Your Perfectly Pampered Menopause

A fun and fabulous health guide for living well at midlife—no prescription required!

Menopause can be a difficult and confusing time—but it doesn’t have to be. Your Perfectly Pampered Menopause has the answers that make the difference, with a clear-cut plan that shows you how to look and feel better now than ever before.

Culling advice from leading medical experts, award-winning reporter Colette Bouchez dispenses the latest news on everything from hot flashes, insomnia, and dysfunctional bleeding to incontinence, bone health, weight control, and more. She explores the latest buzz on HRT, natural hormones, and the newest prescription drugs, as well as the latest in natural and traditional care for a truly comprehensive guide to midlife health.

But she also brings you advice from top beauty and lifestyle experts and clues you in on everything from anti-aging skin and hair care to the hottest news in midlife nutrition (including an anti-hot-flash diet!), divine new relaxation techniques, optimal exercise and dieting secrets, and putting the kick back into your sex life!

With this complete guide to taking care of yourself now and in the future you'll discover how midlife can be the best time of your life!An award-winning medical writer for the New York Daily News, COLETTE BOUCHEZ has more than twenty years of journalism and medical research experience. Her weekly consumer health column is syndicated by The New York Times, and she is a feature writer for WebMD. Her previous books include Your Perfectly Pampered Pregnancy (Broadway 2004), The V Zone: A Woman's Guide to Intimate Health Care, and Getting Pregnant (95,000 copies in print). She lives in New York City.1

Understanding This Thing Called Menopause

What You Need to Know Right from the Start

My good friend Nadine hit me with a sobering thought this morning. We were headed to our local gym to meet Laura, Robyn, Tina, and few other friends for our regular "We're-not-getting-older-we're-getting-better" workouts when she decided to fill me in on the morning's news.

"I read in the paper today that between the year 2005 and 2030 there will be 1 billion women going through menopause . . . all at the same time," she said almost innocently. I wasn't quite sure if she thought this was a good thing or a bad thing. But I know what I thought: That's waaay too many of us having hot flashes and mood swings all at the exact same moment. Talk about your weapons of mass destruction . . .

The funny part is, though, that despite what we have all been conditioned to believe or expect, it's not really this thing called menopause that's going to change our lives in any kind of dramatic way. Because—and I'm speaking strictly in medical terms here—menopause is now clinically defined as not having had a menstrual period for twelve months or more. It is considered the official end to your reproductive years—and for many women that also means an end to some of the most troubling symptoms associated with this time of life, including hot flashes, night sweats, moods swings, and those "touch me and I'll kill you" temper outbursts. And, in fact, as lots of women who have already passed through this transition will likely tell you, reaching menopause can seem more like a beginning than an end anyway—the start of the second phase of your life. If you look at gals who have already opened the door for us—incredible, talented, and, yes, gorgeous women like Diane Sawyer, Oprah Winfrey, Diane Keaton, Tina Turner, Cher, Suzanne Somers, Hillary Clinton—then you know that what's on the other side can be pretty spectacular.

But the getting there—ahhh, now that's a different story. Doctors use the word perimenopause, which technically means the years leading up to menopause—a period that can begin as young as thirty-five or as late as fifty, be as short as one year or as long as ten or more. My friends and I—well, we have coined an entirely different term to describe this time zone. And if you've just rounded the bend past forty—and particularly if you are heading toward age fifty—it's likely you've got a few terms of your own to describe this particular time of life. (Does the word yikes! come to mind?) As you no doubt already know, it's the perimenopause years that can leave you wondering if anything about life is ever going to seem normal again.

• You pick up the phone to call a client—and while it's ringing, you've completely forgotten whom you've called.

• You wake up in the middle of the night warm and flushed and breathing heavy—and sex is the furthest thing from your mind.

• The bakery is out of rye bread—and you cry for forty minutes. In the store.

• You begin to wonder if it's possible to have PMS for forty-seven days in a row.

• You are convinced beyond any reasonable doubt that global warming has arrived—and it's hovering over your house 24/7.

• You go on vacation and without warning your period arrives—ten days early and heavier than you've ever experienced before.

If this all sounds a bit too familiar, then you probably know this can be a time that tries a woman's soul, tests her patience, challenges her resolve, and in many instances leaves her wondering why, after going through labor, giving birth, raising a family—and breaking through a glass ceiling or two along the way—she now has to put up with this! Not to mention a partner whose testosterone levels have been dropping since he hit thirty-five!

