shorten before age 40, then lengthen slightly as you approach menopause. So while your period may occur every 26 days when you're 40 years old, as you reach 45, 35-day cycles may be normal for you.
Heart Palpitations
Heart palpitations are the sudden uncomfortable awareness that your heart is pounding, often at a more rapid rate than normal. Heart palpitations can be frightening, but remember that they aren't uncommon in perimenopausal and menopausal women. Certainly, these women aren't the only ones to experience palpitations — many men and women have them after exercising, when frightened, or while taking some medications. But at menopause, the incidence of heart palpitations seems to rise in women.
Women describe heart palpitations differently, but in general a heart palpitation feels like your heart is beating rapidly, out of sequence, too strenuously, or in some other abnormal fashion. A heart palpitation can feel like no more than a brief fluttering in your chest that passes within a matter of a few seconds. Other, stronger palpitations can feel like a distinct pounding in your chest that lasts a few minutes and can leave you feeling light-headed or short of breath.

Essential
Caffeine, cigarettes, and excess sugar can overstimulate your system and be a contributing factor in heart palpitations. Perimenopause is a great time to cut back on your intake of these.
Involuntary Urine Release
If you've ever experienced urinary tract infections (UTI), you might feel as though they're back with a vengeance during your transition into menopause. And if you've never had urinary tract problems, you might develop them during perimenopause.
According to some estimates, nearly 20 percent of all women over the age of 45 develop some urinary tract problems. Those problems can include UTIs, stress urinary incontinence (caused by a stressor such as sneezing, coughing, or laughing), and urge incontinence (caused by a bladder spasm that forces urine out, even when the bladder is not completely full).

Weight Gain
The results are in: weight gain is commonly seen as people of both sexes age. The term “middle age spread” was coined decades ago to describe the tendency of the post-forty body to take on excess weight. Of course, not everyone gains weight during perimenopause and after menopause, and not everyone who does gain weight gains debilitating amounts.
But the fact is that the majority of women report weight gain at this time. Even women who don't gain weight may experience a change in their body shape. Many women in middle age gain softer, rounder abdomens, larger hips, thicker waistlines, and even extra weight on their shoulders, arms, and thighs.


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Recognizing the Symptoms
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.

So what can a woman expect from perimenopause? What kinds of symptoms are common — or even possible — and what do they mean? If you have to listen to your body in order to understand its condition and needs, how do you interpret the messages of perimenopausal symptoms? And how do you know if your symptoms are related to perimenopause or some other part of the aging process?
You Are the Expert on What's Normal for You
First, it's important to understand that, if you think it may be peri-menopause, it probably is. No one is more familiar than you are with your body's feelings and reactions during your monthly cycles. As the following sections demonstrate, women have reported a wide variety of symptoms during and after perimenopause. Remember, some women experience no symptoms at all.
It's also important to keep in mind that everyone can expect to experience some physical and mental signs of aging. As women age, many of their physical changes are triggered or exacerbated by hormonal fluctuations. The good news is, any overt symptom that is associated with changing hormone levels can be temporary — and may even be diminished through diet, exercise, or other healthy options.
Perimenopause isn't like measles; you don't wake up one day with a clear sign that you've come down with a case of waning estrogen. So identifying when you enter perimenopause isn't always easy. If you start noticing obvious changes in the length of your periods, the intervals between them, or the heaviness of your flow, and you're between the ages of thirty-five and sixty, you should start checking for other signs of perimenopause.
Fact
Don't let the term “symptoms” lead you to believe that this chapter is describing perimenopause as a disease or illness — it's neither. Perimenopause is a natural process of physical change. For the sake of simplicity, this book refers to the body's demonstrations of this natural process as “symptoms,” with no connotation of illness or disease.
Other Early Changes
Changes in your cycle may not be your first indicator that perimenopause is approaching. Many women report symptoms of perimenopause while their periods remain much the same. Most women feel some or all of the following symptoms as their bodies prepare to stop ovulating:
Hot flashes
Mood swings
Decreased sexual drive
Weight gain
Difficulty concentrating
Heart palpitations
Migraine headaches
Irregular and/or heavy periods
Involuntary urine release and bladder urgency
Insomnia
Vaginal dryness and painful intercourse
Anxiety or panic attacks

Add to that list everything from aching joints and muscles to the onset of chin whiskers and you've still only started to talk about the wide variety of symptoms perimenopausal women have reported. Though some women report no symptoms of approaching menopause, most women do experience symptoms so chances are good that you will too. Thinning hair, hot flashes, aching joints — these and other symptoms may seem like inevitable side effects of the aging process. But many symptoms of the aging processes can be triggered or exaggerated by the hormonal fluctuations of perimenopause.

Essential
Don't dismiss symptoms or make up your mind that you're going to tough it out no matter what. You have options for alleviating symptoms — lifestyle changes, behavior modification, hormone therapy, or dietary changes. Do yourself a favor and explore your options
If the preceding list paints a scary picture of perimenopause, it's also important to mention that even among women who experience one or more of these symptoms, their effects can be mild, transient, or otherwise bearable. Your body is adjusting to varying rates of hormones during perimenopause; the signs and symptoms of that adjustment are often temporary and disappear after your body has acclimated itself to its new hormone levels. The following sections offer you a closer look at these symptoms so that you have a better idea of what to expect.


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Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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The Journey Through Perimenopause
by Kate Bracy Kalb, R.N., M.S., A.R.N.P.
Every individual menopause, like every adolescence, is its own story. On average, women begin perimenopause at age 47 and experience it for about four years. But women can enter perimenopause in their late thirties or early fifties, and it can last from a few months to eight or ten years.
You have no way of knowing precisely when or how you'll begin noticing the changes that announce your coming menopause. Instead, you're more likely to find yourself one day connecting the dots of a number of odd symptoms and changes that eventually add up to the fact that you are, indeed, moving toward menopause.
Whew, It's Just Menopause!
Whenever it happens, you're likely to have a difficult time accepting the idea that you actually are perimenopausal, but the realization can be a relief. You may have decided that you were losing your mind or developing an odd and difficult-to-diagnose illness, when in reality the symptoms you experience are normal, manageable demonstrations of a natural stage in your body's development.
Uh-oh, It's Menopause!
The opposite reaction is also common. Once you realize that you are not coming down with a tropical fever or going over the edge with a mental disorder, you may find yourself worried or fearful that you are entering a scary, unknown land of hot flashes and brittle bones. This book should help you sort out what is normal and expected.
The more you know about the possibilities, the better you can cope with them. And just as with adolescence, a list of “typical” symptoms will only give you some ideas about what might happen. Your own passage will be unique to you, and you will be the one to decide when you need support to deal with the changes, and which ones you can ride out on your own.


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Recognizing the Symptoms
By Kate Bracy Kalb, R.N., M.S., A.R.N.P

So what can a woman expect from perimenopause? What kinds of symptoms are common — or even possible — and what do they mean? If you have to listen to your body in order to understand its condition and needs, how do you interpret the messages of perimenopausal symptoms? And how do you know if your symptoms are related to perimenopause or some other part of the aging process?

You Are the Expert on What's Normal for You
First, it's important to understand that, if you think it may be peri-menopause, it probably is. No one is more familiar than you are with your body's feelings and reactions during your monthly cycles. As the following sections demonstrate, women have reported a wide variety of symptoms during and after perimenopause. Remember, some women experience no symptoms at all.
It's also important to keep in mind that everyone can expect to experience some physical and mental signs of aging. As women age, many of their physical changes are triggered or exacerbated by hormonal fluctuations. The good news is, any overt symptom that is associated with changing hormone levels can be temporary — and may even be diminished through diet, exercise, or other healthy options.
Perimenopause isn't like measles; you don't wake up one day with a clear sign that you've come down with a case of waning estrogen. So identifying when you enter perimenopause isn't always easy. If you start noticing obvious changes in the length of your periods, the intervals between them, or the heaviness of your flow, and you're between the ages of thirty-five and sixty, you should start checking for other signs of perimenopause.

Fact
Don't let the term “symptoms” lead you to believe that this chapter is describing perimenopause as a disease or illness — it's neither. Perimenopause is a natural process of physical change. For the sake of simplicity, this book refers to the body's demonstrations of this natural process as “symptoms,” with no connotation of illness or disease.

