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Menopause — when a woman’s body stops menstruating, ovulating and producing estrogen and progesterone — is a natural part of a woman’s life. The average age that women reach menopause is 51.

And you don’t actually go through menopause. Technically, you go through perimenopause, the transitional period of time before you hit menopause which is the specific marker that signifies you haven’t had a menstrual cycle in a year.

The years leading up to perimenopause usually occur between ages 45 and 55. During this time, estrogen production declines. Perimenopause differs from woman to woman. Some women menstruate regularly until their periods suddenly stop. Others may see changes in the amount of menstrual flow or the length of time between periods. Still others have missed periods or bleeding between periods.

Here are 10 signs you’re going through perimenopause:

  • Irregular periods
  • Vaginal dryness
  • Hot flashes
  • Chills
  • Night sweats
  • Sleep problems
  • Mood changes
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness

Although irregular periods, heavy bleeding or bleeding longer than normal often is a normal part of the years leading up to menopause, any of these also can be a warning sign of cancer. If your periods become irregular, heavier or longer than usual, or if you have bleeding between periods, keep a menstrual diary and discuss it with your health care provider, who may decide to check for uterine cancer.

The risk of cardiovascular disease rises with menopause

A woman’s risk for heart disease and stroke increases after menopause. Natural estrogen may help to protect the heart and blood vessels by decreasing the LDL (“bad”) cholesterol and increasing the HDL (“good”) cholesterol in the blood and by having positive effects on blood vessels. Although hormonal therapy (HT) may help relieve menopausal symptoms, it does not appear to prevent heart disease and increases the risk for breast cancer. You can take other steps to reduce your risk for heart disease after menopause by eating a healthy diet, exercising regularly, maintaining a healthy weight, avoiding smoking and, if you have diabetes or high blood pressure, following your treatment plan.

Bone loss increases with menopause

Until a woman turns 30, her body builds bone; after age 30, bone is broken down faster than it is replaced. Mild bone loss will not cause problems, but when the loss becomes excessive, bones weaken and fractures occur. Eating a diet that provides 1,200 to 1,500 mg of calcium a day and 400 to 800 IU of vitamin D (or taking equivalent amounts in supplements), doing weight-bearing exercises and taking medications that help build bone can help prevent excessive bone loss and fractures.

Finding relief

Oral hormone therapy can relieve vaginal dryness, reduce or end hot flashes and help bladder symptoms. HT, however, increases other health risks. For vaginal dryness and urinary incontinence, a prescribed vaginal cream containing estrogen may be helpful. Water-based lubricants, such as K-Y Jelly, Astroglide, Replens or Surgilube, can make sexual intercourse less painful. Talk to your health care provider to find out what is best for you.

Nonhormonal measures also are available to help relieve menopausal symptoms. Herbal products containing estrogen-like substances are not recommended for control of symptoms because their quality cannot be assured and many of their effects have not been studied.

Self-care tips for menopause

  • Dress in layers and wear loose clothing.
  • Drink plenty of water.
  • Do weight-bearing exercise for 30 to 60 minutes a day most days of the week.
  • Avoid caffeine and alcohol, which can intensify hot flashes and cause insomnia.
  • Eat a balanced diet including fruits and vegetables and 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D a day.
  • Achieve and maintain a healthy weight.

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If you think you may have a medical emergency, call 911 immediately, call your doctor, or go to the emergency room/urgent care.