Every woman goes through three developmental phases in her life: puberty, fertility and menopause. Menopause usually happens between 45-55 years of age, and should be considered a transitional phase in a woman's life. Women during menopause have to face many new challenges, particularly in the area of health. As the changes that bring menopause are associated with a decline in physical functioning, the body becomes less adaptive and more susceptible to disease. A good attitude about menopause is essential for a smooth transition through this phase. Experts advise that menopause should really be thought of as the beginning of a second adulthood, a chance to make choices for good long-term healthcare. Most women can expect to live into their 80s, so it is important to consider how to spend the next thirty to forty years by laying a good health foundation for this "second adulthood".

1. What is menopause?

Menopause is the cessation of the menstrual periods, which marks the permanent end of fertility. A woman is said to reach menopause when she has not had a period for 12 consecutive months and there are no other causes for the change. This usually occurs around age 50-51 but may range from age 40-65. The term is also used to describe the physical and emotional changes a woman experiences before or after her periods cease. Sometimes another term, climacteric is used to describe this "change of life".

2. The stages of menopause development

For women undergoing natural menopause, the whole development process is a gradual one, taking 10 to 20 years. It is commonly divided into two stages.

• Peri-menopause: This is the time when the body begins to prepare itself for menopause. Hormonal levels begin to fluctuate, menstrual periods and ovulation become irregular, and fertility declines. Peri-menopause can occur as early as age 35, but usually in the 40s and will last four to five years or longer. In the last one to two years, due to an accelerated decline in estrogen secretion, many women experience certain physical symptoms.
• Post-menopause: Officially, you can say menopause has begun when periods have been absent for 12 consecutive months. After menstruation has ceased completely, the ovaries will further decline in producing sex hormones, but they still keep secreting hormones for 10 years or longer. As time goes on, typical menopause signs will gradually lessen in severity and eventually disappear, however, long-term health risks related to the loss of estrogen such as osteoporosis and heart disease increase.

3. How can I tell that I have started the menopause?

It is difficult to know the exact time that menopause starts or ends, since the process is affected by many factors. However, some suggesting signs or factors are:

• The age of menopause onset is associated with family history; and the age that one's grandmother/mother went through menopause is an indicator of possible onset. However, this is not necessarily the case as living environment, nutrition, general health and many other factors can easily cause menopause to come earlier or later.
• Menstrual changes are important signs when menopause is coming. The periods may become longer, menses flows are shorter and fewer, and then it gradually eases. Some women experience menstrual irregularities such as long menstrual flow or heavy menses, some may have their periods stop suddenly.
• When approaching the menopause, women often experience symptoms like sudden hot feelings in the face and upper body accompanied by sweating and palpitations. For those who with regular periods, breast tenderness, mood swings, sleeping difficulties, bloating and puffiness often occur before menstruation. Mood changes like irritability, anxiety and suspicious may also suggest that menopause is taking place.

4. Why does menopause trouble some women and not others?

The symptoms of menopause are due to changes in estrogen and progesterone levels, the female hormones that regulate ovulation and menstruation. Since the ovaries become less functional, there are not only less hormones produced but they also fluctuate widely, leading to a number of biological changes. Generally, a gradual decline in ovarian functioning allows the body to slowly adjust to these hormonal changes. However, when ovarian functioning stops abruptly such as if the ovaries are surgically removed or by cancer therapy, menopause symptoms can be particularly severe. Women who live a healthy lifestyle, have a positive attitude and take regular exercise can help the body go through this period smoothly.

5. What should one expect during menopause?

Menopause occurs as a natural part of a woman's life transition and is not a disease. The ovaries slowly stop producing eggs and hormones, leading to biological changes throughout the entire body, from the brain to the skin. Although a host of symptoms have been attributed to menopause, most of them are only temporary and they can be managed properly. Menstrual irregularities, hot flashes and vaginal dryness are the most notable symptoms. Others possible symptoms are sleep disturbances, mood swings, fatigue, depression, irritability, palpitations, headaches, aches and pains, changes in libido and bladder control problems.

6. Does every woman experience menopause in the same way?

Although every woman goes through menopause, it is an individual experience for each woman, and greatly varies among women from different cultures and countries. No two women experience it in the same way as regards to age of onset, specific symptoms, severity and duration of the menopause transition. It has been shown that the menopause experience is related to many factors, including genetics, diet and lifestyle as well as social and cultural backgrounds. Statistics from the US shows that 20% experience no noticeable changes other than cessation of menstruation; 70% experience mild to moderate annoying effects; and 10% find they are severely incapacitated.