Other Early Changes
Changes in your cycle may not be your first indicator that perimenopause is approaching. Many women report symptoms of perimenopause while their periods remain much the same. Most women feel some or all of the following symptoms as their bodies prepare to stop ovulating:
Hot flashes
Mood swings
Decreased sexual drive
Weight gain
Difficulty concentrating
Heart palpitations
Migraine headaches
Irregular and/or heavy periods
Involuntary urine release and bladder urgency
Insomnia
Vaginal dryness and painful intercourse
Anxiety or panic attacks

Add to that list everything from aching joints and muscles to the onset of chin whiskers and you've still only started to talk about the wide variety of symptoms perimenopausal women have reported. Though some women report no symptoms of approaching menopause, most women do experience symptoms so chances are good that you will too. Thinning hair, hot flashes, aching joints — these and other symptoms may seem like inevitable side effects of the aging process. But many symptoms of the aging processes can be triggered or exaggerated by the hormonal fluctuations of perimenopause.

Essential
Don't dismiss symptoms or make up your mind that you're going to tough it out no matter what. You have options for alleviating symptoms — lifestyle changes, behavior modification, hormone therapy, or dietary changes. Do yourself a favor and explore your options
If the preceding list paints a scary picture of perimenopause, it's also important to mention that even among women who experience one or more of these symptoms, their effects can be mild, transient, or otherwise bearable. Your body is adjusting to varying rates of hormones during perimenopause; the signs and symptoms of that adjustment are often temporary and disappear after your body has acclimated itself to its new hormone levels. The following sections offer you a closer look at these symptoms so that you have a better idea of what to expect.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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Perimenopause

The Signs and Symptoms of Perimenopause
From Tracee Cornforth, former About.com Guide
Updated September 04, 2009

The signs and symptoms of perimenopause can occur 10 to 15 years before actual menopause occurs, which is the final cessation of your menstrual cycle. Perimenopause actually is the time you have the notable symptoms of menopause (such as hot flashes, and when a woman might say "I'm menopausal."). Once that has ended, you are considered postmenopausal. Most clinicians will say a woman is postmenopausal once she hasn't had a period for a year.
The age when the signs of perimenopause occur varies among women. Most women notice perimenopausal signs in the 45-55 age range, although it varies, and some women never experience any symptoms. The average age for the final menstrual period is 51.
Women who have had hysterectomies with one or both ovaries removed usually experience immediate surgical menopause. Some hyterectomized women whose ovaries were left intact also experience perimenopause.

The Symptoms of Perimenopause
Hot flashes, night sweats, coldness
Irregular periods that can be heavy, light, shorter or longer cycles
Difficulty sleeping either getting to sleep or staying asleep
Mood changes, anxiety, depression, irritability
Heart palpitations (if you experience any heart disturbances, always consult a physician)
Dry skin and/or hair loss
Loss of or decreased sexual desire
Vaginal dryness
Incontinence -- the inability to hold your urine

There are many other symptoms that women may experience during the perimenopause years. Sometimes the symptoms of perimenopause can be mimicked by other conditions -- commonly thyroid disorders, so it's important anytime you experience symptoms that are different for you that you consult your physician.

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Hot Flashes
10 Ways to Relieve Menopausal Hot Flashes
From Tracee Cornforth, former About.com Guide
Updated September 28, 2009
Hot flashes and menopause -- it's almost impossible to think of one without the other. Hot flashes are probably the first symptom we think of when we think of menopause or perimenopause (the years before menopause). Whether you already experience hot flashes, or you are still waiting for your turn, here are ten tips that can help reduce the severity of hot flashes when they happen to you:

1. Some research suggests that soy may have some benefit for reducing hotflashes and other symptoms of menopause. However, it is recommended that you get your soy from foods rather than from supplements. Foods that contain soy include tofu, tempeh, miso, soy milk, whole soybeans, texturized vegetable protein, and soy powder.
2. Black cohosh is a popular choice for the reduction of hot flashes, although little evidence exists about whether it is effective for menopausal symptoms, such as hot flashes and night sweats. You may hear claims that black cohosh provides effective relief against these and other symptoms of menopause, including headaches, heart palpitations, and anxiety. While there have been several small and inconsistent studies regarding the use of black cohosh for menopausal symptoms relief, the results have been inconsistent. According to the North American Menopause Society, despite the lack of definitive evidence, "it would seem that black cohosh is a safe, herbal medicine.”
3. Natural progesterone has been found to provide relief for hot flashes and other symptoms of menopause for many women. It is available in over-the-counter cream, compound prescription cream or capsule, and in traditional prescription --Prometrium (progestins) -- forms.
4. A study published in Gynecologic and Obstetric Investigation found that Vitamin E may help reduce the occurrence and severity of hot flashes and night sweats during menopause.
5. Effexoris a an antidepressant that has been found to reduce hot flashes in women undergoing treatment for breast cancer. Because it works so well for breast cancer patients, researchers believe it may be an option for women who don't want to use traditional hormone replacement therapy during menopause.
6. Exercise at least 30 minutes every day. You can walk, run, ride a bicycle, or do another activity. Just don't exercise within 3 hours of going to bed to help prevent night sweats.
7. Gabapentin is a drug currently used to treat migraine headaches. Anecdotal evidence, however, found that the drug significantly reduced the number of hot flashes experienced in a small group of women.
8. Dietary triggers that can start a bout of hot flashes include alcohol, caffeine, and cayenne and other spicy foods. If your hot flashes seem to be worse after consuming these foods, try eliminating the offenders and see if the hot flashes subside.
9. Traditional hormone replacement therapy (HRT)that includes estrogen replacement provides relief from hot flashes associated with menopause. However, estrogen has been associated with some medical risk and should be used sparingly. Before choosing estrogen replacement therapy, be sure you understand the both the risks and the benefits and how their relevance to your personal medical history. Talk to your medical provider.
10. Hot flashes are often worse during hot weather. Wear all cotton clothes that allow your skin to breathe and keep a fan nearby during hot weather to reduce the number of hot flashes you experience.



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Comparing different types of Treatment for Menopause
Sources
• Types of menopause treatment. Reviewed by 34-menopause-sypmtoms.com

Although menopause is a natural transition for women it does cause a lot of symptoms that can greatly affect a woman´s life. Menopause is different for every female though the majority will suffer from several of the 34 menopause symptoms that exist. Treatment for menopause is almost always necessary and women looking for relief from their menopausal symptoms and treatment for menopause have a variety of options to choose from.

What treatment for menopause is available?
A woman looking to relieve her menopause symptoms has three types of treatment for menopause to consider:

Lifestyle Changes – for example, eating a balanced diet and doing regular exercise.
Alternative Medicine – herbal remedies are the most well-known.
Drugs and Surgery – Hormone Replacement Therapy (HRT).

Women are encouraged to begin with the least risky approach to treatment for menopause, lifestyle changes. Yet, while such lifestyle changes are often an effective treatment for menopause, they alone do nothing to address the underlying cause of menopause symptoms - hormonal imbalance. Fortunately, natural remedies can be combined with lifestyle changes to provide a safe and effective treatment for menopause. While medical intervention is not usually necessary some women may wish to consider HRT if they are unable to relieve their menopausal symptoms. Keep reading to find out how to choose the best treatment for menopause for you.

How do I choose a treatment for menopause?
The task of choosing a treatment for menopause is never an easy one. Every woman has different needs and will know her body well enough to understand which treatment for menopause is likely to be most successful. However, to help make this decision, it is advisable to speak to your healthcare provider to discuss your medical history and to see if you need a prescription treatment. Your doctor will assess all of your menopause symptoms and help establish the right treatment for menopause for you. Read on to learn about the safety of HRT as a treatment for menopause.

Is HRT the best treatment for menopause?
In a word, no. Used in the short-term HRT is an effective treatment for menopause and it also helps to protect bone health. However, if you suffer from certain health conditions you may not be suitable for HRT, so speak to a doctor about these. It is worth noting that in 2002 the Women's Health Initiative (WHI) undertook the largest clinical trial ever conducted in the United States to investigate the possible benefits and risks associated with HRT. This study was canceled in July 2002 after it was proven that synthetic hormones increase risks of ovarian and breast cancer as well as heart disease, blood clots, and strokes. Thus, the longer a woman is using HRT as a treatment for menopause the higher the risk of developing serious condition such as these. Please keep reading to understand how natural remedies can be used as a treatment for menopause.

