Before you began your monthly periods, your body went through many changes. In the same way, your body changes during perimenopause (the three to five years before menopause) and menopause (the time at which monthly periods stop (usually around age 51). This article explains how the changes happen and what you can do to help yourself through common problems you may have during this time.

Menopause is the time of life when your ovaries, the organs that form your eggs, stop making female hormones. Hormones are chemicals that move through your blood and have an effect on other body organs.

For example, the hormone called estrogen is needed so that you can have a normal, monthly period. When estrogen levels change as you get older, your periods often will slow down. Then your periods will stop, and you can no longer have a baby.

This drop in estrogen levels also can affect you in other ways. You may have one or more of the following:

• Quick body temperature changes (hot flashes)
• Problems with sex
• Dryness or itching in your vagina
• Weaker bones
• A higher risk for heart problems

Menopause: Changes

Hot flashes are a sudden feeling of heat in the body. This feeling comes when blood vessels open up and let a lot of blood flow through the skin. Your face may turn red and you will suddenly feel hot. The feeling lasts one to five minutes. Then you may feel very cold and even wet (clammy) as your sweat dries and you return to normal.

Here are some things to try without seeing a doctor:

• Avoid hot places and wear lighter clothes
• Don't eat spicy foods
• Try to avoid stress in your life, which may bring on hot flashes

If you still have strong hot flashes, you may want to visit your doctor and get help. The best way to treat hot flashes is to replace the estrogen your body is losing. Your doctor can prescribe an estrogen pill or other drugs.

NOTE: Some women who cannot take estrogen or don't want to take estrogen can try other drugs. Some women who take estrogen may have a higher risk of getting breast cancer and cancer of the uterus. Other drugs, such as megestrol acetate, clonidine, and SSRI drugs (anti-depressants) also may help with hot flashes. Talk to your doctor to see if these may work for you. As with all drugs, these may have side effects. Please talk with your doctor before taking any drugs.

Problems With Sex and Vaginal Dryness

Hormone changes can affect the vagina, because estrogen loss leads to thinner tissues in those areas. When the tissues that line the vagina get thinner, you may have pain during sex. You may have dryness or itching in the vagina, or swelling tissues.

You can buy fluids that relieve dryness in the vagina. Drug stores sell these products. If these products don't work, replacing your body's estrogen may help. In this case, estrogen can be delivered in the vagina in smaller doses so that very little will get into the body through the blood stream. This estrogen can be in the form of a cream or a ring worn in the vagina that releases estrogen.

Some women lose their urge to have sex at this time of life. Taking a low dose of a male hormone may help. Ask your doctor if this answer would be right for you.

You can also try other ways to get back your desire for sex:

• Talk more with your partner
• Find a more pleasing and relaxing time for sex
• Enjoy other activities together
• Seek counseling

Moods

In some women, menopause is associated with mood changes or deep feelings of sadness (depression). If your mood changes seem to be mild, then discussing any sad or stressful life events with your doctor may help.

If your mood changes are becoming a big problem, however, then you could try other methods:

• Learn ways to avoid stress
• Get more exercise
• Go for counseling or join a support group

If you still have mood swings, you can also try to replace the estrogen your body is losing. Some women who cannot take estrogen or don't want to take estrogen can try other drugs.

The SSRI drugs also are very good at treating medium and high levels of depression.

Problems With Your Bladder

When tissues thin near the bladder, the sac that holds urine, you may have changes in urination. You may feel pain when you urinate or a need to urinate more often. You may also have a sudden loss of urine that you cannot control.

Possible ways to fight these problems include:

Some drugs act on the muscles near your bladder to keep it emptying more fully or not as often. Some drugs tighten muscles at the bladder opening to prevent leaks. If drugs don't help, surgery to support the bladder may be an answer.

Heart Disease

Women who have gone through menopause have a higher risk of heart attacks than younger women. A heart attack hits when blood vessels around the heart are so clogged with fat that oxygen cannot reach all parts of the heart. At about age 60, half of the deaths in women are caused by heart disease.

See your doctor if you are having chest pain, shortness of breath or pain radiating down your arm. Also see your doctor if you have a family history of heart attacks or strokes.

To keep your heart healthy, you can: Eat a low-fat diet, quit smoking, exercise daily, drink very little alcohol, take a low-dose aspirin every day, and keep your cholesterol and body weight low.

Another way to prevent heart disease is to try drugs that take aim at high cholesterol. These drugs, which your doctor prescribes, are called the "statin" drugs. Lovostatin, simvastatin, and atorvastatin can lower your risk of dying from a heart attack.

If you have high blood pressure, there are other medicines that may be helpful.

Bone Weakness

One body change you may not notice is that your bone tissue may break down. If this happens, you might get a "widow's hump," which makes you look bent over. Breaks in your backbone or hipbone can happen when you fall. You may find it hard to recover from broken bones as you get older.

First, you may want to learn how strong your bones really are. A DEXA scan or bone density study can show if you have lost bone or are at risk of losing bone.

If your bone loss is small, you can make some simple changes. It helps to:

• Stop smoking
• Drink only a small number of alcoholic drinks each week
• Exercise at least 20 minutes three times each week
• Take in at least 1500 mg of calcium every day (with a mix of dairy products and calcium pills)
• Take 400 International Units of Vitamin D every day (Vitamin D often is given to make bones stronger by increasing calcium absorption)

Estrogen can help to prevent bone loss and broken bones. SERMs (Selective Estrogen Receptor Modulators), such as raloxifne, are safer in some ways than natural estrogen, because they may lower the risk of getting breast cancer. These drugs can do some of the things that estrogens do, including keeping your bones strong, and they are approved for this use.

You also can try drugs called bisphosphonates. Some of the drugs in this family are etidronate, alendronate, risedronate, and ibandronate. Another drug you can take is calcitonin, which also blocks the breakdown of bone. It is safe, and can be taken through your nose in spray form. Again, please make sure to discuss the possible side effects of these drugs with your doctor before taking them.

Tell Your Doctor About:

• Health problems you seem to be having often
• Drugs you take every day, including herbal medicines*
• Reactions you have had to drugs
• Chest pain
• Pain during sex
• Pain or trouble urinating
• A need to urinate more often or a sudden unexpected loss of urine
• Swings from hot to cold in your body
• Sudden changes in moods or deep sadness
• Signs of weaker bones, such as bone fractures without a previous injury or a "widow's hump" that makes you look bent over
• Women in your family who have weak bones
• Any form of cancer you have had
• Women in your family who have had breast cancer
• Women in your family who have had cancer of the uterus
• Liver problems you have
• Problems you have with blood clots
• Bleeding from your vagina that is not normal