Time for a change -- the change of life; Stages: Millions of baby-boomer women are moving into menopause and facing its dilemmas.; HEALTH & FITNESS


You're savoring a spicy Mexican enchilada when rivulets of sweat start pouring down your face. You walk into the next room to get something and forget what you're looking for. One moment you're happy as could be and then, for no perceptible reason, you're angry or irritable or bursting into tears.

No, you're not having a nervous breakdown. You're experiencing symptoms of menopause, also referred to as the climacteric or the "change of life," and, for better or for worse, lots of baby- boomer women are going through the same thing.

By next year, menopause will begin to affect 44 million American women.

And the American College of Obstetricians and Gynecologists predicts: "The result will be a national health concern of dramatic proportions unless women are better educated about the changes of menopause and the measures that can prolong and enhance their lives."

Menopause, the cessation of the menstrual period, is preceded by a transitional period called perimenopause, which can last anywhere from several months to seven or eight years. Perimenopause, when estrogen production is decreasing, is marked by menstrual irregularities, insomnia, mood swings and inability to concentrate. Decreased libido, urinary incontinence and depression are common. The average age for menopause is 51, although it ranges from age 38 to 55.

The American Medical Association points out that every woman experiences menopause in a different way. Estrogen depletion can have a variety of effects on a woman's body, ranging from vasomotor symptoms such as night sweats to long-term health risks such as heart disease and osteoporosis. About 75 percent of menopausal women experience hot flashes -- sudden, brief increases in body temperature, often accompanied by heart palpitations, flushing and dizziness.

Hormone replacement therapy (HRT), now used by about 11 million American women, has been found to reduce many of these troublesome symptoms, as well as providing protection against osteoporosis and heart disease. Long-term use of HRT is still controversial, since it may lead to increased risk of cancer.

The Nurses' Health Study, conducted at Harvard Medical School and reported in the June 1995 New England Journal of Medicine, showed that women taking estrogen and a synthetic progestin had a 32- to 46-percent increase in the risk of breast cancer. Some studies show that estrogen does not cause cancer in the short-term, but the long-term usage (more than 10 years) leads to an elevated risk of breast and uterine cancer.

The risk of endometrial cancer or overgrowth is believed to be lessened by the now-common practice of combination therapy, in which progesterone is given in conjunction with replacement therapy. (Women who have had hysterectomies for fibroids or other disease do not need progesterone since they no longer need protection from endometrial cancer.)

Estrogen replacement therapy has five major advantages: It reduces symptoms like hot flashes; prevents osteoporosis by slowing the acceleration of bone loss; dramatically reduces the risk of coronary artery disease by preventing artery blockage and raising the levels of "good cholesterol" (HDL); improves mental function and may prevent Alzheimer's disease; and reduces urogenital problems such as incontinence and vaginal dryness.

Estrogen and progesterone can be used separately or together, depending on the medical history and needs on the individual. It can be administered orally, in a vaginal cream or through a patch. Estrogen supplements are usually contraindicated in women who have had blood clots (thromboembolic disease), or endometrial or breast cancer; they should be used cautiously in women with a history of gall bladder disease.

An option for the prevention of osteoporosis is a selective estrogen receptor modulator (SERM), sometimes referred to as designer estrogens. Products such as Evista (raloxifene, HCL) have been found to preserve bones without many of the possible side effects or risks incurred by taking estrogen. SERMS, however, do not provide many of the other cardiovascular benefits of estrogen, and do not help with hot flashes.

Lifestyle changes that may help relieve menopause symptoms include regular exercise, and dietary restriction of caffeine, alcohol, sugar and salt. Phytoestrogens (found in peanuts, oats, corn, apples, and also marketed in supplements such as powders or teas) can also provide relief. Research is being done to determine their efficacy in reducing the risks of heart disease, osteoporosis or breast cancer.

Soy products contain an estrogen-mimicking substance found to reduce the frequency and intensity of hot flashes. Other alternatives that some women have found useful include Chinese herbal extracts such as dong quai, vitamin E supplements, wild yam creams (which produce benefits similar to those of progesterone) and gingko biloba, which may help with memory and concentration.

(c) Barbra Williams Cosentino

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