Too often, women confuse natural aging changes with menopause. The few symptoms actually associated with the hormonal changes during menopause can usually be handled with a few minor lifestyle changes. Contrary to what most women have heard about menopause, it’s a natural period of transition that gives rise to an exciting and challenging period in life.

Menopause is a period of four or five years, usually two years before the last menstrual period and two to three years after it. For most women, menopause occurs between the ages of 45 and 53, although some women experience it earlier and others go through it at a later age. A woman generally experiences menopause at about the same age as her mother did.

Menopause begins with changes in the menstrual cycle?shorter or longer periods, heavier or lighter bleeding, decreased or increased premenstrual symptoms?until the menstrual periods cease altogether. Women should keep track of their irregular bleeding so their physician can help them determine whether these changes are normal or whether they indicate some abnormal changes in the uterine lining.

Although there is much talk about menopausal “symptoms,” the only symptoms that have been clearly demonstrated to be associated with the hormonal changes of menopause are hot flashes and vaginal dryness. Mood swings or depression aren’t related to hormonal changes as much as they are to fatigue caused from sleep disturbances due to hot flashes, according to Amanda Clark, M.D., assistant professor of obstetrics and gynecology at Oregon Health Sciences University in Portland. “The hormonal fluctuations of menopause aren’t believed to cause any major psychological depression,” she says.

But menopause signals more than hormonal changes. It is the doorway to a new life. Postmenopausal women are free of the discomforts of menstruation, free of the need for contraceptives, and, in many cases, free of child-rearing responsibilities. For the first time, many women find they can concentrate on their own agendas and do the things they want to do.

Here are some tips about how to make the most of this exciting transition called menopause:

Dress for hot flashes. Eight in ten women experience periods of sudden, intense heat and accompanying sweating often called “flushes” or “hot flashes,” according to Sadja Greenwood, M.D., an assistant clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California at San Francisco. “Hot flashes are the body’s response to lower-than-usual estrogen levels,” says Greenwood. She recommends wearing loose clothing that is easily removed, such as cardigan sweaters.

Douse it. If you’re at home or in a place where it’s convenient, you can “spritz” your face with a spray of cool water from a squeeze bottle or you can blot your face with a cool washcloth or moist towelette.

Avoid caffeine and alcohol. If hot flashes seem to be triggered by caffeine and alcohol consumption, Greenwood advises women to avoid them completely. Try substituting noncaffeinated teas or decaffeinated coffee for caffeinated beverages. (Keep in mind that caffeine withdrawal may cause headaches and fatigue for several days.) Greenwood says excess caffeine also causes the kidneys to excrete more calcium, a factor in bone thinning in postmenopausal women.

Carry a personal fan. Many women find they can get relief from the sudden heat of hot flashes by using a small personal fan. Inexpensive wood?and paper fans or battery-powered personal fans are small enough to be carried in a?purse and can be used anywhere.

Exercise regularly. Menopause has been erroneously linked with depression. Several studies have found that women between the ages of 45 and 55 have no increase in susceptibility to depression. Mood swings during this time may have more to do with a woman’s changing role and her self- concept and the physical changes of aging she’s experiencing. “For many women,” says Clark, “menopause is a milestone, a negative milestone, in their lives.

They find the idea of menopause?depressing. We need to discard those old ideas.” Regular, aerobic exercise such as brisk walking does much to increase the general health level, fight fatigue, and raise the spirits. Exercise also appears to slow changes like loss of strength that many believe to be age related, but are actually more associated with a sedentary lifestyle.

Regular, weight-bearing exercises such as walking or jogging can also help stave off the bone thinning of osteoporosis, a problem for many menopausal women. Clark says bones get stronger with regular exercise no matter what your age. “Any weight-bearing exercise is good,” says Clark. “But it has to be a weight-bearing exercise, not like swimming, to increase bone density.”

Get support. “Another term for menopause is `climacteric,’ ” says Susan Woodruff, B.S.N., childbirth and parenting education coordinator at Tuality Community Hospital in Hillsboro, Oregon. “That word applies because it is a really big change. You’re closing one chapter in your life and moving on. You may notice body changes?new aches, pains, wrinkles. Menopause is one of life’s major change signals. It’s helpful to talk to other women about these changes.”

