Got hot flashes? Got night sweats? Way too young for menopause? Read this!

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PHOTO (COLOR): Breeze through the topsy-turvy years before menopause by eating yemmy foods, taking all-natural herbs, or, it all else fails, some very safe prescription drugs.

Ever since she was 18, Cathy's periods had come so regularly that she'd always been able to plan vacations around them. But not now that she's in her 40s. Last month, her period arrived-off schedule-the day she flew off for a scuba diving adventure.

Cathy has entered perimenopause-a stage of life sometimes called "the change before the change." She is one of millions of women between the ages of 40 and 55 who experiences irregular menstrual periods and the other symptoms that come with the beginning of the end of their reproductive years.

But Cathy isn't stuck with her symptoms-and neither are you. There are loads of treatments, from drugs to herbs, that can make perimenopause smooth sailing.

Perimenopause is a distinct phase of a woman's life, doctors say, that usually spans about 4 years, but can last as long as 10.

"Perimenopause is a time when the abnormal becomes normal," says Patricia Y. Allen, MD, founder and director of the New York Menopause Center in New York City.

"Your menstrual periods may be longer, shorter, heavier, lighter, closer together, or farther apart," says Dr. Allen, who is an assistant attending obstetrician and gynecologist at The New York Hospital-Cornell Medical Center. Also common are hot flashes and night sweats, as well as insomnia, irritability, anxiety, forgetfulness, and fatigue.

But just because the symptoms are normal doesn't mean you have to put up with them. There are safe prescription drugs, yummy foods, herbal remedies, even mind/body techniques that can help you better navigate your way through perimenopause. And there's a bonus: they can help during menopause too.

Symptom 1: Irregular Periods
Who gets them: About 95% of perimenopausal women. In fact, an erratic period is considered the classic sign of perimenopause.

What causes them: Fluctuating levels of the female hormones estrogen and progesterone. (To understand how your hormones work when they're working properly, see "Get to Know Your Hormones Again,"on p 114.)

The natural solution: Certain chemical compounds in soy foods have an estrogen-like effect and may help relieve symptoms such as irregular periods for some. Aim for one serving of soy a day, such as a soy smoothie made with 1 cup of low-fat soy milk and frozen fruit whirled in the blender, or have 2 tablespoons of roasted soy nuts.

The medical solution: If soy doesn't help as much as you would like, talk to your doctor about taking low-dose birth-control pills (BCPs). Or try a prescription natural micronized progesterone, says Tracy Gaudet, MD, executive director of the program in integrative medicine at the University of Arizona in Tucson.

Micronized progesterone is synthesized from soy beans and/or wild yams and matches your body's own progesterone. (It's available by prescription in capsules called Prometrium.) It works just as well as the commonly prescribed Provera-a synthetic progesterone called a progestin. But because Prometrium is exactly like the progesterone your body makes, it usually doesn't have the same side effects as synthetic progesterone does, such as breast tenderness, irritability, and bloating.

One caveat: Women should avoid taking BCPs if they smoke cigarettes, have had breast or endometrial cancer, have active liver disease or hepatitis, or have a personal or strong family history of strokes or blood clots. The estrogen in BCPs may aggravate existing health problems, says Dr. Allen.

Always report any unusual bleeding to your doctor; though they're usually just a perimenopausal symptom, they can signal something more serious, such as fibroids, endometrial polyps, a thyroid-hormone problem, or even cancer.

Symptom 2: Heavy Bleeding
Who gets it: About 75% of perimenopausal women What causes it: You're not ovulating regularly, so the uterine lining becomes thicker than usual.

The natural solution: Visualization-really! Relax with a few deep breaths, then close your eyes and picture your uterus, says Dr. Gaudet. Try to imagine the bleeding becoming less and less. Use the first image that comes to mind. "One of my patients visualized faucets throughout her uterus," says the Arizona physician. "She turned them tighter and tighter until the bleeding just stopped."

The medical solution: If bleeding remains a problem, see your doctor to figure out the cause and to ask about taking a natural micronized progesterone such as Prometrium, says Dr. Gaudet. But don't bother with over-the-counter progesterone creams for heavy bleeding. There's no evidence that they work.

You should also get a blood test to make sure that you're not anemic.

Symptom 3: Hot Flashes
Who gets them: About 75% of peri-menopausal women Some experience only mild, brief flushes while others suffer frequent, searing bouts of inner heat that make them perspire. (The worst hot flashes tend to occur two to three years before menopause actually occurs.)

What causes them: Dwindling estrogen. Low estrogen levels affect your body's climate control center in the brain, upsetting its normal temperature regulation. Experts speculate that when estrogen levels take a dive, the center reads that event as a drop in body temperature. So it turns up your thermostat.

