When can I expect to stop having periods and what will it be like? Most women stop having periods somewhere between 48 and 52, but this may occur earlier or later, depend-ing on lifestyle, heredity, and other factors. Hot flashes, vaginal dryness, and night sweats are the most common symptoms, however many women also experience delayed or more frequent periods, heavy or scant menstrual bleeding, and mood changes such as irritability or depres-sion. These symptoms may occur fleetingly, or may last for several years or more. I've seen a number of women who have made the transition through menopause quite easily, with a mini- mum of symptoms. Other women, usually those who went through menopause without knowing help was available for them, may have a different story to tell and be very glad that it's all over. Many women think they're starting menopause in their early forties, then discover that their abnormal bleeding is caused by uterine fibroids (see the August, l990 issue of The New Times for more information).

How can I be sure I'm going through menopause? If you are in your late forties or early fifties, are having the symptoms mentioned above, and your periods or changing or have stopped, it is highly likely that menopause is occuring. It is important to consult with a physi- cian you trust, either a gynecologist or an alternative practitioner such as a naturopath, or both, for a number of reasons, rather than just going it on your own. If there is abnormal bleeding, it may be important to rule out other causes besides menopause, such as cervical, uterine, or ovarian cancer or fibroids, which are unlikely, but possible. In some cases, it is important to get very specific information through measuring blood levels of the various types of estrogen ad of progesterone. New tests are available to measure the amount of bone loss, preferably during the first year after menopause, when up to 30% of the loss is said to occur. Menopause is a very literally a change of life which necessitates your making some choices. If you choose to take hormones, you need regular gynecologic care. If you choose not to, there are definite dietary, vitamin/mineral, and lifestyle recommendations which are very important for you to integrate into your life. Choosing simply to avoid the issue entirely and hope that all works out for the best is, in my opinion, not a responsible option.

What about hormones for menopause? The use of estrogen replacement therapy (ERT) for women who have reached menopause with at least one ovary is quite controversial and a very personal decision on the part of each woman. Opinions on the subject range from the vehemently anti-hormone philosophy espoused in Women and The Crisis in Sex Hormones by Seaman to the attitude that, "Of course, you need to take hormones" of orthodox gynecologists. I would estimate that 30 to 40% of my women patients experiencing menopause choose to take estrogen. ERT is usually effective in eliminating or improving hot flashes, vaginal dryness (often in conjunction with a vaginal estrogen-containing cream), night sweats as well as preventing osteoporosis. It may not address other symptoms such as wrinkling, aging, and psychological concerns.

In the mid-70's, by which time ERT had been very popular for ten or fifteen years, research began to indicate that ERT in post-menopausal women could increase the risk of uterine cancer