Woodruff recommends joining a menopause?support group sponsored by a local hospital, community college, or professional group. Or you might want to form your own support group with ?friends who are experiencing menopause.

?“Menopause affects how you see yourself, yourself-concept, because your roles in life are changing at this time,” says Woodruff. “A support group of other women who understand can really help you see yourself as a strong person experiencing a natural life change.”

Get plenty of calcium. “Everyone loses calcium as they get older,” says Clark. “But in women, as estrogen levels decline, the rate of bone loss increases.”

Sonja Connor, M.S., R.D., research associate professor in the School of Medicine at Oregon Health Sciences University in Portland, says, “At menopause, there’s an outpouring of calcium in response to the lower estrogen levels. Unless you have really good stores of calcium already, during this time you’re going to have an increased need for calcium.”

Clark says postmenopausal women taking hormone replacement need 1,000 milligrams of elemental calcium daily; women not taking hormones need 1,500 milligrams of elemental calcium.

Dairy products are good sources of calcium, although you’ll be doing yourself an even bigger favor if you choose those that are low in fat, such as skim milk, nonfat yogurt, and low-fat cheeses.

For example, an eight-ounce glass of whole milk and an eight-ounce glass of skim milk contain the same amount of elemental calcium (350 milligrams), but the whole milk contains about 70 calories more from fat. To add to your calcium stores, eat a diet that is also rich in vegetables, fruits, and complex carbohydrates.

If your diet isn’t calcium rich or if your stores of calcium are seriously depleted from a lifetime of poor eating habits, Clark suggests taking calcium supplements. Keep in mind that the number of milligrams of calcium listed on the label of a supplement may not reflect the amount of elemental calcium in the product. For example, it takes 1,200 milligrams of calcium carbonate to get 500 milligrams of elemental calcium. Ask your doctor or pharmacist for advice on choosing a calcium supplement.

Eat a balanced, low-fat diet. Women at menopause not only have an increased risk of osteoporosis, they may also be at risk for heart disease. “At menopause, women’s levels of LDL, or so-called `bad’ cholesterol, go up,” explains Connor. “Within about ten years, they have the same risk for heart disease as men.”

Connor says diet can go a long way toward preventing serious health problems like osteoporosis, cancer, and heart disease in menopausal women. “Diets high in animal products and salt cause the body to excrete more?calcium, which contributes to osteoporosis,” she says. “Menopausal women should eat less animal protein and less salt. If they switch to more foods from the vegetable kingdom and more complex carbohydrates, they’ll be getting less fat [high-fat diets are related to some cancers and heart disease], more calcium, and more of the anticancer elements like beta carotene.”

Plan for menopause. “The problem,” says Connor, “is that most women eat the typical American diet: 40 percent of calories from fat, 20 percent from sugar, and 5 percent from alcohol?essentially empty calories. That means they’re getting nutrients from only 35 percent of their calories. On top of that, they don’t do any regular exercise. When menopause comes, they need medical intervention in the form of hormone therapy just to catch up with what they’ve done to their bodies all these years.”

Connor believes only a small percentage of women would need hormone therapy if they’d anticipate menopause by eating right and exercising regularly for at least 20 years before the onset of menopause. “Prevention is the best thing,” she says. “A lifelong lifestyle of low-fat eating, not smoking, and exercising regularly will usually get you ready to face menopausal changes without any problems.” And, of course, no matter what stage in life you’re in, it’s never too late to benefit from switching to a healthier lifestyle.

There are actually two types of increased hair growth. One is hirsutism, which happens as a result of increased amounts of or increased sensitivity to hormones called androgens. The causes can include menopause, pregnancy (rarely), an overactive adrenal gland, Cushing’s disease, polycystic ovary syndrome, a pituitary tumor, an ovarian tumor, and the use of medication that contains androgens.

The second type of abnormal hair growth is called hypertrichosis, which has nothing to do with?hormones but rather is often due to ethnic and geographic influences. Among white people, those of Mediterranean and Semitic descent tend to be hairier than Scandinavians and Anglo-Saxons. The least hairy peoples are Asians and American

Indians. Hypertrichosis can also be caused by certain medications, physical factors such as chronic rubbing, and systemic ( bodywide) disease.