7. Can I prevent or reduce menopause symptoms?

There is no way to prevent the onset of menopause, but you can reduce the severity of its symptoms. For menopausal women, many of the unpleasant signs are not simply due to internal hormonal changes; they are more related to external factors such as stress, poor nutrition, and inadequate exercise. They can often be greatly reduced by improving lifestyle habits. A positive attitude, healthy diet and regular exercise are crucial during the menopause transition.

8. Should you see a doctor when menopause occurs?

Doctors generally believe that menopause is a natural event, not a medical crisis or deficiency disease. Menopause has no definite treatment and the signs associated with menopause are temporary. However, if your life or health are seriously disrupted, you should seek help without hesitation. Many steps can be taken to relieve the discomfort, from lifestyle modification to medication. While irregular periods are common when approaching menopause, they may also indicate other health problems. Therefore, you should see your doctor if you have:

• heavy menses, or accompanied by blood clots;
• periods lasting longer than usual;
• spotting between periods;
• shorter periods, less than 21 days apart.

It is also recommended that women have more frequent checkups when approaching or passing through menopause.

9. How does menopause affect a woman's long-term health?

After menopause, women will lose the protection of estrogen and develop a higher risk for chronic problems. It is necessary to be aware of the following conditions:

• Elevated cholesterol levels increase the risk of cardiovascular conditions, such as heart attack, high blood pressure and stroke.
• The rate of bone loss becomes faster after menopause which increases the risk of osteoporosis. Women after menopause are especially susceptible to fractures of the hip, wrist and spine.
• Body composition changes, the amount of body fat increases while muscle mass decreases. The basic metabolic rate reduces, it is harder to keep fit and maintain muscle tone.
• As the tissues of the vagina and urethra lose the support of estrogen, regional infections and incontinence may occur. The low level of estrogen also causes the breasts, uterus and other genital organs to shrink.

With proper management, many of the above consequences can be prevented, reduced or delayed.

10. Menopause with mood problems

A long-held belief is that menopause transition is a time to suffer emotional troubles, everything from depression, anxiety, irritability, crying spells to emotional outbursts with no reason or warning. Studies have found that menopausal women are no more depressed than the general population. Moreover, those who become depressed at this time do not show a depressive pattern distinct from that of younger or older women. Mood problems occur during this time are closely related to personality, if the individuals already have mood controlling problems before menopause, they are more likely to suffer from that. Studies also indicated that many cases of depression are associated with "midlife crises" rather than menopause, including change in family role, isolation from social support, interpersonal loss and awareness of aging as well as declining physical ability. These dramatic changes impact heavily on the self esteem and emotional outlook of women. For some women, their irritability, fatigue and minor moodiness may simply due to disrupted sleep or hot flashes.

11. Hormonal therapy (HT) is bad?

Since the Women's Health Initiative found that hormonal therapy increases the risk of women developing certain serious conditions, people are more conservative in prescribing it. However, estrogen therapy is still a common and effective option for relieving hot flashes and vaginal dryness, affecting cholesterol levels, reducing bone loss, and many other unpleasant signs of menopause. It may be appropriate for short-term use in women with moderate to severe symptoms. Most women find their discomfort diminishes or ceases, have better sleep and more energy for their daily routines after undergoing this treatment.

In fact, the hormonal doses prescribed for menopausal women is much lower than that found in birth control pills, and it can be given in many forms such as tablets, patches, gels, vaginal creams or suppositories. Discuss with your doctor about your personal risks and benefits of hormonal therapy; they will help you find out whether it suitable for you or not.

Some women are definitely not suitable for HT, for example if they have a medical history of the following:

• Endometrial cancer
• Breast cancer
• Stroke
• Active blood-clotting disorders
• Undiagnosed abnormal vaginal bleeding
• Liver dysfunction

12. Do men also experience menopause?

Even though men do not have periods and the male hormone decline is a slower process, some also experience symptoms such as hot flashes, night sweats, fatigue, depression and sexual problems around middle age, very similar to those experienced by women during menopause. Some doctors refer the problem to androgen (testosterone) decline in them, which is usually triggered by disease states such as diabetes, heart and lung problems. Hormonal therapy has reportedly been found to relieve some of the associated signs.