The natural solution: Try 40 mg of black cohosh a day. (Larger doses are unnecessary and may be unsafe.) It seems to act like estrogen in the body, says Dr. Gaudet. And, if you're not taking blood thinners, you should also take 400 international units (IU) of vitamin E daily. Try that dosage for a month, says Dr. Gaudet. If you still get flashes, boost it to 800 IU. That daily serving of soy that we talked about earlier may also cool hot flashes.

Though dong quai is often promoted as a hot-flash quencher, studies have shown it's ineffective by itself. However, says Dr. Gaudet, it may be helpful if you're taking it in combination with other Chinese herbs formulated by a qualified Chinese Medicine practitioner. That's because Chinese herbs may work by creating a synergy among the various plant chemicals.

The medical solution: The medical options include low-dose BCPs.
Symptom 4: Night Sweats
Who gets them: Almost anyone who gets hot flashes

What causes them: Dwindling levels of estrogen

The natural and medicalsolutions: The same things you do for hot flashes. Night sweats are simply hot flashes that occur at night while you sleep.

Symptom 5: Sleep Disturbances
Who gets them: About 70% of perimenopausal women

What causes them: If you can't fall asleep, chances are the sense of uncertainty that often accompanies this time of physical transition has placed your sympathetic nervous system on the alert. And if you wake during the night, it's a good bet that a hot flash roused you from sleep.

The natural solution: Use a mind/body relaxation technique every night before bed and when you wake during the night, says Dr. Gaudet. The easiest is the breathing exercise in "For Quick Relief: The Woman Doctor's Survival Guide for Perimenopause," below.

Women who train themselves to do a relaxation technique usually report that they're sleeping better within three weeks, says Ann Webster, PhD, a health psychologist who runs a clinic for perimenopausal and menopausal women at Beth Israel Deaconess Hospital in Boston.

If you're having a particularly difficult time sleeping, try taking valerian about 45 minutes before bed, suggests Dr. Gaudet. Try 1/2 to 1 teaspoon of tincture in water or juice. Also, eliminate caffeine and alcohol after 5 pm, says Dr. Allen.

And don't forget the wonderful benefits of exercise. Not only does regular exercise make you feel and look better, it also reduces stress and helps you sleep, says Dr. Webster.

The medical solution: Low-dose BCPs can boost declining estrogen levels and eliminate the hot flashes that disrupt sleep. Natural micronized progesterone taken 30 minutes before bed may promote sleep for some, says Dr. Allen.

Symptom 6: Irritability and Anxiety
Who gets them: There are no available figures, but the doctors who treat perimenopausal women say these emotional symptoms do occur, especially among women whose sleep is disturbed by night sweats.

What causes them: Fluctuating hormone levels, which can affect your general sense of well-being; and/or unresolved worries and concerns during this transition time

The natural solution: Take a deep breath. (Try the breathing exercise in "For Quick Relief: The Woman Doctor's Survival Guide for Perimenopause," on p 116.) And give yourself some breathing space too, advises Dr. Gaudet. You need time to work out issues that emerge during perimenopause.

Hormones aside, middle age is a topsy-turvy time when you may find yourself facing-and making-many changes in all parts of your life, from your career, to your family, to your relationships. Your kids may be gone or going, your career stalled or soaring, and your relationships stale or finally sparking. You also may find you're less tolerant of what once seemed like petty annoyances. After toting up your "years left," you may simply feel you don't want to put up with some things anymore.

If you're having a particularly stressful day, you may want to try the herb kava. Because of its potency, don't use it for everyday anxieties or to cover up problems that need to be addressed. And don't use kava in combination with alcohol, barbiturates, or other agents that depress the central nervous system. Look for a standardized product containing kavapyrones and stay within the standard dose of 60 to 120 mg of kavapyrones, or follow the label directions.

Symptom 7: Forgetfulness and Poor Concentration
Who gets them: About 50% of perimenopausal women-particularly those who are losing sleep due to night sweats, which can leave them feeling permanently jet-lagged

What causes them: Fluctuating hormones; the craziness of the life transition

The natural solution: "Learning to be mindful, focused, and in the present by paying attention to all of your senses is the best way of combating forgetfulness and poor concentration," advises Dr. Webster.

Another way to improve concentration and alertness is to use techniques that elicit the relaxation response:

Close your eyes, take a deep breath through your nose, then exhale through your mouth. Focus your mind on a single word that has meaning to you, preferably a word related to your faith. Mentally repeat the word on every indrawn breath. If your mind wanders-guaranteed the first few times you do it-just gently bring it back to the word. After 10 minutes or so, open your eyes.

You might also want to consider using the herb panax ginseng, says Dr. Gaudet. Ginseng has an estrogen-like effect on the body. And in Chinese Medicine, it is used as a daily tonic to help balance some of the forces at work during perimenopause. Choose a product containing 4 to 7% ginsenosides and take a 100-mg capsule once or twice a day.