Are natural remedies an effective treatment for menopause?
Alternative approaches involve little to no risk and can be an extremely effective treatment for menopause. Herbal remedies are the only viable option to treat the hormonal imbalance that occurs during menopause directly at its source. Thereare two types of herbs that can be used as a treatment for menopause: phytoestrogenic and non-estrogenic herbs. Non-estrogenic herbs are regarded as the safest because they don´tcontain any estrogen and they don´t add plant hormones into the body like phytoestrogenic herbs do. Non-estrogenic herbs stimulate a woman´s hormone production by nourishing the pituitary and endocrine glands, causing them to more efficiently produce natural hormones. This ultimately results in balancing not only estrogen but other pertinent hormones such as progesterone. Non-estrogenic herbs such as Macafem can be considered the safest treatment for menopausebecause the body creates its own hormones and doesn´t require any outside assistance.




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Natural Menopause 8 Natural Alternatives to Reduce the Symptoms of Menopause
From Tracee Cornforth, former About.com Guide

Menopause occurs at the natural end of every woman's reproductive life. So why not treat it in a natural way? Hormone replacement therapy (HRT) was long the standard treatment for menopause, however, since we now know that traditional HRT using synthetic estrogen and progestins increases the risk of breast cancer and heart disease, many women and healthcare providers are no longer routinely asking for or prescribing traditional estrogen replacement therapy.
More and more women, every day, are turning to natural alternative treatments to treat the symptoms they experience during menopause including hot flashes, night sweats, and mood swings. Try the following tips to ease your symptoms of menopause:
• Your diet is an important tool that you can use to help control your menopausal symptoms. Foods to avoid include high amounts of caffeine in any foods, and carbonated beverages which contain phosphorous and can increase bone loss. Also, limit your consumption of commercially raised meats including beef, pork, and chicken because these meats contain a high amount of saturated fats and decrease the body's ability to metabolize estrogen. Excessive sugar intake also limits your liver's ability to metabolize estrogen and impairs the immune system.

Increase your intake of foods that contain phytoestrogens including soy. Other foods that you should include in your diet include grains ,oats, wheat, brown rice, tofu, almonds, cashews, and fresh fruits and vegetables.



• According to research published by the Journal of the British Menopause Society, red clover isoflavone supplements, used in controlled studies, have been shown to have a significant positive effect on the rate of bone loss, improve cardiovascular health, and may offer some protective effect against breast and endometrial cancer. There is also evidence which suggests that red clover isoflavones decrease the incidence of hot flashes, one of the most common vasomotor complaints experienced by peri-menopausal and menopausal women. In one study, after 8 weeks using Promensil 40mg daily participants experienced a 58% decrease in the number of hot flashes experienced; study participants also experienced a significant reduction in the severity of night sweats. Promensil is a dietary supplement that is available over-the-counter, without a prescription, at retail grocery, drug, and health food stores.
• Lactobacillus acidophilus and Bifidus (the "good" bacteria in our intestines) cultures are important for women during menopause to help with metabolism and utilization of estrogen, and some believe these "good" bacteria help reduce the occurrence of yeast infections. These can be found in various nutritional formulas on the market.
• In his book, Medicinal Herbal Therapy: A Pharmacist's Viewpoint, registered pharmacist Steven G. Ottariano says that certain vitamins and minerals can provide particular benefits to menopausal women. These include Vitamin E (400 to 800 IU daily) to help reduce hot flashes and night sweats; Calcium (1500 mg daily)--the best type of calcium is not calcium carbonate which may not be fully absorbed, but microcrystalline calcium hydroxyapatite calcium (MCHC) or calcium citrate; Magnesium (500 mg to 750 mg daily) is essential to help with the absorption of calcium; Vitamin C (1,000 mg to 2,000 mg daily) helps absorption of Vitamin E and decreases capillary fragility.
• Also recommended by Pharmacist Ottariano is Black Cohosh (20 mg to 60 mg, 3 times daily) which is a phytoestrogen that helps many women manage menopause symptoms. There are a number of Black Cohosh products on the market for menopause including Remifemin. However it's important to note (as I have learned through my personal experience) that women with surgical menopause may not find phytoestrogens as helpful as those who experience natural menopause. Other herbs recommended as potentially beneficial by Ottariano include Dong Quai (500 mg to 1000 mg, 2 or 3 times daily), Evening Primrose Oil (500 mg 3 or 4 times daily), Ginseng (100 mg to 500 mg, 3 times daily), and Vitex Agnus Castus (175 mg daily).
• Natural estrogen compounds are available by prescription from compounding pharmacists. These types of estrogen are bio-identical -- they are chemically equal to the estrogen produced naturally in your body. There are 3 types of estrogens commonly used in bio-identical hormone replacement therapy. These are: Estrone (E1); Estradiol (E2), and Estriol (E3). Estrone and estradiol cause most of the risks associated with estrogen use. Natural or bio-identical estrogen compounds are prepared in any combination or number of these 3 types of estrogen; the most common formulation is 10 percent Estrone, 10 percent Estradiol, and 80 percent Estriol--called Tri-estrogen or Tri-est. A two estrogen bio-identical compound is called bi-estrogen.
• Natural progesterone is an important component in menopausal symptom management for many women. It's available over-the-counter in products such as Pro-Gest, in compounded prescriptions, and a pharmaceutical called Prometrium. The benefit of using a cream product over an oral form is that you need a much lower dose because it does not have to be metabolized by the liver. Progestins such as Provera are not natural progesterone but a synthetic version which is not chemically equivalent to the progesterone produced by the body. Natural progesterone causes virtually no side effects--progestins cause side effects that include irregular bleeding and fluid retention.
• Of course, don't forget to get plenty of regular exercise. Exercise is probably the single most important thing a woman can do to improve her overall health and well-being throughout her life. Regular exercise (at least 3 or 4 days a week) helps prevent and reduce bone loss, and plays a key role in reducing your risk of many types of cancer, as well as heart disease.
Although these suggestions work for many women, remember every woman is different and it may take some time for you to find which treatments, or combination of treatments, work best for you. Always inform your healthcare provider of any natural alternative treatments you are using--this includes all vitamins, herbs, creams, etc.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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TANYA602's Photo TANYA602 Posts: 1,036
5/11/12 4:57 P

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I like that the topic here started to turn, as well. I had a full hysterectomy a year ago and am on a low dose of estradiol. I don't know if I can necessarily blame it for making it so hard to get the weight off, but I am going to. Before my surgery I had lost - on doctor's orders - 16 pounds. Which I promptly have put right back on. I have been here on SP 15 weeks .In that time I've started working out 7 days a week and tracking what I eat and I've lost 12 pounds. I am building good muscle, but the scale seems awfully stubborn. I can totally sympathize with Arubatime and am wondering if anyone else is struggling with this. I am tempted to cut my dosage, but also don't want to go back to have night sweats and insomnia. I feel a bit lost.....

Edited by: TANYA602 at: 5/11/2012 (17:02)
Tanya
San Diego, CA

"Somebody said they saw me, swinging the world by the tail
Bouncing over a white cloud, killing the blues."
Robert Plant/Allison Krauss


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1SERIOUSCHICA's Photo 1SERIOUSCHICA Posts: 33
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Thank you ladies for your wealth of knowledge. I have been on the Vivelle Dot since my total hystectomy on April 2010 and I have questions from time to time that I would like "real" answers to.

ITSERTIME Posts: 467
8/22/10 6:18 P

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well i was on yaz about 3 years go for peri menapause symptoms and did woeful on it made me more pms, I finally buckled down and got a new low dose estrogen hoping it will be different cause like all of u i am sick and tired of these symptoms any suggestions would be appreciated thanks the name of it is: loestrinFe, Erica

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NANCYJACK Posts: 4
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You can also find the details on the Norethindrone drug at http://www.internationaldrugmart.com/noret
hindrone.html www.internationaldrugmart.com/noreth
in
drone.html


Edited by: NANCYJACK at: 7/15/2010 (09:02)
TRYING2LOSE's Photo TRYING2LOSE Posts: 12
5/19/10 1:17 P

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I am 50 and I had blood work done before starting a HRT. I never had a hot flash or any symptoms of Menopause but the blood work said I was in Menopause so I started on HRT Activella. I had heard to many horror stories about Menopause and I did not want to go through it without HRT.... emoticon

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SLENDERELLA2010's Photo SLENDERELLA2010 Posts: 1,042
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How wonderful for you !!


HEBREWS 12:1-2
"...let us throw off everything that hinders us and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith".


