Menopause
FOR

DUMmIES
2ND

‰

EDITION

by Marcia L. Jones, PhD, Theresa Eichenwald, MD,
and Nancy W. Hall



Menopause
FOR

DUMmIES
2ND

‰

EDITION

by Marcia L. Jones, PhD, Theresa Eichenwald, MD,
and Nancy W. Hall


Menopause For Dummies®, 2nd Edition
Published by

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About the Authors
Nancy W. Hall, M.S., M.Phil., lived the menopause experience in real life as
she wrote this book. In addition to delving into the most up-to-date research
on perimenopause, menopause, women’s health, and treatments for
menopausal symptoms, she relentlessly grilled her friends and a shocking
number of complete strangers about their experiences.
Nancy received her Master’s degrees in psychology at Yale University. Her
interest in various aspects of parenting led her to research and write about
all sorts of issues pertaining to children’s and women’s health and work-life
concerns. Nancy has been a contributing editor for both Child magazine and
Parents magazine, and a frequent contributor to other parenting, women’s,
and health magazines and Web sites. Her books on child development, family

policy, and health include Balancing Pregnancy and Work: How to Make the
Most of the Next 9 Months on the Job (Rodale, 2004).
Nancy is the mom of a son and a daughter (both keepers). When she’s not
writing books and magazine articles about these and other topics, she knits,
bakes artisan breads, raises bees, and studies goju ryu karate.
Marcia L. Jones, PhD, has life experience in fertility treatment, perimenopause,
and menopause. In 1991, while attempting to start a family at the age of 38, she
scoured bookstores searching for down-to-earth information on the likely problems and how to proceed. Her doctor directed her to the only information available at the time, photocopies of technical articles from medical journals and
pamphlets written by pharmaceutical companies trying to sell product. Today,
many women are delaying childbirth, so the issue of fertility fits nicely into a
discussion of perimenopause and menopause. These experiences served as her
primary motivation for writing this book. She became certain that women in
their mid-thirties to late forties need current, unbiased, reliable information on
perimenopause and menopause written for a layperson.
Thanks to the efforts of her doctor Jane Chihal, MD, a contributor to this
book and a recognized expert on menopause and fertility, Dr. Jones was the
proud mother of two girls ages 6 and 4.
Dr. Jones received her PhD from Southern Methodist University in anthropology. She led many research expeditions in the Middle East and served
as an associate professor of anthropology at the University of Tulsa.
Growing weary of academia, Marcia shifted her career focus and entered the
fast-paced world of software, achieving the rank of chief operating officer and
co-owner of Criterion, a company that developed human-resource software


for Fortune 1000 organizations. She grew Criterion from a $1.5 million company to a $10 million company and recently sold it to Peopleclick. During the
past 18 years, she has written many articles on people in the workforce and
taught courses in the use of human-resource technology as an adjunct professor in the Graduate School of Management at the University of Dallas.
Theresa Eichenwald has extensive experience caring for menopausal women
as an internist at hospitals in New York, Washington D.C., Philadelphia, and,
most recently, Texas. She has taught at Albert Einstein School of Medicine

and Mount Sinai Medical Center in New York.
In addition to teaching and caring for patients, Dr. Eichenwald has authored a
number of articles for professional journals, covering topics such as breast
cancer and ovarian tumors, as well as patient education pamphlets. She is a
member of the American Medical Association, the American College of
Physicians, and in medical school participated in the American Medical
Student Association Task Force on Aging.


Dedication
To David, through all the ages, and to Wilson and Meg, through all the stages.

Author’s Acknowledgments
My work could not have been accomplished without the solid foundation,
wit, and wisdom of the first edition’s authors, the late Marcia L. Jones, PhD
and Theresa Eichenwald, MD.
Special thanks to Leslie Connor and Sandi Kahn Shelton for always, always
being there for me, and to Leslie, Sandi, and to Judy Theiss and the many
other women with whom I spoke for graciously sharing their time and their
own experiences. Thanks, too, to the hundreds of thousands of women who
unselfishly participate every day in health studies and clinical trials that
benefit millions of us. It’s not hot in here after all, but it’s nice to know it’s not
just me.
A huge thank you to Marilyn Allen, who put me in the right place at precisely
the right time.
The terrific Wiley Publishing staff was delightful to work with. Special thanks
to Michael Lewis, who brought me on board and supported my approach to
the book’s second edition. The wonderful support and spot-on advice of my
project editor, Jennifer Connolly, didn’t just make it look easy — with Jenn to
light the way, it really was easy.