Symptom 8: Tiredness
Who gets it: Nearly 50% of perimenopausal women

What causes it: Changes in sleep patterns that are caused by hormonal fluctuations or night sweats. You try waking up three or four times a night to cool yourself off! You won't have any more energy the next day than you did when you got up at night with a newborn.

The natural solution: Take a brisk walk. Studies indicate that women who do some type of moderate intensity exercise three times a week for 30 minutes at a stretch will have fewer symptoms and more energy during perimenopause, says Dr. Gaudet. If you still need a boost, try ginseng she adds. (See "Forgetfulness and Poor Concentration" for the amount to take.)

But for a quick shot of energy whenever you need it most, try this breathing technique:

Put one hand on your belly. Quickly breathe in and out through your nose, pushing your belly against your hand with each breath. Keep the breaths short and fast. It's just like panting during labor, except that this time you're using your nose instead of your mouth.

The medical solution: Always get fatigue checked out by your doctor. For example, your fatigue may be a sign of anemia, especially if you've had heavy bleeding, or it could be a symptom of another medical condition such as a thyroid problem.

PHOTO (COLOR): Now, just imagine doing this naked. Getting cooler?

Chill a Hot Flash in 60 Seconds
Heat surges pouring through your body can drive you nuts. Here are some simple strategies to smash the flash:

Take several long, deep breaths and imagine yourself totally naked, sliding through soft, cold snow down the gentle slope of a mountain.
Just breathe-deep belly breaths six to eight times a minute. Studies show that this alone can reduce hot flashes in some women.
Suck on an ice cube.
Drink a big glass of ice water.
Keep a mini-fan handy for those heat waves.
Take off any piece of clothing you can. And be creative. There are some things you can take off that no one else will notice!
PHOTO (COLOR): Menopause without hot flashes and night sweats? No sweat!

Get to Know Your Hormones Again
Remember your sixth-grade lecture on menstruation? Of course you don't. So here's a brief refresher course to help you understand why the hormonal ups and downs of perimenopause can cause problems.

As you begin your menstrual cycle, estrogen is produced from the follicles in your ovaries. Patricia Y. Allen, MD, director of the New York Menopause Center in New York City, calls these follicles "wanna-be eggs." After a few days, one of the wanna-bes becomes the dominant follicle. At midcycle (about the 14th day) that follicle ruptures, thus producing the Egg of the Month. That's ovulation.

"At ovulation, there is always a sudden drop in estrogen," says Dr. Allen. Luteinizing hormone is produced, and the former follicle-now called the corpus luteum-produces progesterone. The progesterone then causes the lining of the uterus to become lush.

If you don't get pregnant, at about day 22 or 23, the corpus luteum starts to die, says Dr. Allen. Progesterone levels fall, estrogen rapidly drops, and your uterus sheds its lining as a "period."

"At that point, estrogen and progesterone are almost all gone," says Dr. Allen. So the brain responds, with the hypothalamus signaling the pituitary gland to produce follicle-stimulating hormone. The follicles are stimulated, begin to produce estrogen, and the whole cycle repeats itself.

In perimenopause, levels of these hormones may surge or be released at odd times in the month. "As the ovaries age, fewer follicles develop, or there may be no dominant follicle, and therefore no ovulation," says Dr. Allen. The result can be the irregular, missing, or heavy periods that frequently characterize perimenopause.

For Quick Relief

The Woman Doctor's Survival Guide for Perimenopause
Following just four simple strategies during perimenopause will make you less likely to have troublesome symptoms, says gynecologist Tracy Gaudet, MD, of the University of Arizona in Tucson. Try these for relief:

SLIP THE BONDS OF STRESS. Practice a mind/body relaxation technique twice a day, once in the morning and once at night. One of the easiest is an ancient technique in which you close your eyes, breathe in through your nostrils to the count of four, hold for a count of seven, and breathe out again through your nostrils for a count of eight. Repeat the sequence four times in a row.
ENJOY SOY. Add one serving a day to your diet. It's another potent source of helpful plant estrogens.
SNACK ON FLAX. Flaxseed contains substances called lignan precursors that your body turns into weak estrogens. Added to your own dwindling supply, this may help balance your shifting hormones. Try 1 tablespoon of ground flaxseed on your cereal or salad. Grind right before eating.
HIT THE ROAD, JACK. Walk, run, bike, or swim. Choose whatever type of pulse-accelerating exercise you like, but do some form of moderate intensity exercise three times a week (or more) for 30 minutes at a stretch. No one understands just how exercise reduces perimenopausal problems, only that it does.
PHOTO (COLOR): Rx: Just 90 minutes of pulse-pounding exercise a week.

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By Carol Keough

Carol Keough is a freelance writer in Chalfont, PA. She last wrote for Prevention about the safety of our drinking water.

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