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TIME2RETIRE Posts: 3
9/23/09 10:20 A

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I am 50, and I started taking Prometrium and Estrace about 6 months ago. The hot flashes and sweats have subsided and I am able to sleep. I have no regrets. emoticon

SLENDERELLA2010's Photo SLENDERELLA2010 Posts: 1,042
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So glad you posted! Even happier that you are feeling so much better since starting your HRT.
As for me, I didn't have LOTS of symptoms....but my quality of life was becoming so diminished that I felt I had to do something. I was a walking hot flash during the day and I would wake up three and four times a night to peel off clothing and mop off my sheets. My libido was low too, which I didn't even realize until I started taking my Prempro. My symptom reduction was almost immediate.






HEBREWS 12:1-2
"...let us throw off everything that hinders us and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith".


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LLAURIA2's Photo LLAURIA2 Posts: 1
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Thank goodness the discussion has finally turned to the USE of HRT! I stayed away from this site for a month because of the negative warnings from women who don't use HRT but do write books they'd like to sell.

I have suffered from perimenopausal night sweats, disrupted sleep, hot flashes during the day, vaginal dryness and tearing, mood swings, low libido, and a general feeling of unwell-ness. I read Dr. Christianne's book, watched Oprah, and did lots of research. In May I found a wonderful gyn that specializes in women's total wellbeing, had lots of hormone testing, and started HRT. Very low doses of progesterone and DHEA, also started on an anti-depressant. I felt better almost immediately! I know there is some risk to any hormone replacement but I also know that the quality of my life was greatly affected. HRT is a very personal choice and its important to make an informed decision.

I know for me its been a lifesaver. I don't know why more women don't share their experiences, what has and has not helped, how they've felt through it all, how it affects relationships, sex lives, all of it. I am more than happy to help others in making their decision by sharing my own experience.

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SLENDERELLA2010's Photo SLENDERELLA2010 Posts: 1,042
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I'm with you, Lisa. Pretty sure that there are venues for people who want to slam hormone therapy, but this team is supposed to be for those using, and at peace
with using, hormone therapy.
I am almost 50, had a hysterectomy in 2006 and chose to retain one ovary for hormone supply, I'm not unhappy with that decision. The past year I have suffered
terribly from hot flashes and night sweats. I did not *want* to go on replacement therapy, yet my quality of life had become so difficult that it felt more like a need.
Just ten days ago I started Fempro. Smallest dosage. I FEEL FABULOUS!!!!
To be able to work without sweat dripping down my face (I'm a dental assistant), to sleep and not wake up three times a night with literal PUDDLES
of sweat on my sheets..... I just thank God for HRT.
My internist AND GYN have both told me that as long as I can wean myself from hormones by age 60, the contraindications are negligible.
I'm no dope. I realize that there is a risk to ANY medication. There are also
risks to so-called "natural" therapies for menopause. I pray that I've chosen wisely and have been well informed. I am happy not to be suffering anymore.
Looking forward to meeting you all.


HEBREWS 12:1-2
"...let us throw off everything that hinders us and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith".


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WHATAGRL42's Photo WHATAGRL42 SparkPoints: (49,512)
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8/31/09 12:43 A

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So I joined this team because of its title: Women in menopause USING HRT. It's a very personal decision to take hormones, even when armed with all the data, pro and con. I feel it's akin to the decision a woman makes with respect to breastfeeding: to nurse or not to nurse. I did with all my girls, including my twins and my 31 week premature daughter: and that was even post breast reduction surgery.
But some women just don't want to ( or cannot) nurse.

Likewise, some women just want to take hormone therapy, as they enter into menopause. We know the data, have read the studies. But we weigh and measure the pros and cons, and make a personal decision. We who choose to take HRT, or choose to revisit the topic, should not be made to feel inadequate or uninformed.

HRT makes me feel better. There is a chance I could get cancer. There is also a chance I won't get cancer. My mother is in her 70's and had a surgical menopause in her mid 30's. She's always taken hormones. We pray she won't succumb to breast (or endometrial, or uterine, or ovarian, etc) cancer, but so far, she's lived a long productive... and comfortable life, with hormones.

Administrator: California Natives Team






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TIME2RETIRE Posts: 3
6/22/09 10:45 P

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Was wondering if you've read Hormones and your Health by Winnifred Cutler.

TIME2RETIRE Posts: 3
6/22/09 10:44 P

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Was wondering if you've read Hormones and your Health by Winnifred Cutler.

SUZADMS Posts: 45
5/30/09 9:43 A

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This just in: A drop in hormone replacement therapy leads to a decline in breast cancer cases

The decrease in deaths from breast cancer accounted for 37 percent of the reduction in the death rate among women during the 15-year period. See report: http://www.cnn.com/2009/HEALTH/05/27/healt
h.cancer.death.rate/index.html?eref=rs
s_health

See also the National Women's Health Network's health alert:
http://www.nwhn.org/alerts/details.cfm?e
mail_message_id=280

Natural or not, revved up hormones do the same thing, increase cell division in reproductive organs. Ask Suzanne Somers about her hysterectomy for severe hyperplasia of the endometrium while on bioidentical hormones.

A naturally high estrogen effect in cells has always been associated with endometrial cancer. These cells in an older women are red flagged in cytology and scrutinized for cancer.


SUZADMS Posts: 45
4/8/09 1:50 A

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Read the latest March 25th US News post interviewing Suzanne Somers regarding bio-identical hormones (BHRT). In the end, Suzanne Somers admitted she recently had to have a hysterectomy after experiencing uterine bleeding and severe hyperplasia. Severe endometrial hyperplasia is a stage before endometrial cancer which I would expect to happen with her history of breast cancer, 22 years on the birth control pill, and now on BHRT. She is very lucky they caught it in time.


PS: See US News Post at:
http://health.usnews.com/blogs/on-women/
2009/03/25/why-suzanne-somers-loves-bi
oidentical-hormones.html

suzanne adams (age 55 and doing well without drugs or hormones of any kind; just micronutrients and good food).
medical cytologist and nutritionist
www.i2k.com/suzanne/hormones.html



SUZADMS Posts: 45
3/29/09 6:19 P

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The worst thing women can do is take hormones, and that includes the Pill. As a cytologist who has screened for cancer and seen countless cases of it from breast to cervical, ovarian and endometrial, and who has studied the subject intensively, I can tell you it is these hormones revved up in pill form that are causing much of the cancer today. It is so bad amphibians & birds downstream from waste water treatment plants are becoming sexually deformed with birth defective offspring due to these hormones in the water. Chronic hormone use comes with a price--increased cell division in reproductive organs, vascular problems, & immune suppression. Couple this with poor nutrition & you have a recipe for cancer (uncontrolled cell division) & heart disease. Women who have never had children have more cancer because they never had a break from estrogen by being pregnant & nursing. The dramatic drop in breast cancer alone in tandem with the drop in HRT in the past few years should not be forgotten. This is the 1st time in history that breast cancer rates have fallen. Hormones, WHETHER NATURAL OR NOT, are dangerous because they all stimulate cell division. A lack of micronutrients (folic acid, zinc, B12, D, omegas, mag, cal, etc.) is what's causing much of our health problems today, including menopausal symptoms. Nutrients help make the needed hormones in our body that control mood, sleep, appetite, ovarian cycles, etc. I am 55 and went through menopause easily by fueling my body properly with nutrient-dense foods (fruits, vegetables, and fish, etc.) & good supplements. It's all about money now in the medical world. Don't be fooled. The creator of our bodies has the health-giving substances of life out there in nature. Trust the real doctor.

Here's a good chapter to read out of my book on the history of estrogen and its risks:
http://www.i2k.com/~suzanne/estrogen%20r
isk.pdf
and a page on my web site about hormones and Paps
http://www.i2k.com/~suzanne/hormones.htm
l

Suzanne CT (ASCP)
daughter of a breast cancer survivor & sister of a DES exposed baby. www.i2k.com/suzanne/cytology.htm

"The problems that exist in the world today cannot be solved by the level of thinking that created them." -Albert Einstein


Edited by: SUZADMS at: 3/29/2009 (18:20)
SKEEWEEAKA's Photo SKEEWEEAKA Posts: 343
12/31/08 12:50 A

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Hello all...

Rhonda are you taking progesterone with that. I think I've read you're supposed to take it days 14-28 when you're taking estrogen...not sure if I got the days right. That could explain the weight gain because the estrogen is unopposed...

TJ

Have a Beautiful, Blessed Day!