In short, if your mother and your mother’s mother kept a hairy upper lip, you probably don’t have to be concerned that there is a medical problem underlying your excess hair growth. If on the other hand, you come from a long line of sparsely whiskered folk, the appearance of a crop of dark?and for coarse hair on your face, chest, back, arms, or legs should be reported to your doctor. Often, the excess hair will disappear once the underlying condition is corrected.

Signs that you may have mastitis include a reddened area on the fleshy part of the breast that is painful to the touch and ranges from the size of a quarter to the whole side of the breast, a fever of up to 102 degrees Fahrenheit, general achiness, and chills. You may have one or two of these symptoms, or you may have all of them at once. They tend to come on very rapidly. “You may be feeling a little off at 7?30 in the morning and an hour later feel as if a truck ran over you.

While you will need to see a doctor if you suspect a breast infection, there are afew things you should do on your own during the course of an infection.

Continue nursing, starting with the infected breast each time. This may, sound like sheer lunacy when you are in so much pain, but it helps clear the infection and will not hurt the baby. “The milk is absolutely not infected. It is the area around the milk duct that is infected. Nursing at least every two to three hours, and more frequently if the baby is willing is recommended.

Prior to nursing, pack the breast in heat. Again, use a warm towel with a plastic bag over it to maintain the heat. “Then massage and stroke the breast from the fleshy part down to the nipple, focusing especially on that sore spot,” says Phyllis Frey, A.R. N. P

Get in bed. You need to go on full bed rest. This is your time to take care of yourself and let everyone else nurture you while you get over the infection. Usually, it takes only about 24 to 36 hours for the pain to pass. But Fox stresses the importance of continuing the antibiotics throughout their full 10-to 14-day course, despite the fact that you’re feeling better.

Other problems that can cause discomfort include yeast infections in the nipple and clogged milk ducts. “Yeast infections can cause ongoing discomfort in the nipple and need to be diagnosed and treated by your doctor,” says Frey.

Clogged ducts, on the other hand, usually resolve themselves within 24 hours. They are characterized by a hard, uncomfortable lump in the fleshy part of the breast. It can be very tender to the touch but
isn’t usually accompanied by a fever To relieve the pain of a clogged duct, pack the breast in heat before feedings, get the baby to nurse on the infected breast first, and massage the hard spot the whole time the baby is nursing in order to loosen up the milk and unclog the duct.

“If the milk is locked in the duct for more than 24 hours, it can start leaking into the breast tissue and leave a moist breeding ground for bacteria,” cautions Frey. ‘And once it becomes infected, it is a hot spot that hurts all of the time.” Fox adds that the pattern tends to be sore nipples, engorgement, clogged ducts, and mastitis. Solving the first two problems will usually prevent the latter.

“Every expert is a little different in terms of their advice on how to best wean a baby,” says Harold Zimmer, M. D. “Some advise you to go `cold turkey’ and some advise you to truly wean,” he continues. For Mom, it is a little more comfortable to do it gradually, but some babies will decide to wean themselves and will abruptly reject the breast for good. “Generally, trying to drop one feeding about every two days is what I recommend,” says Zimmer ‘And the last feedings to be dropped should be the first one in the morning and the last one at night because the baby tends to be most attached to breast-feeding at these times,” he explains. It is also important to never drop two feedings in a row. In other words, if you typically breast-feed your baby twice in the morning, twice in the afternoon, and twice in the evening, avoid dropping one morning feeding one day and another morning feeding two days later Instead, try dropping one morning feeding, then an afternoon feeding, then an evening feeding.

As far as the pain of engorgement that can result, there are a few things you can do. “Tying a towel or Ace bandage around your breasts can help decrease your milk supply, because the extra pressure collapses the glands so that they can’t hold as much milk,” says Zimmer ‘Applying ice packs to the breasts decreases circulation and further reduces the degree of engorgement and swelling,” he continues. And once you have started to wean, he gives his OK to taking aspirin. ‘Aspirin is a good anti-inflammatory and can relieve some of the discomfort of engorgement,” he says.

