What's this thing called midlife?

Most women experience natural menopause (not caused by medical interventions such as a hysterectomy) between the ages of 44 and 55 - on average at about age 51. Some women reach menopause in their 30s and 40s and a few, in their 50s.

What do perimenopause and postmenopause mean?

What are the signs of perimenopause?

Irregular Periods. As estrogen levels drop, our cycles become irregular and the duration and intensity of bleeding begins to vary. Some women skip periods, even for months at a time, then start again. Any pattern is possible.

Hot Flashes (Hot Flushes). An estimated two-thirds to three-fourths of all women have hot flashes during perimenopause – a sudden warmth in the face and upper body, accompanied by blushing, increased pulse rate and perspiration. A cold chill often follows. Some women never have a hot flash. Those who do can experience them over a period of three to five years. In rare cases, hot flashes continue into the ninth decade of life.

Urogenital Changes. These are changes in the vagina or genital area as well as the urinary tract. Urogenital changes are among the most embarrassing and often are ignored for that reason. Changes include (1) dryness and/or irritation of the vagina, (2) itching or irritation of the vulva, (3) the need to urinate more frequently and/or discomfort on passing urine, and (4) urinary incontinence or leaking urine, particularly when exercising, sneezing, laughing or lifting (stress incontinence). As many as 40% of women aged 45 – 64 have urinary incontinence, yet fewer than half seek help. Treatment options do exist. In today's world, women do not need to live in embarrassment or narrow their lives because of this common problem.

About two-thirds of all women have hot flashes during perimenopause. After age 55, women are at as high of risk for heart disease as men and twice as likely as men to die from a heart attack.

Memory Lapses. Enough women at midlife complain of forgetfulness to make some experts acknowledge it's a natural symptom of menopause.

Scientists think that decreased levels of estrogen (which regulates tissue growth and repair and helps maintain normal brain function) may cause memory lapses. In fact, some studies suggest estrogen replacement may help prevent Alzheimer's Disease.

Depression and Anxiety. There are no scientific studies to support the belief that menopause causes depression and anxiety. In fact, after menopause, many women experience a surge of optimism and well-being. However, it's perfectly normal for perminopausal women to experience mood swings and irritability. Our body is changing hormonally and now we have to get acquainted with a new body rhythm. We can also experience physical changes such as dizziness, heart palpitations, fatigue, weight gain, and sexual dysfunction. These changes can coincide with other stresses in life, such as aging parents, divorce or widowhood, troubles with adolescent children, empty nest syndrome, and changes in our physical appearance. All of this at once can make us feel overwhelmed.?

What are my health risks at midlife and beyond?

Osteoporosis. Osteoporosis is due to gradual loss of bone mass. It leaves our bones porous and fragile and subject to increased risk of fractures. It can also lead to disfigurement of the back (dowager's hump). A major cause of osteoporosis is reduced levels of estrogen. Osteoporosis is easier to prevent than treat. Weight bearing exercise and getting enough calcium and Vitamin D can help reduce the risk. Hormone replacement therapy, when begun as soon after menopause as possible, can also help prevent bone loss and maintain bone health. Other drugs are available to help reverse bone loss.

Heart Disease. Heart attacks don't just happen to men. After age 60, women are at as high a risk for a heart attack as men and twice as likely as men to die from a heart attack within the first weeks after its occurrence. We need to know the symptoms and act immediately if they occur. Delaying treatment can damage heart muscle and prolong recovery. To help reduce the risk of heart disease, don't smoke (this is the single most important preventive measure a woman can take), eat foods low in saturated fat, keep your weight within a healthy range, exercise, and keep your blood pressure and cholesterol under control. Women who have diabetes or a family whose members have died before age 60 of heart disease are at greater risk.

Cancer. Though cancer rates in women increase with age, menopause is not directly associated with increased cancer risk. However, women in midlife must pay extra attention to the most common cancers that can affect them - lung, breast, uterine, cervical, ovarian, colon, rectal and skin. The best defense against lung cancer is to not smoke and to avoid secondhand smoke. For breast cancer, early detection via monthly self-exams and an annual mammogram are key. A Pap test (Pap smear) is the best way to detect cervical cancer, and this test should continue even after menopause. Today, 25% of new cases and more than 40% of deaths from cervical cancer occur in women over age 60. An annual exam with your physician is the preferred way to detect uterine and ovarian cancer as well as colon and rectal cancer. To reduce risk of skin cancer, limit your time in the sun, and wear a sunscreen that carries a SPF of at least 15 and protects against both UVB and UVA rays.