Could it be THYROID? www.stopthethyroidmadness.com/
Could it be VITAMIN/MINERAL Deficiencies? forums.wrongdiagnosis.com/showthread
.php?t=9948


GOALS:
1. Whole Foods
2. Exercise walking and goal is jogging.
3. Vitamin/Mineral Supplements
4. Detox Baths
5. Down a size by end of August

TJ :)


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TEXASGAL491's Photo TEXASGAL491 Posts: 3,854
12/27/08 2:48 P

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Well gals, i had my hysterectomy on 12/3, and really need help. I've read so much negativity on Webmd.com about HRT and breast cancer..I take Lexapro for the anxiety and some days it helps but, wow though some days i actually feel like the devil.

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ARUBATIME's Photo ARUBATIME Posts: 17
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Hello. I am now taking a very low dosage daily of estrogen to handle the extreme hot flashes and mood swings. Finally, something is working for me! I have been taking them since April. Unfortunate part is I have gained almost 10 lbs since April, and I am REALLY struggling with getting the weight off. Anyone else struggling with this? AND I would love some suggestions. I am staying within my calorie count, exercising 5 times a week --- to very little results!

Rhonda


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8/1/08 3:05 P

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I think prozac was a better decision than HRT but can't quit either. Hanging on to this too shall pass!

" When I wake up in the morning, I have to decide to either be an example or an excuse."
Author Unknown


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Don’t deny yourself to please others. You only lose yourself in the promise.”


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DSMBURTON Posts: 3,394
7/4/08 12:06 A

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Knowledge is power so the more we learn the better it will be. I want to learn more because that is how you grown and learn to overcome. Sometimes though the information isn't reliable and I tend to weight the information based on the source.

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6/11/08 12:25 P

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Yea, we need to keep sharing all the inforamtion we find. As the data changes almost daily for menopause treatments and such. *S*

Together, as a team, we can empower some women, right? *S*

(((HUGS))))



Pamela aka Scottieluvr

" When I wake up in the morning, I have to decide to either be an example or an excuse."
Author Unknown

" As long as a man stands in his own way, everything seems to be in his way."
Ralph Waldo Emerson

" I have yet to find a man, however exalted his station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism."
Charles Schwab

Personal web site: http://scottieluvr


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NAOLEE's Photo NAOLEE Posts: 4,851
6/11/08 7:55 A

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Thank you, Scottie. Great article. I have to be prepare and I am learning here.

Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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6/10/08 3:16 P

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The HRT article only:

[quote]

Hormone replacement therapy (HRT) - www.revolutionhealth.com/cond
itions/re
productive-health/menopause/t
reat-
overview/index


Examples
Date updated: May 26, 2006,
Kathe Gallagher, MSW - Content provided by Healthwise

Hormone replacement therapy (HRT) refers to the use of estrogen plus progestin for the treatment of perimenopausal symptoms. It is also commonly referred to as "opposed estrogen therapy."

Estrogen and progestin combinations (pills or tablets)

Brand Name Chemical Name
Premphase, Prempro conjugated estrogens/medroxyprogesterone
Activella estradiol/norethindrone acetate
Transdermal combination preparations (a patch placed on the skin that continuously releases estrogen and progestin)
Brand Name Chemical Name
CombiPatch estradiol/norethindrone acetate
Oral progestin (pills or tablets; used along with an estrogen-only preparation)
Brand Name Chemical Name
Provera medroxyprogesterone
Prometrium micronized progesterone
Micronor, Norlutin, Nor-QD norethindrone
Aygestin norethindrone acetate
Progestin intrauterine device (IUD; used along with an estrogen-only preparation)
Brand Name Chemical Name
Mirena levonorgestrel
Estrogen-progestin hormone therapy, or HRT, is recommended for all women with a uterus who choose to take estrogen. Using estrogen without progestin greatly increases your risk of endometrial cancer. Taking progestin with estrogen eliminates this increased risk.1

How It Works

HRT increases the estrogen and progestin levels in your body. There are several standard hormone replacement therapy schedules, including continuous and cyclic along with higher-dose and low-dose.

Combining progestin with estrogen:

Protects against endometrial cancer (which can develop with estrogen-only therapy).

Is not needed for women who have no uterus.

May trigger monthly withdrawal bleeding when progestin is used periodically (such as in cyclic HRT).

Patch warning. Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.

Why It Is Used

The estrogen in hormone therapy is used by some postmenopausal women to increase estrogen levels. This helps prevent osteoporosis and perimenopausal symptoms, such as hot flashes and sleep problems.

But HRT slightly increases risks of some serious health problems. This means that in a small number of women, HRT is known to cause breast cancer, ovarian cancer, blood clots, or dementia. In women who are 10 or more years past menopause, using HRT slightly raises the risk of heart disease.2

The FDA recommends HRT only for:

Short-term treatment of menopausal symptoms, at the lowest effective dose for as short a time as possible.3

Osteoporosis prevention and treatment, in select cases. Most experts recommend that HRT only be considered for women with significant risk of osteoporosis that may outweigh their risks of taking HRT.4 Women are now encouraged to consider all possible osteoporosis treatments and to compare their risks and benefits.5 For more information, see the topic Osteoporosis.

Who should not use HRT

You should not use HRT if you:

Could be pregnant.

Have a personal history of breast cancer or ovarian cancer.

Have a personal history of certain endometrial cancers.

Have a personal history of pulmonary embolism, deep vein thrombosis, heart attack, or stroke.1

Have vaginal bleeding from an unknown cause.

Have active liver disease. You may be able to use an alternative to oral estrogen that bypasses the liver, such as estrogen delivered from a skin patch (transdermal) or vaginal cream.

How Well It Works

HRT increases estrogen levels, which:6, 7

Helps prevent postmenopausal osteoporosis by slowing bone loss and promoting some increase in bone density.7

Reduces hot flashes, depression, and sleep problems in most, but not all, women.7, 8

Maintains the lining of the vagina, reducing irritation.

Increases skin collagen levels, which drop as estrogen levels naturally decrease. Collagen is responsible for the stretch in skin and muscle.

Reduces the risk of dental problems, such as tooth loss and gum disease.

May slightly lower the risk of colon cancer.6 (This is based on one study.)

Side Effects

Risks of hormone replacement therapy

Hormone replacement therapy was part of a large set of clinical trials called the Women's Health Initiative (WHI). The HRT portion of these trials showed a small increase in the rate of breast cancer among the women taking a combination of 0.625 mg of estrogen plus 2.5 mg of progestin daily. WHI data has also shown an increased rate of blood clots, heart disease, ovarian cancer, and dementia with HRT use.

HRT risk slightly raises the risk of several serious health problems. This means that in a small number of women, using HRT causes a serious health problem:

HRT-related breast cancers first become apparent after 4 years of HRT use. The number of HRT-related breast cancers increased with each additional year of HRT use. Women taking HRT generally had larger, more advanced tumors than women who developed breast cancer while taking placebo treatment.6

HRT slightly increases stroke risk in all healthy postmenopausal women, regardless of risk factors.6, 9 The increase in strokes first becomes apparent during the second year of HRT use.10

In women who are 10 or more years past menopause, HRT slightly raises the risk of heart disease. Early signs of heart disease can first become apparent during the first year of hormone use.11, 12, 2

HRT slightly raises the risk of blood clots in the lungs (pulmonary embolism) and legs (deep vein thrombosis) in all healthy postmenopausal women regardless of risk factors.10

HRT raises the risk for Alzheimer’s disease and other dementias in women ages 65 and older. The increased risk first becomes apparent in women taking HRT for more than 4 years. The WHI researchers have concluded that HRT does not provide protection from dementia or cognitive impairment, as was previously believed.13

HRT slightly raises ovarian cancer risk. This means that for a small number of women, taking HRT causes ovarian cancer.14

Among HRT users, the number of abnormal mammograms increases by approximately 4% per year, first apparent after 1 year of HRT use. (Daily estrogen plus progestin increased breast density compared with estrogen alone or placebo.) Although the abnormal mammograms required additional medical evaluation, they were not linked to the increase in breast cancer. Studies are ongoing to determine the significance of this finding.15

Experts do not yet know whether lower-dose, shorter-term HRT reduces or eliminates these risks.

