As straight-talking baby boomers get older, a word that used to be spoken in hushed tones is now openly discussed. The word is menopause. Women approaching mid-life today have opted to be more open about this natural occurrence and to seek information that will help them experience it more positively than perhaps their mothers did.

If you are 40-something and still having menstrual periods, it's good to be prepared for the changes your body will face, usually between the ages of 45 and 55. While menopause technically begins a year after your final menstrual period, a phase called "perimenopause" begins when menstrual cycles become irregular and ends a year after menopause. It's during this time, which usually lasts three to four years, when you can experience some fairly dramatic symptoms caused by variations in your level of circulating estrogen.

Scientists believe that surges and drops in estrogen during perimenopause may play an important role in the following conditions:

• Heavy periods.
• Uterine fibroids (benign tumors of the uterus that can enlarge and bleed during perimenopause, often leading to hysterectomy).
• Endometriosis (when uterine tissue grows outside the uterus).
• Mood changes, since estrogen appears to affect levels of neurotransmitters, which are signaling chemicals in the brain.
• Hot flashes and other more subtle temperature variations that can disrupt sleep.
• Vaginal dryness, because estrogen-sensitive tissues in the vagina may become thinner and drier.
• Memory and concentration problems--less understood but thought to be related to reduced estrogen circulation.
• Decreased sex drive.

To determine if you are in the perimenopause phase, a test that measures levels of follicle stimulating hormone (FSH) can be done. An elevated FSH level is a sign that the pituitary gland is trying in vain to trigger ovulation. But this test is not reliable in itself; therefore, to determine perimenopause, your physician will also consider other symptoms. Once you're fairly certain your symptoms are perimenopausal, there are ways to help alleviate the common complaints. Hormone replacement therapy is the mainstay of treatment, but there are other non-pharmaceutical options.

Your physician is your best guide in finding symptomatic relief that suits you, and can also assess your general health, which can also change during this time. It's especially important to be aware that your risk for heart disease, for one thing, increases after menopause.

This time in your life is not one event, but a complex process. It may not be over quickly, but you don’t have to suffer through these years alone. Along with your physician, friends who've passed through menopause ahead of you will also be a valuable source of information and support.

For more information on menopause or perimenopause, contact your physician. If you need a physician in the Greater Cincinnati area, call (513) 749-DrDr.

SOURCE: Harvard Women's Health Watch, September 1999.