At first, Carol Dixon thought the air conditioning system in her office was on the fritz. One moment she was wrapped in a sweater – worn to ward off the chill from the air conditioning vent above her desk – and the next she’d feel a flush crawl across her skin as her body began to overheat. The warmth felt unbearable and the sweat that poured from her skin was embarrassing.

Then there were the surges of irritability that over-took her. “I was happy one minute and ready to scream in frustration the next,” she says. She blamed it on the stress of balancing a demanding job with raising a child and maintaining a marriage.

Next her menstrual cycle went wacky. “My periods weren’t just irregular, and they were meaner when they finally came,” she remembers. “They were heavier and lasted longer, and the cramps were very painful.”

Enough was enough: She visited her doctor to learn why her periods had become so problematic. Not thinking to mention the hot flashes and irritability, Dixon told him she had recently stopped taking birth control pills. His diagnosis: her body was adjusting to hormonal changes caused by stopping the pill. “Give it a few months to get back to normal,” he told her.

She gave it six months. “The hot flashes and irritability were getting worse, and my cycle hadn’t gotten any better,” she says. This time she described all of her symptoms, and her doctor ran some tests. But when his office called to tell her she had entered perimenopause, the 42-year-old was stunned. “I flipped out,” Dixon recalls.

Perimenopause is a term doctors use to describe the transitional time before menstruation stops completely – the time commonly known as “going through menopause.” During perimenopause, the ovaries stop releasing eggs and cease secreting estrogen and progesterone. Rather than shut down overnight, however, the ovaries slow down these functions and even stop temporarily, only to start again. Menstruation becomes erratic and hormone levels surge and plummet. The fluctuating hormones can cause a wide range of distressing symptoms: hot flashes, irregular periods, memory loss, incontinence, mood swings, and a decreased sex drive.

Equally troubling to some women are the emotional issues they face. While many welcome their freedom from the menstrual cycle, some still want children – or at least that choice. Yet others view menopause as an unwelcome reminder of advancing age.

A New Stage of Life

“Menopause is a life passage whose approach often stirs apprehension,” says

Dr. Geoffrey Redmond, M.D., an internationally recognized specialist in female hormones and author of The Good News AboutWomen’s Hormones. Yes the meaning of menopause has changed.

“The first thing to realize is that menopause is simply a decrease in estrogen – the idea that it is the equivalent of getting old is obsolete,” says Dr. Redmond, who is also the director of The Hormone Center of New York in New York City. His website – www.hormonehelpNY.com – provides a detailed discussion of menopause.

Post-menopausal women do face a higher risk for developing heart disease and osteoporosis, but most women today will also live 30 or more years beyond menopause.

Each woman’s perimenopause experience is unique. Some women start perimenopause as early as 40, others as late as 55. In addition to the symptoms already mentioned, falling estrogen levels can cause insomnia, vaginal dryness, skin sensitivity, and weight again. Depression and slow or “clouded” thinking also are common. You could experience one or all, in their mild or most severe form – but think positive.

“Often these changes are mild,” assures Dr. Redmond, “and few women are so unlucky as to get all of them.” If you start experiencing symptoms of menopause, see your doctor for an exam to rule out other causes. “The symptoms of menopause can start before or after menstruation stops.”

Options to Ease the Change

Menopause itself lasts just a day the one-year anniversary, if you will, of a woman’s last menstrual cycle.  Many women describe their post-menopause years as the most productive and satisfying of their lives. To make the best of yours, Dr. Redmond recommends adopting a “menopause program” that draws on four areas: lifestyle, nutrition, supplements and herbs.

Lifestyle changes include getting enough exercise, which will help keep you heart and bones stay strong and healthy as well as help to hold off the post-menopausal bulge. You also can combat symptoms such as hot flashes by wearing lighter clothes and opting for a layered style that makes it easy to cool clown quickly.

Good nutrition becomes more important than ever. A low-fat, high-calcium diet will help to keep bones strong, the heart healthy, and the body lean. Few women get enough calcium from natural sources, so start taking, a calcium supplement fortified with vitamin D now, regardless of your age. Nutritionists also recommend that post-menopausal women incorporate soy into their diets because it’s been shown to lower cholesterol and help prevent breast cancer – but opt for “real” sources such as soy milk and tofu.

For those seeking alternative herbal treatments, Dr. Redmond says some evidence exists that black cohosh (another phytoestrogen) can help alleviate some menopausal symptoms such as hot flashes. However, more remains to be learned about the herb, and most experts recommend limiting its use to six months or less.

Modern medicine also offers a variety of medications to alleviate specific menopause symptoms as well as to prevent and treat diseases. Post-menopausal women are at higher risk for conditions such as osteoporosis and cardiovascular disease. Ask your doctor about treatments for your specific symptoms and concerns.

The most logical answer to reducing the undesirable aspects of menopause would seem to be replacing the estrogen and progesterone hormones that the ovaries stop producing naturally. It’s certainly an option, but hormone replacement therapy (HRT) has become somewhat controversial.

HRT: Decide What’s Best for You

To replace the hormones your body has stopped producing or not – that’s the question only you can answer, and only with the informed advice of your doctor. HRT has been proved as an effective panacea for many of the common discomforts of perimenopause.

“[HRT] can relieve hot flashes, night sweats, insomnia, vaginal dryness, and more subtle but just as real changes such as skin discomfort and mood swings,” Dr. Redmond explains. Over the long term HRT may also reduce your risks for heart disease, osteoporosis, colon cancer, and Alzheimer’s disease.

The controversy surrounding HRT lies in whether or not it increases the risk of breast cancer. “There have been many studies attempting to answer this question, but they simply do not agree,” explains Dr. Redmond. A number of comprehensive studies on HRT are underway, but the general consensus today is that women with a higher risk for breast cancer (those with a family history of breast cancer, for example) should forego HRT in favor of other therapies. Most doctors also recommend remaining on HRT no more than five years because studies suggest the risk of developing breast cancer becomes higher for these women.

Why even risk it? It’s a question many women ask. Dr. Redmond’s answer is quite simple: “Quality of life.” Some women just do not feel well enough without it. If you try HRT with no success, Dr. Redmond recommends consulting a specialist in women’s hormones who can individualize the dosage and form of estrogen to your needs.

The Circle of Life

Five years into perimenopause, Dixon’s physical symptoms continue, but she’s accepted the changes. “At first I had a real identity crisis because I was becoming a different person,” she says. “I had to settle into the attitude that this was OK.”

Friends and family weren’t much help because they either didn’t want to discuss it or just couldn’t understand how it made her feel.  The Internet became her saving grace, providing abundant information and an unexpected source of support in the form of a menopause forum on a medical website.

“It became a place to get information as well as to vent,” she says of the forum.  “The group helped me accept the changes, and now we go way beyond that. We share family stories and recipes as well as information on new research and medications.”

Dixon now accepts menopause not as a sign of old age but as a marker for a new stage in life. “It’s very empowering,” she says. “Rather than energy flowing from me toward family and friends and mothering, I’m turning it internally to nurture and develop myself.”