Serious health events caused or prevented by HRT, per 1,000 women (estrogen 0.625 mg plus progestin 2.5 mg):16

Health event After 2 years of HRT use After 5.2 years of HRT use
Blood clots (venous thromboembolism) 6 more* 9 more
Coronary artery disease 3 more ** 4 more
Breast cancer No change*** 4 more
Stroke 1 more**** 4 more
Colorectal cancer No change 3 fewer#
Hip fractures 1 fewer 2 fewer
Death No change No change
* Risk is greatest during the first 2 years of use.
** Signs develop as early as the first year of use.
*** First noted after 4 years of use.
**** First noted after 1 year of use.
# Benefit noted after 3 years of use.

These average increased risks are relatively low in the general population of postmenopausal women. Your personal risk that hormone therapy may stimulate breast cancer, ovarian cancer, cardiovascular problems, blood clots, or neurological changes may be significantly lower or higher, depending on your risk factors. Not all possible risk factors are known.

Estrogen side effects

Side effects that can occur with all forms of estrogen but are more frequent with oral estrogen include:

Irregular vaginal bleeding.
Headaches.
Nausea.
Vaginal discharge.
Fluid retention.
Weight gain.
Breast tenderness.
Spotting or darkening of the skin, particularly on the face.

Asthma. Newly diagnosed asthma appears to be more common among women taking HRT or estrogen-alone (ERT) than women who are not. (Estrogen is thought to be a factor that causes or worsens asthma across the life span.)17

Gallstones. Women who use estrogen replacement therapy are more likely to have gallstones that cause symptoms than women who do not use ERT. (High estrogen levels are linked to gallbladder disease.)

Rarely, an increased growth of preexisting uterine fibroids or a worsening of endometriosis.

In addition, the estrogen patch (transdermal estrogen) may cause skin irritation.

Some of these side effects, such as headaches, nausea, fluid retention, weight gain, and breast tenderness, may go away after a few weeks of use.

Progestin side effects

The side effects of progestin often cause women to stop using hormone replacement therapy (HRT). Adjusting the progestin dose, changing the dosing schedule, or changing the type of progestin may reduce side effects. The progestin intrauterine device (IUD) reduces or eliminates side effects that are common with oral progestin.1

Progestin side effects include:

Mood changes, such as anxiety, irritability, or depression.
Headache.
Breast pain or tenderness.
Abdominal pain or bloating (distention).
Dizziness or drowsiness.
Diarrhea.
Vaginal discharge.

Cyclic progestin (taken 10 to 14 days per month) is more likely to cause:

Premenstrual-like symptoms, such as bloating, cramping, breast tenderness, nausea, and depression.

Monthly withdrawal bleeding.

The combination transdermal patch may cause skin irritation.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

If you have been taking HRT, talk with your health professional about your reasons for taking it. Are you taking it to help with perimenopausal symptoms or for long-term health reasons? Consider changing to another treatment, depending on the problem you are using HRT to treat. If HRT seems like the best choice for you, plan to use the lowest possible effective dose.

If you are unable to tolerate the side effects of progestin in hormone replacement therapy and you have not had a hysterectomy, try nonhormonal treatment options.

Some women use estrogen-only therapy (ERT) if testing does not show abnormalities of the lining of the uterus (endometrium). However, because this greatly increases your risk of uterine cancer, health professionals don't recommend taking estrogen alone. If you do take estrogen without progestin, you must have regular checks for precancerous changes of the endometrium. This means an annual pelvic exam along with an annual endometrial biopsy or transvaginal ultrasound.

The British Million Women Study has confirmed the Women's Health Initiative findings and has provided more information about estrogen, progestin, and breast and endometrial cancers.18 This is important information for women deciding whether to take estrogen without progestin, as described above.

When given with a skin patch, estrogen-progestin enters the bloodstream directly, without passing through the liver. The estrogen and progestin in pills must be processed by the liver before entering the bloodstream. This is why women with liver or gallbladder disease can usually use a patch form of HRT.

Complete the new medication information form (PDF) //content.revolutionhealth.com/contentfile
s/form_zm2260.pdf(What is a PDF document?) to help you understand this medication.

References

Citations
11. Speroff L, Fritz MA (2005). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 689–777. Philadelphia: Lippincott Williams and Wilkins.
12. Rossouw JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13): 1465–1477.
13. North American Menopause Society (2004). Position statement: Recommendations for estrogen and progestogen use in peri- and postmenopausal women: October 2004 position statement of the North American Menopause Society. Menopause, 11(6): 589–600. Available online: http://www.menopause.org/edumaterials/2004
HTreport.pdf.
14. National Heart, Lung, and Blood Institute (2003). Postmenopausal hormone therapy: Questions and answers. Available online: http://www.nhlbi.nih.gov/health/women/q_a.
htm.
15. American College of Obstetricians and Gynecologists (2003). Statement of the American College of Obstetricians and Gynecologists on hormone therapy for the prevention and treatment of postmenopausal osteoporosis. ACOG News Release. Available online: http://www.acog.com/from_home/publications
/press_releases/nr10-07-03.cfm.
16. Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.
17. Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
18. Rapkin AJ, et al. (2002). The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Current Psychiatry Reports, 4(6): 419–428.
19. Manson JE, et al. (2003). Estrogen plus progestin and the risk of coronary heart disease. New England Journal of Medicine, 349(6): 523–534.
20. Wassertheir-Smoller S (2003). Effect of estrogen plus progestin on stroke in postmenopausal women. The Women's Health Initiative: A randomized trial. JAMA, 289(20): 2673–2684.
21. Grodstein F, et al. (2006). Hormone therapy and coronary heart disease: The role of time since menopause and age at hormone initiation. Journal of Women's Health, 15(1): 35–44.
22. Prentice RL, et al. (2006). Combined analysis of Women's Health Initiative observational and clinical trial data on postmenopausal hormone treatment and cardiovascular disease. American Journal of Epidemiology, 163(7): 589–599.
23. Shumaker SA, et al. (2003). Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Women's Health Initiative memory study: A randomized controlled trial. JAMA, 289(20): 2651–2662.
24. Beral V, et al. (2007). Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet, 369(9574): 1703–1710.
25. Chlebowski T, et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative randomized trial. JAMA, 289(24): 3243–3253.
26. Solomon CG, Dluhy RG (2003). Rethinking postmenopausal hormone therapy. New England Journal of Medicine, 348(7): 579–580.
27. Barr RG, et al. (2004). Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease. Archives of Internal Medicine, 164(4): 379–386.
28. Million Women Study Collaborators (2003). Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet, 362(9382): 419–427.
http://www.healthwise.org/ © Copyright 1995 - 2008, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED


[end quote]

Pamela aka Scottieluvr

" When I wake up in the morning, I have to decide to either be an example or an excuse."
Author Unknown

" As long as a man stands in his own way, everything seems to be in his way."
Ralph Waldo Emerson

" I have yet to find a man, however exalted his station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism."
Charles Schwab

Personal web site: http://scottieluvr


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I found an article that goes into depth about EHT, HRT and bHRT... check it out ladies! *S*

Here is ERT article only:

[quote]
Estrogen replacement therapy (ERT) - www.revolutionhealth.com/cond
itions/re
productive-health/menopause/t
reat-
overview/index


Examples
Date updated: May 26, 2006, Kathe Gallagher, MSW - Content provided by Healthwise

Oral (pills or tablets)
Brand Name Chemical Name
Cenestin, Enjuvia, Premarin conjugated estrogens
Enjuvia contains plant-based, rather than animal-based, estrogen. Risks and benefits are thought to be the same for both types of estrogen.
Brand Name Chemical Name
Estratab, Menest esterified estrogens
Estrace estradiol
Ogen, Ortho-Est estropipate


Transdermal (patch placed on the skin that releases estrogen continuously)
Brand Name Chemical Name
Alora, Climara, Estraderm, Vivelle-Dot estradiol
Climara estradiol (low-dose)


Vaginal ring (inserted high into the vagina; releases estrogen continuously for 3 months)
Brand Name Chemical Name
Femring estradiol


Skin cream (applied daily to the legs, thighs, or calves)
Brand Name Chemical Name
Estrasorb estradiol


Skin gel (applied daily to an arm from wrist to shoulder)
Brand Name Chemical Name
Estrogel estradiol

How It Works

Estrogen replacement therapy (ERT) increases the estrogen level in your body. Estrogen impacts multiple systems of the body.

When given through an estrogen patch, vaginal ring, or skin cream or gel (transdermal estrogen), estrogen enters the bloodstream directly, without passing through the liver. The estrogen in pills must be processed by the liver before entering the bloodstream, which stresses an impaired liver.

