"It's Menopause! Deal with It!"
by Sheila Buff

My friend Susan, who is exactly three days older than me, called recently and told me that after a frantic search, she had finally found her car keys in the freezer—again. Because I have recently been finding coffee mugs and the occasional pen in the refrigerator, I sympathized.

Comparing notes on this and other symptoms brought us to the unsurprising conclusion that we are feeling the early signs of perimenopause, the few years that lead up to the final halt of menstruation (you're officially in menopause when you haven't had a period for at least six months). Other fun things to look forward to? Hot flashes, even more weird memory lapses, weight gain, and an increased risk of a variety of unpleasant diseases, including breast cancer, heart attack, and osteoporosis. On the emotional side, irritability, depression, and mood swings seem to lead the list. But then again, who wouldn't be irritated and depressed over gaining weight and finding yourself staring vacantly into a closet for no reason you can remember? As for the mood swings, during the perimenopause years your levels of the hormones estrogen and progesterone start to fluctuate wildly. It's like adolescence in reverse. Just scream (or sob, depending) "It's menopause! Deal with it!" to everyone around you. They'll either understand or flee for their lives.

Coping with the Inevitable
For about half of all women, menopause symptoms are mild to nonexistent (or so they claim). For the rest, however, perimenopause means a range of symptoms, some more annoying and disruptive than others. Of all the annoying and disruptive perimenopause symptoms, hot flashes top the list—anywhere from 70 to 80 percent of all women have them. I once sat in a meeting with a very fair-skinned women and watched with fascination as every 20 minutes or so her face flushed for a few minutes and then paled again. She handled the situation with aplomb, mostly by simply ignoring it—a good reminder that attitude and a sense of humor count for a lot. When my mother was going through this time, my brother started calling her "Flash" and my father gave her a beautiful antique folding fan for her birthday. She laughed, if a bit grimly. I suspect she secretly longed to shoot them both.

It's harder to laugh and have a good attitude, how-ever, when hot flashes and sweats interrupt your sleep night after night. If the situation is getting really hard to bear (you'll know when you have the bright idea of selling your soul for a good night's sleep and start searching on-line for a nearby Satanic cult), short-term hormone replacement therapy (HRT) may be helpful. In fact, this is the one use for HRT that is still advised, but it's a very individual decision that may not be appropriate for you. (See the sidebar for more on this.)

Soy foods such as tofu and soy milk are often recommended as a natural way to treat hot flashes. The thinking behind this is that soy foods contain phyto-estrogens, plant-based substances that resemble the hormone estrogen. In theory, then, eating soy foods should help replace some of the estrogen your body is no longer making, and that in turn should help relieve hot flashes. After all, women in Asia, where soy foods are a regular part of the diet, typically report fewer hot flashes than women elsewhere. But does soy really work? A lot of women swear it does, but scientific studies of soy over the years have shown only modestly positive results at best. A recent study of the effects of soy on hot flashes—actually a "meta-analysis," a study that combines and analyzes the results of many studies—concluded that it didn't make any difference at all. That's good news for those of us who really hate that awful soy milk.

Unfortunately, the same is true of a lot of other natural remedies for hot flashes and other menopausal symptoms, including black cohosh, red clover, and vitamin E. They work for some women, at least for a while, but the evidence for them tends to evaporate when they're rigorously studied. Try them, cautiously and only after talking to your doctor, but also try some other self-help steps: Avoid caffeine and alcohol, get regular aerobic exercise, drink plenty of cold liquids, and dress in layers so you can cool off quickly when a hot flash strikes. Most of all, remember that even this will come to an end. Most women have frequent hot flashes for just a year or so, and then they taper off and almost always stop within four years.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) was once almost routinely prescribed for women as they entered the perimenopausal years. In 2002, how-ever, results from the Women's Health Initiative study showed that HRT does not protect against heart disease—in fact, it turns out that combined hormone therapy with estrogen and progestin could increase heart risk. In addition, taking the hormones was shown to lead to a slight but significant increase in the risk of breast cancer, stroke, and blood clots. Even so, many women continue to accept the risks of hormone therapy. Why? Because it works.

According to the latest guidelines from the American College of Obstetricians and Gynecologists, hormone therapy is still the most effective therapy for relief of menopausal symptoms, including hot flashes, night sweats, and vaginal dryness—but only if you have carefully weighed the risks and benefits with your doctor. If you and your doctor decide that HRT is appropriate, the guidelines call for using the smallest effective dose for the shortest possible time and reviewing the decision every year. Most women use HRT for just a year or two, stopping when the worst of the symptoms seem to be over.