Before you get too discouraged, remember, there is an upside. With just a little bit of knowledge—and some patience and resolve—you can discover how to put that "kick" back in your engine, pick up speed, and head into the second half of your life, raring to go! How do you begin? For me, the best place to start was in discovering my new body—what's changed, what's different, and, overall, what I can come to expect from myself and my own slightly used biology, now and in the years to come.

It's Not Your Mother's Menopause—But Nobody's Told Your Ovaries

One of the really great things about being in perimenopause today—as compared to when your mom or grandmother went through it—is that it really doesn't signify much, except an aging of your ovaries. Indeed, thirty or forty years ago "middle-aged" was considered "elderly"—with women resigned to living out the second half of life in frumpy print dresses and low-heeled shoes. Well, it's not your mother's menopause! Today turning fifty comes with a whole new attitude—not to mention a whole new look—with high-achieving, high-energy gals from all walks of life proving that the face of aging is definitely changing. And, with a few shots of Botox and a bottle of moisturizer, the future can look pretty darned good! Unfortunately, your ovaries don't quite share in that same youthful enthusiasm. No matter how young you look or feel or act, when it comes to your reproductive system . . . well, let's just say you're lucky your ovaries are on the inside of your body. Because the truth is, they are aging, and that fact is pretty much responsible for most, if not all, of the perimenopause symptoms you are or will soon be experiencing—including the common symptoms like hot flashes and night sweats and mood swings, but also the less discussed problems such as dysfunctional bleeding, memory loss, insomnia, and more.

Before you can fully appreciate all that changes as your ovaries age, it's important to understand a little something about how they work in general—and how they control hormonal activity during all the phases of your life. In this respect, much of their activity revolves around the production of estrogen and progesterone. During your peak reproductive years—from your teens to your mid-thirties—the vast majority of the estrogen in your body, and pretty much all of your progesterone, is the direct result of what's going on in your ovaries. The other two hormones that matter most are FSH, short for follicle-stimulating hormone, and LH, short for luteinizing hormone. While both are manufactured in the brain, their primary activity is to stimulate the ovaries.

The other key players on your reproductive team are your follicles—tiny sacs within each ovary that contain the biological makings of an egg. At birth you have several million follicles already in place, just waiting for puberty to jump-start your hormones and allow the reproductive process to begin. When it does, a tightly wound network of action and reaction begins, and it all plays out something like this:

• As each monthly cycle starts, estrogen levels are relatively low—something which your brain readily senses. When it does, it begins to producing the chemical FSH. As the name (follicle-stimulating hormone) suggests, a rise in FSH stimulates the follicles inside your ovary to grow and eggs to begin developing, which makes estrogen levels rise.

• As this occurs, your ovaries send another message to your brain to initiate the production of LH, a hormone that encourages the release of your developing egg—a process known as ovulation. The sac in which the egg developed—known as the corpus luteum—is left behind, and it begins producing progesterone. Together, estrogen and progesterone help create a thick, spongy lining inside your uterus in anticipation of a newly fertilized egg.

• If that egg isn't fertilized and no pregnancy occurs, levels of estrogen and progesterone drop sharply. This, in turn, causes the newly thickened uterine lining to shed, leaving your body in the form of menstrual blood. After it does the whole cycle begins again—and a month later, you get another period.

That's the way it goes, month in and month out, for pretty much most of your reproductive life. As you begin to age, however, some of these steps begin to change. As early as age thirty-five, for example, your cycle may go from the average twenty-eight-day schedule to twenty-four or twenty-five days. While doctors don't understand why, older women seem to ovulate within ten or twelve days of their last period, instead of the customary fourteen, thus shortening their cycle. Eventually—usually between age thirty-five and forty—you will stop ovulating every month. Although it sounds like the several million follicles you are born with should last well into your nineties, they don't. As you age many begin to die off. The follicles that do remain are getting "older"—and they don't respond to hormonal stimulation quite as readily. So, while in your peak reproductive years you were probably ovulating every twenty-eight days, and doing so ten or twelve times a year, once you hit age forty, you are probably ovulating just six to eight times a year—and the older you get, the fewer eggs you "hatch," so the less frequently you ovulate. The end result here: Your estrogen levels begin to fluctuate, sometimes dramatically.