Low-dose vaginal estrogen affects only the urinary and genital area. For more information, see Low-dose vaginal estrogen for dryness and atrophy.

Patch warning. Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.

Why It Is Used

Estrogen replacement therapy (ERT) is used to increase estrogen levels in postmenopausal women who have no uterus. This helps prevent perimenopausal symptoms, osteoporosis, and colon cancer.

Women in their 20s, 30s, and 40s who experience early menopause after having their ovaries removed (oophorectomy) or because of other medical reasons typically take ERT to reduce their risk of early bone loss and osteoporosis. Historically, women have continued using ERT for years beyond menopause. Some women now discontinue ERT around the age of menopause.

Women with a uterus who take estrogen also need the hormone progestin to prevent the estrogen from overgrowing the uterine lining, which can lead to endometrial (uterine) cancer. Estrogen-progestin is called hormone replacement therapy (HRT).

Do not use estrogen treatment if you:

Are pregnant.
Have unexplained vaginal bleeding.
Have active liver disease or chronic impaired liver function. (Transdermal estrogen does not stress the liver.)
Have a personal history of breast cancer, ovarian cancer, or endometrial cancer.
Are a smoker.

Talk to your health professional about your risks versus benefits if you have a family history of breast cancer, ovarian cancer, stroke, blood clots, or endometrial cancer.

How Well It Works

Systemic estrogen replacement therapy (ERT) affects your entire body and reverses the effect of low estrogen. Systemic ERT:

Helps prevent postmenopausal osteoporosis by slowing bone loss and promoting some increase in bone density.1

Reduces the frequency and severity of hot flashes.1

Improves depression and sleep problems related to hormone changes.2

Maintains the lining of the vagina, reducing irritation.

Increases skin collagen levels, which decline as estrogen levels decline. Collagen is responsible for the stretch in skin and muscle.

Reduces the risk of dental problems, such as tooth loss and gum disease.

May reduce the risk of colon cancer.3

Low-dose estrogen. Researchers are studying the effects of low-dose estrogen therapy. A small early study has shown that a low estrogen dose—0.25 mg per day—may keep the bones as strong as the higher dose.4 However, the long-term risks of taking low-dose estrogen are not yet known.

Side Effects

Risks of estrogen replacement therapy

Systemic estrogen replacement therapy (ERT) causes health problems in a small number of women. Using ERT increases your risks of:3

Stroke. ERT use slightly increases the risk of stroke.5

Blood clots. ERT slightly increases the risk of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism), which can be life-threatening. This risk is greatest in the first year of use.6 A recent small study suggests that oral ERT slightly increases blood clot risk, but the ERT patch does not. When taken orally, ERT seems to increase a clotting factor in the blood; this does not happen with ERT that is absorbed through the skin.7

Breast cancer. The Million Women Study has shown that, in women using ERT for 10 years, the number of breast cancers is slightly higher than in women not taking ERT.8 Although the Women's Health Initiative (WHI) trial found no increase in breast cancer over 7 years of ERT use, experts continue to take the breast cancer risk seriously.9

Uterine (endometrial) cancer (only if you have a uterus). Taking progestin with estrogen eliminates this risk.8

Gallstones. Women who use estrogen replacement therapy are more likely to have gallstones that cause symptoms than women who do not use ERT. (High estrogen levels are linked to gallbladder disease.)

Ovarian cancer (which is rare). In women using ERT over 5 years, the number of ovarian cancers is slightly higher than normal. Using ERT causes ovarian cancer in about 0.4 per 1,000 women. (This is the same as 1 in 2,500 women.) This risk only applies to women who have their ovaries and are taking estrogen.

ERT breast cancer risk is lower than the estrogen-progestin (HRT) breast cancer risk. In the British Million Women study of women who took hormone therapy for 10 years till age 60:8

Estrogen-progestin use increased breast cancer by 19 per 1,000 women.

Estrogen-alone use increased breast cancer by 5 per 1,000 women.

Side effects that can occur with all forms of estrogen but are more common with oral estrogen (and less common with a patch, cream, gel, or vaginal ring) include:

Headaches.
Nausea.
Vaginal discharge.
Fluid retention.
Weight gain.
Breast tenderness.
Spotting or darkening of the skin, particularly on the face.

Asthma. Newly diagnosed asthma appears to be more common among women taking ERT or HRT than women who are not. (Estrogen is thought to be a factor that causes or worsens asthma across the life span.)10

Rarely, an increased growth of preexisting uterine fibroids or a worsening of endometriosis.
Some of these side effects, such as headaches, nausea, fluid retention, weight gain, and breast tenderness, may go away after a few weeks of use.

The estrogen patch (transdermal estrogen) may cause skin irritation.

An estrogen ring must be replaced every 3 months. If the ring falls out at any time during the 3-month treatment period, you may rinse it with lukewarm water and reinsert it.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

In the Million Women Study of British women ages 50 to 64, taking any form of estrogen for 10 years increased breast cancer risk. The Women's Health Initiative study did not show this increased risk for women taking estrogen alone (ERT) for 7 years.9 Therefore, taking long-term ERT probably slightly increases breast cancer risk; taking it with progestin (HRT) further increases breast cancer risk.8 However, only women who have had a hysterectomy can take estrogen alone without also worrying about endometrial (uterine) cancer risk.8

ERT use slightly increases the risk of stroke. For this reason, the Women's Health Initiative ERT trial was stopped sooner than originally planned. In this large trial, women using ERT had no change in heart disease risk, had fewer hip fractures (a sign of estrogen's bone-protecting effect), and (unlike the larger Million Women Study) had no increase in breast cancer risk during the study's nearly 7 years of ERT treatment.9

If you are taking ERT after early menopause caused by a surgical hysterectomy, talk with your health professional about long-term ERT risks and benefits.

If you have your uterus but are unable to tolerate the side effects of progestin in hormone replacement therapy (HRT) or you are concerned about increased breast cancer risk, you may consider estrogen-only replacement therapy (ERT) if testing shows no abnormalities of the uterine lining (endometrium). But close observation for precancerous changes of the endometrium is required, including an annual pelvic exam and an annual endometrial biopsy.

Complete the new medication information form (PDF) //content.revolutionhealth.com/contentfile
s/form_zm2260.pdf(What is a PDF document?) to help you understand this medication.

References
Citations
1. Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
2. Rapkin AJ, et al. (2002). The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Current Psychiatry Reports, 4(6): 419–428.
3. Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.
4. Prestwood KM, et al. (2003). Ultralow-dose micronized 17 B-estradiol and bone density and bone metabolism in older women. JAMA, 290(8): 1042–1048.
5. American College of Obstetricians and Gynecologists Women's Health Care Physicians (2004). Stroke. Obstetrics and Gynecology, 104(4, Suppl): 97S–105S.
6. American College of Obstetricians and Gynecologists Women's Health Care Physicians (2004). Venous thromboembolic disease. Obstetrics and Gynecology, 104(4, Suppl): 118S–127S.
7. Scarabin PY, et al. (2003). Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet, 362(9382): 428–432.
8. Million Women Study Collaborators (2003). Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet, 362(9382): 419–427.
9. Women's Health Initiative Steering Committee (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA, 291(14): 1701–1712.
10. Barr RG, et al. (2004). Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease. Archives of Internal Medicine, 164(4): 379–386.

http://www.healthwise.org/http://www.hea
lthwise.org/ - © Copyright 1995 - 2008, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED

[end quote]

Pamela aka Scottieluvr

" When I wake up in the morning, I have to decide to either be an example or an excuse."
Author Unknown

" As long as a man stands in his own way, everything seems to be in his way."
Ralph Waldo Emerson

" I have yet to find a man, however exalted his station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism."
Charles Schwab

Personal web site: http://scottieluvr


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5/30/08 4:16 P

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Burton, I do the same. I use meds that a drug addict can pay me a lot of money for them. I need those meds. I don't care if people think I'll be a drug addict. I care about my health. Everything you need for your health that make you feel better is good for you and that is all you need.

Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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DSMBURTON Posts: 3,394
5/28/08 6:09 P

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I feel taking any meds have risks and you have to look at what is more important to you. If I don't take HRT my night sweats are so bad I don't sleep and my blood pressure then gets dangerouly high so I am at risk of a stroke. I take the HRT because it makes me more functional as I am not if I go for days without really sleeping.

