Androgens are like male hormones but they very much belong in a female body. Androgens are responsible for a sense of well being and for maintaining muscle strength and sex drive. Androgens can also be converted into estrogens.

According to Dr. Sadja Greenwood, a leading menopause expert and author of the book, MENOPAUSE NATURALLY, "the best menopausal body is one that is a little plump." This is because the fat cells can convert androgens into estrogen. This extra estrogen cushions women against the extremes of menopausal symptoms. At the same time the extra estrogen may cause erratic or heavier bleeding.

Heavy menstrual bleeding can be a frightening and sometimes debilitating experience. Heavy bleeding is usually the result of hormonal imbalance (fluctuating levels of estrogen with not enough progesterone). In a small percentage of cases, the bleeding is due to uterine fibroids, an overgrowth of the uterine lining, cancer of the cervix or cancer of the uterus. After these other causes have been ruled out, becoming anemic may be the only risk. Iron supplements may be needed (See chapter on Iron).

Hot Flashes

The second well known symptom of menopause is hot flashes. Although these occur in the majority of women in North America, Japanese women, for example, do not get hot flashes and some women, especially overweight women, have no hot flashes at all.

A hot flash is described as sudden reddening of the skin over the head, neck and chest or even the entire body, accompanied by a feeling of intense body heat. The hot flash may last from several seconds to several minutes, rarely up to an hour. The frequency of hot flashes varies from rare to occurring every half hour. They are sometimes more frequent at night. Some women sweat profusely; others just a little, or not at all. Hot flashes are usually preceded or followed by chills. Within two years after the last period, hot flashes will subside completely for the most part. However, one third of women may continue well after that.

Hot flashes may be visible to others, but not usually. They can also be triggered by hot drinks, spicy food, alcohol, emotional stress hot weather or overheated rooms. The key to handling hot flashes is to keep cool, dress in layers, carry a portable fan, avoid the triggering factors, and keep a sense of humour. Hot flashes have been likened to teenage acne. Some women find hot flashes enjoyable. More importantly, hot flashes are absolutely harmless.

A small number of women are incapacitated with hot flashes. They interfere with their sleep or work. Some women wake up drenched in sweat and have to change their nightgown and sheets three to four times a night. These women may want to consider taking low doses of estrogen, after a careful discussion of the risks versus benefits with their doctor. Estrogen usually stops hot flashes immediately. It does not prevent wrinkles or other signs of aging or treat psychological problems. Estrogen is usually prescribed in combination with a progesterone (see below for a discussion on the pros and cons of hormones).

Vaginal Dryness

The third symptom of menopause is vaginal soreness and dryness. This dryness can sometimes cause painful sex.

As you age, the lining of the vagina becomes thinner, the walls of the vagina become smoother, and the colour changes from deep pink to lighter pink. The cervix no longer secretes as much mucous for lubrication as it once did.

Fortunately, this problem is one that is easily remedied. Simple lubricants such as vegetable oils or water soluble jellies like Lubrafax or KY Jelly may be all that is needed. Astroglide and Replens are special products designed specifically as lubricants for menopause. Slower sex with more foreplay may also be very helpful. Regular sex, through intercourse or masturbation, increases the amount of vaginal lubrication.

Finally, if necessary, estrogen cream applied to the vaginal area will alleviate the problem within a few weeks. Estrogen taken this way is absorbed directly into the blood stream, bypassing both the digestive track and the liver. However, circulating levels of estrogen after vaginal administration are only one quarter of those seen with equivalent doses orally. Usually about one eighth of an inch of an applicator is all that is needed once or twice a week for maintenance. At that low dose, there is no increase in blood levels of estrogen and it may not be necessary to take a progesterone.