B

B

Answers will vary. Menopause, or the "change of life," is the cessation of menstruation. Menopause is a normal process that most commonly occurs between the ages of 46 and 50 and lasts for about 2 years. Menopause is a specific event in a longer-term process known as the climacteric ("critical period"), which is the gradual decline in the reproductive capacity of the ovaries due to a decline in production of estrogen. The estrogen deficit may lead to unpleasant perimenopausal sensations, such as night sweats and hot flashes (suddenly feeling hot) and hot flushes (suddenly reddened skin). Hot flashes and flushes may alternate with cold sweats, in which a woman feels suddenly cold and clammy. All of these sensations reflect vasomotor instability, disruptions in the body mechanisms that dilate or constrict the blood vessels to maintain an even body temperature. Additional signs of estrogen deficiency include dizziness, headaches, joint pain, tingling in the hands or feet, burning or itchy skin, and heart palpitations. The skin usually becomes drier. There is some loss of breast tissue and decreased vaginal lubrication during sexual arousal. However, menopause does not signal an end to women's sexual appetite. Long-term estrogen deficiency has been linked to brittleness and porosity of the bones-osteoporosis. Osteoporosis can be handicapping, even life-threatening. The brittleness of the bones increases the risk of serious fractures, especially of the hip, and many older women never recover from them. Estrogen deficiency also can impair cognitive functioning and feelings of psychological well-being. Some women with severe physical symptoms have been helped by hormone replacement therapy (HRT), which typically consists of synthetic estrogen and progesterone. HRT may reduce the hot flushes and other symptoms brought about by hormonal deficiencies. Estrogen replacement also lowers the risks of osteoporosis and colon cancer. Yet HRT is controversial. The Women's Health Initiative study of some 16,600 postmenopausal women aged 50 to 79 found that exposure to a combination of estrogen and progestin appears to significantly increase the risk of breast cancer, strokes, and blood clots. Because of the Chlebowski study and studies with similar findings, the number of women using HRT has dropped significantly over the past few years, and many women are considering alternatives. Progestin alone-that is, the use of progestin without estrogen-prevents or lessens hot flashes in many women. Selective serotonin reuptake inhibitors (SSRIs) may also be of help.

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