Since attitude plays a significant role in the physical response to menopause, it helps to understand the changes that are taking place. These changes can start several years before menopause proper actually sets in, with erratic periods or unusually heavy or light bleeding. This phase is called perimenopause or premenopause and provides an opportunity to prepare emotionally and physically for the larger transition to come. During premenopause the ovaries no longer ovulate on a regular basis. This is the basis for the cycle changes and the beginning of symptoms such as hot flashes.
Menopause itself usually begins in the mid-forties to early fifties. When the ovaries stop producing significant amounts of estrogen and progesterone, the menstrual cycle ceases; a woman who has had no periods for a year is said to be menopausal.
Women’s reactions to menopause vary widely. Some enjoy the change, while others suffer from problems like hot flashes, vaginal dryness, heart palpitations, and mood swings, often for years. But if a woman is healthy, active, and well nourished, her adrenal glands will usually respond to menopause by creating precursor hormones such as pregnenelone and DHEA that are then converted into estrogen, progesterone, and testosterone.
The days of routinely prescribing synthetic estrogen and/or synthetic progesterone should be over. Several studies, including the well publicized Women’s Health Initiative Study that involved over 16,000 women, concluded the “benefits did not outweigh the risks” of using the combination of synthetic estrogen (Premarin) and synthetic progesterone (Provera).
When menopause is brought about by hysterectomy or removal of the ovaries, natural hormonal replacement therapy may be necessary to counter the sudden depletion of estrogen, testosterone, and progesterone and resulting bone loss.