DESCRIPTION
Menopause is the time in a woman's life when menstruation stops. Menopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones, which cause menstrual periods to become irregular and eventually stop. The hormonal changes often cause other symptoms. Menopause can also occur when the ovaries are surgically removed. Normally menopause occurs in women between ages 45 and 60. In the United States, menopause occurs at age 52 on average.

SIGNS AND SYMPTOMS
You may have physical, emotional and mental symptoms during menopause. Symptoms may occur for a few weeks, months or years. Your symptoms may come and go, or they may occur regularly.

Physical symptoms that are common during menopause:

• Irregular menstrual periods
• Hot flashes
• Night sweats
• Disturbed sleep patterns
• Vaginal dryness and shrinkage of genital tissues
• Discomfort or pain during sexual intercourse
• Dry skin
• Frequent urination or leakage of urine (urinary incontinence)
• Frequent minor vaginal and urinary infections.

Menopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement or career changes. These changes, in addition to the changes in your body, may result in mental or emotional stress.

Emotional or mental symptoms of menopause may include:

• Anxiety
• Depression
• Tearfulness
• Irritability
• Sleeplessness
• Less desire for sex
• Lack of concentration
• Difficulty remembering

DURATION OF SYMPTOMS
Symptoms of menopause may last only a month or may continue for several years. If you have had no menstrual periods for several months and then have bleeding from the vagina, check with your health care provider promptly. Vaginal bleeding in a woman, who has not had periods for months or years, can be a symptom of cancer.

DIAGNOSIS
Menopause can often be diagnosed through your medical history. Your health care provider may also check a blood test, a pelvic exam and a Pap smear to diagnose menopause.

TREATMENT
Menopause is a natural part of a woman's life cycle. It is not a disease and does not necessarily require any treatment. However certain health problems, such as osteoporosis, are associated with low estrogen. To help prevent such problems, you may choose to take estrogen to replace what your body is no longer producing. If your uterus has been removed, you may take estrogen alone. This treatment is called estrogen replacement therapy (ERT). If your uterus is still intact, you will need to take both estrogen and progesterone, because taking estrogen alone may increase your risk of cancer of the uterus. This treatment is called hormone replacement therapy (HRT). You and your health care provider should discuss the advantages and potential risks of ERT and HRT. Your age, race, family history and health history should be considered.

ERT and HRT are very effective in preventing osteoporosis (loss of bone density). Also, ERT and HRT may benefit your heart and blood vessels. Discuss these potential benefits with your health care provider, especially if you have a family history of osteoporosis or heart disease.

Women who have had some types of breast cancer or other cancer, blood clots or certain liver disease should not take estrogen. There are other ways to help prevent osteoporosis, such as taking calcium supplements and exercising regularly.

If you and your health care provider decide you will start taking estrogen, it may be prescribed in the form of tablets to be swallowed, patches to be applied to the skin or cream to be inserted in the vagina. You will probably continue the treatment for at least several months and possibly many years.

Ask your health care professional about side effects or special precautions you should know about hormones. Make sure that your provider knows about all other medications you are taking.

GENERAL CONSIDERATIONS
To help your general mental and physical well being, you should consider:

• Having a mammogram every year after age 50
• Eating more foods that are high in calcium, such as green vegetables, nonfat (skim) milk and dairy products
• Reducing saturated fats in your diet - check labels for product contents before you buy them
• Exercising regularly
• Using birth control during sexual intercourse, until your health care provider instructs you to stop, to avoid high-risk pregnancies

You may also choose to:

• Wear cotton sleepwear to reduce discomfort from night sweats
• Use a vaginal lubricating cream or jelly if intercourse is painful - this problem is usually caused by a lack of estrogen and should be discussed with your health care provider
• Talk and share feelings with a friend or family member who understands what you are experiencing
• Join a support group for women who have been or are going through menopause