Menopause

• Irregular periods. Your menstrual periods may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching.
• Decreased fertility. When ovulation begins to fluctuate, you're less likely to become pregnant. Until you haven't had a period for a year, however, pregnancy is still possible.
• Vaginal and urinary changes. As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication you may experience burning or itching, along with increased risk of infections of your urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful. You may feel the need to urinate more frequently or more urgently, and you may experience urinary incontinence.
• Hot flashes. As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. The frequency, as well as the duration, of hot flashes varies from person to person. You may have them once every hour or only occasionally. They can occur any time during the day or night. They may be a part of your life for a year or more, or you may never have them.
• Sleep disturbances and night sweats. Night sweats are often a consequence of hot flashes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep. Lack of sleep may affect your mood and overall health.
• Changes in appearance. Many women gain a modest amount of weight — about 5 pounds on average — during the menopausal transition. The fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin. If you previously experienced adult acne, it may become worse. Although your estrogen level drops, your body continues to produce small amounts of the male hormone testosterone. As a result, you may develop coarse hair on your chin, upper lip, chest and abdomen.
• Emotional and cognitive changes. You may experience irritability, fatigue, decreased memory and diminished concentration as you approach menopause. These symptoms have sometimes been attributed to hormonal fluctuations. Yet other factors are more likely to contribute to these changes, including sleep deprivation and stressful life events — such as the illness or death of a parent, grown children leaving home or returning home, and retirement

• Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you're still ovulating. Your hormone levels rise and fall unevenly, and you may have hot flashes and variations in your periods. For instance, your flow may be irregular or heavier or lighter than usual. This is a normal process leading up to menopause and may last four to five years or longer.
• Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and progesterone, and they don't release eggs. The years that follow are called postmenopause.

• Cardiovascular disease. At the same time your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. Yet you can do a great deal to reduce your risk of heart disease. These risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise and eating a diet low in saturated fats and plentiful in whole grains, fruits and vegetables.
• Osteoporosis. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. That's why it's especially important during this time to get adequate calcium — 1,500 milligrams daily — and vitamin D — 400 to 800 international units daily. It's also important to exercise regularly. Strength training and weight-bearing activities such as walking and jogging are especially beneficial in keeping your bones strong.
• Urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate (urge incontinence) or incontinence with coughing, laughing or lifting (stress incontinence).
• Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.

• Hormone therapy (HT). Results from several recent, long-term studies suggest that benefits of HT use may be outweighed by the risks. One large study called the Women's Health Initiative (WHI), funded by the National Institutes of Health, was halted early when researchers found that women given a certain type of combined estrogen and progesterone were at increased risk of heart attack, stroke and breast cancer. Later results from the WHI study showed that estrogen alone also increased stroke risk, but did not increase breast cancer or heart disease risk. Although these results have changed the landscape for women taking or considering taking estrogen, it's important to put the risks in perspective. In the WHI study, fewer than 10 additional cases each of heart attack, stroke and breast cancer occurred each year among 10,000 women taking combination hormone therapy compared with 10,000 women taking placebo. Estrogen therapy remains the most effective treatment option for menopausal symptoms such as hot flashes and vaginal discomfort. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you.
• Low-dose antidepressants. Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), may decrease hot flashes by up to 60 percent. Other drugs in the SSRI class that can be helpful include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalpram (Celexa) and sertraline (Zoloft). These medications may cause side effects including nausea, dizziness or sexual dysfunction.
• Gabapentin (Neurontin). This drug is approved to treat seizures and is commonly used to manage chronic, nerve-related pain, but it also has been shown to significantly reduce hot flashes. Side effects may include drowsiness, dizziness, nausea and swelling.
• Clonidine (Catapres, others). Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but side effects such as dizziness, drowsiness, dry mouth and constipation are common.
• Bisphosphonates. Doctors may recommend these nonhormonal medications, which include alendronate (Fosamax) and risedronate (Actonel), to prevent or treat osteoporosis. These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women. Side effects may include nausea, abdominal pain and irritation of the esophagus.
• Selective estrogen receptor modulators (SERMs). SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots.
• Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen locally to vaginal tissue, and can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each.