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5/28/08 2:13 P

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I am reading Dr. Christiane Northrup's book, "The Wisdom of Menopause". Then I saw a PBS special last night that had her as the soeaker. She stated (quoting out of context) that HRT is changing constantly as new developments occur. So women should expect the selection of hormone replacement therapy to continously change throughout their menopausal years. Even post menopausal medical science is changing - for the better. Woo-Hoo

Just like we watch the TV news daily, women should stay abreast of medical breakthroughs in HRT and other menopausal therapies.

Pamela aka Scottieluvr

" When I wake up in the morning, I have to decide to either be an example or an excuse."
Author Unknown

" As long as a man stands in his own way, everything seems to be in his way."
Ralph Waldo Emerson

" I have yet to find a man, however exalted his station, who did not do better work and put forth greater effort under a spirit of approval than under a spirit of criticism."
Charles Schwab

Personal web site: http://scottieluvr


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5/28/08 10:21 A

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HRT: Revisiting the Hormone Decision
It's been 5 years since studies proclaimed hormone replacement therapy a danger for women. WebMD investigates today’s changes and tells you what you need to know to make the HRT decision.
By Colette Bouchez
WebMD Feature
Reviewed by Louise Chang, MD
It was the summer of 2002 when the news about hormone replacement therapy (HRT) shook us to the core.
In what felt like a bomb dropped on all womankind, the U.S. federal government halted the hormone trial of the Women's Health Initiative early – a study designed to evaluate the risks and benefits of hormone replacement therapy on disease prevention.
The reason: Not only had HRT failed to be the protective fountain of youth doctors and women had long since believed, evidence was mounting that taking it may be harmful.
"It was like an abrupt hit in the solar plexus -- with a message that was loud and clear: If you value your life, don't even be in the same room as a bottle of hormones," says Steven Goldstein, MD, professor of medicine at NYU Medical Center and board member of the North American Menopause Society.
Increased risks of breast cancer, heart disease, stroke, and blood clots were just some of the problems researchers documented in women using HRT.
And while the study also found hormone therapy reduced the risk of fractures and possibly colon cancer, on a cultural as well as a medical level that didn't seem to matter. The moment the estrogen hit the fan, women began rejecting hormone use in droves.
At the time, certainly the WHI findings seemed to be the final word on HRT. But fast-forward five years and we find the picture of hormone replacement therapy is changing yet again.
"We have had time and resources to carefully tease out the data and perhaps collect a little bit more, and what we have found at least reassures us that for some women who have menopausal symptoms, HRT is not the ominous prescription we thought when the data first came out," says Cynthia Stuenkel, MD, professor of medicine at the University of California at San Diego.
Clearly, at least some of the problems with HRT brought to light in 2002 are still in place today.
The WISDOM (Women's International Study of Long Duration Oestrogen after Menopause) study recently published in the BMJ duplicated many of the same findings detailed by the WHI, particularly concerning the increased risk of heart disease in older women who began or restarted hormone therapy long after menopause.
At the same time, however, in the five years since the WHI, another, equally important fact has emerged: The seemingly huge difference a few birthday candles can make when it comes to the impact of HRT on a woman's heart.
Why Age Matters
Because the WHI study included women from ages 50 to 79, the initial results were a combined tabulation of all age groups together. But Goldstein says that when data was re-analyzed to focus on the youngest members alone, an entirely different risk-to-benefit ratio of HRT began to emerge.
"What we discovered is that if a woman is between the ages of 50 and 55 when she starts taking hormones, or if she begins HRT less than 10 years after she started menopause, she has less heart disease and less death from any cause, compared to the placebo group," says Goldstein.
Those results were published in April 2007 in the Journal of the American Medical Association – and then again reinforced by similar research published in The New England Journal of Medicine the following June.
Here researchers focused on younger women who had a hysterectomy, and took estrogen alone. These results suggested that in these women HRT may also have protective effects on the heart.
"Women who were in their 50s in the estrogen-alone trial tended to have less coronary artery calcium if they received estrogen compared to placebo. And coronary artery calcium is ... a strong predictor of future risk of coronary heart disease, so these results lend support to the theory that estrogen may slow early stages of arteriosclerosis," says researcher JoAnn Manson, MD, DrPH, chief of preventive medicine, Brigham and Women's Hospital, and professor of medicine and women's health, Harvard Medical School, Boston.
Unfortunately, Goldstein says neither message seems to have been relayed to women or even their doctors, and as a result many women are suffering unnecessarily, afraid to use hormones to quell menopause symptoms in order to protect their heart.

"We have strong evidence to show that if it is less than 10 years since you started menopause, using HRT on a short-term basis is not likely to harm you, and it can help you; you shouldn't be afraid," he says.
Cardiologist Nieca Goldberg, MD, agrees. "Women can sort of relax a little -- that when they’re younger and need to go on hormone therapy because of their symptoms, that this may not be detrimental to their heart," she says.
Those at risk for stroke, however, may not share this same sense of relief. In the same April 2007 JAMA study, researchers found the risk of stroke increased in HRT users by some 32% -- and that age or years since menopause didn't matter.
HRT and Breast Cancer
While the impact of HRT on the heart may seem less ominous today than in 2002, links to breast cancer are less clear -- and some say less encouraging.
Many experts say that more than coincidence was at work when, in the years following the WHI announcement, women stopped taking hormones en masse -- and the incidence of breast cancer subsequently declined.
"A drop in hormone use may not have been the sole reason we saw fewer breast cancers, but I am certainly convinced it played a significant role," says Julia Smith, MD, director of the Lynne Cohen Breast Cancer Preventive Care Program at the NYU Medical Center in New York City.
But Smith says the back-story linking hormone use and breast cancer goes far beyond just connecting a few incriminating dots. It's a complex relationship, she says, that is still not fully explained – or explainable.
"What we have learned since the WHI is that for most women taking hormones short term -- for two or three years for symptom relief -- there won't be an increase in breast cancer in the short term, but this doesn't necessarily mean these women won't see an increase in breast cancer in the long term," says Smith.
Stuenkel tells WebMD even Mother Nature validates this line of thinking.
"Population studies for a women who go into menopause at age 55 instead of 50, there is an overall increased risk of breast cancer, so the duration of hormone stimulation definitely matters," says Stuenkel. Indeed, the WHI showed breast cancer risks clearly increased the longer a woman remained on HRT.
At the same time, however, Goldstein notes that at least one reanalysis of the WHI findings published in JAMA in 2006 found that women who had a hysterectomy and used estrogen-only therapy for an average of seven years had no increase in breast cancer rates.
"In fact, risks of at least one type of breast cancer were reduced in these women," says Goldstein.
But again, Stuenkel reminds us that the duration of hormone use might change that picture, too. She points to results from the Harvard Nurses' Health Study published in the Archives of Internal Medicine in 2006, which reported that those women who took estrogen only experienced an increase in breast cancer after 20 years of use.
"I have not bought into the idea that estrogen alone reduces breast cancer, and for me the duration of exposure is still a key issue – when it comes to HRT, I just don't believe there's going to be a free lunch for any woman," says Stuenkel.
Where We Are Today
While studies are still ongoing, and reanalysis of the original data continues to shape our opinions, experts say there are a few lessons learned thus far that are not likely to change.
Among them: That hormone replacement therapy is not a panacea for disease prevention -- even in situations where it was found to be helpful, such as reduction in hip fractures.
Moreover, if hormone replacement therapy must be used to quell menopause symptoms, the lowest possible dose for the shortest possible duration is now the standard of care.
Today the emphasis rests on the importance of treating every woman individually, with decisions about hormone use made strictly on a case-by-case basis.
"Gone forever are the days when every doctor routinely prescribed HRT for every woman over 50; today, the decision to go on hormone therapy, even short term, must take into consideration a host of individual health and lifestyle factors," says Smith.
Among the most important things to discuss with your doctor, says Smith, is your personal and family history of heart disease, stroke, blood clots, breast cancer and breast disease, and your reproductive history. Also important: personal lifestyle choices such as smoking, alcohol use, diet, and your current weight and blood pressure.
"I think one of the most valuable lessons to come out WHI is that every woman needs -- and deserves to have -- individualized care, not just for menopause symptoms, but for all health concerns," Stuenkel notes.
And that, she says, is a lesson we should not soon forget.


Show hospitality to strangers for, by doing that, some have entertained angels unawares.
Never stop helping others because others think that they abuse you. That stranger can be Jesus and you lose the opportunity to serve, even in something simple.


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