Whatever you do, avoid any extra stimulation to the breasts during weaning. ‘Anything that stimulates the breasts will promote more milk production,” warns Zimmer

• A lump or firmness
• Soreness in only one breast
• A change in your breast self-exam
• Nipple discharge on one side (Lactating breasts may secrete white/yellow discharge for up to a year after nursing is discontinued.)

In addition, be sure to examine your breasts monthly, regardless of whether you are having any discomfort or not. Self-examination of the breasts is an effective way to detect cancerous changes early. The best time to perform the examination is during the week following your menstrual period. If you do not know how to do a breast self-examination or are not sure if you are doing it properly, talk to your doctor.

Try cutting back on caffeine. Greenwood says that the scientific evidence is mixed about whether or not eliminating caffeine helps lumpy, fibrocystic breasts. One study, reported by the National Institutes of Health, which included more than 3,000 women, found no relationship between caffeine consumption and fibrocystic disease. On the other hand, some women have reported good results from cutting back or eliminating caffeinated coffees, teas, colas, and chocolate. Try reducing your consumption of caffeine to see if your breast discomfort decreases.

Cut salt. Many women are bothered by fluid retention, particularly near the time of their menstrual period, says Clark. “Avoiding salt around this time can help minimize fluid retention,” she says.

Apply heat/cold packs. Woodruff says that some women find relief from painful breasts by alternating a warm heating pad and ice packs. Try using the heating pad for 30 minutes, then the ice packs for 10 minutes, then the heating pad for 30 minutes, and so on.

Try a nonprescription pain reliever. Aspirin, ibuprofen, or acetaminophen can ease the pain of premenstrual breasts, says Clark. For fibrocystic breasts, Purcell recommends ibuprofen.

Check out your cosmetics. Some herbal cosmetics and remedies, such as those made with ginseng, can have steroidal effects similar to estrogen. If you suspect that a product that you use may have such an effect, try avoiding the product temporarily to see if your condition improves.

Breast discomfort is a normal part of being a woman. It is almost always not a sign of breast cancer. Breasts are mammary glands that are responsive to natural hormonal changes, especially fluctuations in estrogen, that occur at menstruation, menopause, and pregnancy. Hormonal changes can cause breasts to become hot, swollen, tender, and painful to the touch. “Breast discomfort is really common for women,” says Amanda Clark, M.D., assistant professor of obstetrics and gynecology at Oregon Health Sciences University in Portland. “We see it a great deal during early pregnancy, with menstruation, and during early hormone therapy at menopause.”

All of the hormonal changes that occur just before menstruation and during pregnancy prepare the woman’s breasts for breast-feeding. With the onset of menstruation, estrogen levels fall and the breasts return to normal.

With pregnancy, the hormonal changes continue, and the breasts begin producing milk for the baby. Lactating breasts present their own special problems and challenges. Sometimes, a mother’s milk comes in too early or too heavily and causes a painful condition called engorgement. Nursing nipples can become sore. Milk ducts may become backed up and can lead to a painful infection called mastitis.

During menopause, many women opt for hormone therapy to reduce menopausal symptoms such as hot flashes and to reduce their risk of developing the bone-thinning disease osteoporosis. However, it often takes a while to find just the right combination and dosage of hormones for each woman. During this period, many women experience breast discomfort.

Some women also suffer from a noncancerous breast condition such as fibrocystic breasts that can cause the breasts to feel lumpy, painful, and tender. The condition is related to monthly
hormonal fluctuations. As many as 30 percent of all women suffer from fibrocystic breasts, according to Sadja Greenwood, M.D., assistant clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California at San Francisco. “Fibrocystic breasts were once considered a disease,” she says. “But it’s very common and is considered a normal?although somewhat painful? condition.”

Even young girls who are just beginning to develop breasts are subject to hormonal fluctuations and can therefore experience breast tenderness. “Breast discomfort in prepubescent young women with breast budding is normal,” says Deborah Purcell, M.D., a pediatrician in private practice and past chairperson of the Department of Pediatrics at St. Vincent Hospital and Medical Center in Portland, Oregon. As odd as it may sound, “even young boys can experience some enlargement of the breasts and discomfort during this growth spurt,” says Purcell.