Understanding menopause is crucial in order to demystifying these very normal parts of women's lifecycles. Looking into current medical studies and proactively keeping open communication with doctors and other providers is part of making smart and safe decisions during this stage in a woman's life.

During menopause, the ovaries begin the process of ending egg production. The woman's periods are less frequent and eventually the woman will completely cease menstruation due less and less of the hormones estrogen and progesterone, which are key to the fertility process. The term perimenopause simply refers to the years prior to menopause, generally two to eight years in which a woman gradually enters menopause.

The age that a woman enters menopause can vary, but it usually is between 45 and 55. The most common bodily changes that a woman will notice are the "hot flashes"-a brief but uncomfortable heated feeling in the face and chest-as well as changes in affect and temperament As the hormone estrogen is reduced in the body, these symptoms are normal reactions to the endocrine changes occurring as a woman ages and menstruation slows and then stops. Additional changes women can face include vaginal discomfort, changes in sleep patterns and difficulty initiating or maintaining sleep, lowered sexual desire, mild urinary incontinence, and irregular heartbeats. Pelvic exams, blood tests, and bone scans can all be conducted to investigate symptoms changes associated with menopause.

Traditionally, many women in the past immediately began taking supplemental estrogen at the first sign of menopausal symptoms such as those listed above. Yet, it is vital that women be aware of recent research, which shows that there can be very real and severe risks associated with the use of supplemental estrogen pills such as Premarin. Previously these risks were minimized and misunderstood by the medical community, but now large studies have proved that estrogen must be taken only with caution and only in certain populations. Cancer, stroke, and heart problems have all been linked to the use of estrogen. Thus, currently doctors are limiting the use of estrogen in women who are at a high risk of cardiovascular problems or cancer, and long-term use of estrogen is discouraged. Furthermore, women who have been menopausal for a long time are not considered to be benefiting from estrogen, and may be at risk should they take it.

Interestingly, recent research has shown that the hormone testosterone-naturally present in women's bodies in small amounts-can be of great benefit when it is taken in very small doses. The masculinization of women on testosterone supplementation is very rare because the doses are so small, but the benefits can be noticeable in the areas of sex drive and general energy problems. As with all medical decisions, this should be discussed with healthcare providers and the risks and benefits should be well understood. Non-western and less standard approaches to symptom management should be investigated women and their healthcare practitioners as well. Eating foods high in soy such as soymilk and tofu, which contain natural estrogens, may be of help.

Both menopause and perimenopause are natural processes, but they can produce bothersome symptoms, which should be dealt with appropriately and safely. This is particularly important in light of the fact that recent research studies have shown risks inherent in some forms of HRT which were previously thought to be perfectly safe.