JoAnn Pinkerton:          I'm JoAnn Pinkerton. I'm a professor of obstetrics and gynecology, and also the executive director for the North American Menopause Society, the society that takes care of menopausal women.

Menopause is defined as 12 months without a period, but leading up to that is this entire transition called perimenopause, where fluctuating periods, hot flashes can come and go, migraine headaches, PMS. Once a woman is menopausal, then we still have to worry about the decline in her estrogen because her ovaries aren't functioning. 

Good news is, she can't get pregnant once she's menopausal. Bad news is she's not making much estrogen, and therefore she can have hot flashes or sleep fatigue, fuzzy brain, painful sex, bladder issues, and bone loss. Menopause is a time when health risks really change for women. It becomes really important to try to get women to take care of themselves, to exercise, to lose that 10 pounds, to think about hormone therapy if they need it, and also if they're just having vaginal symptoms to know we have treatments that can help them be able to have sex without having pain. 

The average age of menopause is between 51 and 52. Perimenopause is about five to 10 years before that, so many women in their 40s are perimenopausal. There's a bell-shaped curve around menopause, so 45 to 55, and past 55 that's called late menopause, and before 45 is early menopause. 

There's one unique thing. Women will go through an early menopause particularly an early surgery menopause have more health risks, so they really are candidates for hormone therapy at least to menopause. Women who go through a late menopause have more risk of breast and uterine cancer. It really does matter when women go through menopause. 
 
For women who have hot flashes, we have other options. Women could try hypnosis, cognitive behavioral therapy. They can try some of the over-the-counter product that may not work better than placebo because placebo works 50% of the time, but might help like black cohosh or soy products. They can lose weight, which helps. They can exercise or do yoga. All of those things might help. Acupuncture and sham acupuncture both work, or they could simply avoid triggers like avoiding red wine or avoiding spicy foods. Wearing layered clothing so they can take off a sweater, put on a sweater. The temperature zone actually narrows in women who have hot flashes. They're more likely to get hot or cold at any given temperature. 

Then we have prescription therapies. Besides hormones, not everyone wants to take hormones, or should, we also have low-dose antidepressants or gabapentin. Those are medications that women can take that will help their hot flashes. We also have to think about bone loss because women can lose up to 20% of their bone during menopause, so we have to think about calcium, dietary calcium, vitamin D, and strength training. 
                    Women who are menopausal need to take care of themselves, which is hard to get them to do. It means getting seven hours of sleep. Many women get five to six hours of sleep. It means a regular exercise pattern. It doesn't mean you have to go to the gym, but you need to get 30 minutes of exercise most days of the work. It could be 10-minute walks three times a day. It could be the gym. It could be running up and down stairs, but you've got to keep going or else you'll gain weight. 

Then finding ways to decrease their stress. What works for them. Some people do meditation. Some people to Tai chi. Some people do exercise, but handling their stress will help them go through this, and then proper eating. Many women, when they're stressed, want to eat comfort food. Their metabolism is slow, so they're much more likely to gain weight. We want them to get sleep, eat healthy, exercise, and then look at what a trigger is. 

If every night you have red wine, you wake up soaking in the middle of the night. Maybe you shouldn't have that glass of red wine. Maybe you should have sparkling water instead. Those are some things that women can do to help themselves through the process.