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Contents at a Glance
Introduction .................................................................1
Part I: The Main Facts about Menopause ........................7
Chapter 1: Mapping Out Menopause ...............................................................................9
Chapter 2: Talking Biology and Psychology:
Your Mind and Body on Menopause ...........................................................................17
Chapter 3: Fooling Mother Nature: Early Menopause ................................................31
Chapter 4: Getting In Sync with the Symptoms ............................................................41


Part II: The Effects of Menopause
on Your Body and Mind...............................................53
Chapter 5: The Business of Your Bones ........................................................................55
Chapter 6: Getting a Handle on Heart Health ...............................................................79
Chapter 7: Dealing with Vaginal and Urinary Changes ................................................95
Chapter 8: Examining Your Skin and Hair on Menopause.........................................107
Chapter 9: Maintaining Your Sex Life Through Menopause......................................115
Chapter 10: Mental and Emotional Issues ...................................................................129

Part III: Treating the Effects......................................141
Chapter 11: The Basics of Hormone Therapy.............................................................143
Chapter 12: Understanding Hormone Therapy and Your Heart...............................161
Chapter 13: Checking Out Hormone Therapy and Breast Cancer ...........................173
Chapter 14: Reviewing Reproductive Cancers and Hormone Therapy...................185
Chapter 15: Considering Hormone Therapy and Other Health Conditions............197
Chapter 16: Making the Decision about Hormone Therapy .....................................209
Chapter 17: Taking an Alternate Route: Non-Hormone Therapies...........................225

Part IV: Lifestyle Issues for Menopause and Beyond....239
Chapter 18: Eating for the Change ...............................................................................241
Chapter 19: Focusing on Fitness...................................................................................261
Chapter 20: Enjoying a New Lease on Life ..................................................................285


Part V: The Part of Tens ............................................297
Chapter 21: Ten Menopause Myths Exposed..............................................................299
Chapter 22: Ten Medical Tests for Menopausal Women ...........................................307
Chapter 23: Ten Terrific Fitness Programs for Menopausal Women .......................313
Chapter 24: Ten Powerhouse Foods for Menopausal Women ..................................319


Part VI: Appendixes ..................................................325
Appendix A: Glossary ....................................................................................................327
Appendix B: Resources..................................................................................................335

Index .......................................................................343


Table of Contents
Introduction ..................................................................1
About This Book...............................................................................................2
Foolish Assumptions .......................................................................................2
How This Book Is Organized...........................................................................3
Part I: The Main Facts about Menopause............................................3
Part II: The Effects of Menopause on Your Body and Mind ..............4
Part III: Treating the Effects...................................................................4
Part IV: Lifestyle Issues for Menopause and Beyond.........................4
Part V: The Part of Tens.........................................................................5
Part VI: The Appendixes........................................................................5
Conventions Used in This Book .....................................................................5
Icons Used in This Book..................................................................................6
Where to Go from Here....................................................................................6

Part I: The Main Facts about Menopause.........................7
Chapter 1: Mapping Out Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Defining Menopause ........................................................................................9
Getting the terminology right .............................................................10
Approaching the change: Perimenopause ........................................11
Menstruating no more: Menopause ..................................................12
Getting past menopause: Postmenopause........................................12

Anticipating Menopause ...............................................................................13
Transitioning to Menopause.........................................................................13
Starting out............................................................................................14
Identifying symptoms ..........................................................................14
Calling in the professionals .................................................................15
Seeing it through to the end................................................................15
Treating Menopause ......................................................................................15
Promoting Longevity .....................................................................................16

Chapter 2: Talking Biology and Psychology:
Your Mind and Body on Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Setting the Stage.............................................................................................18
Making the Menstrual Cycle and Hormone Connection ...........................19
Surveying the Role of Hormones .................................................................21
Linking your brain and body...............................................................22
Explaining estrogen..............................................................................23
Promoting progesterone......................................................................24
Investigating androgens ......................................................................25


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Menopause For Dummies, 2nd Edition
Understanding the Stages of Menopause....................................................26
Previewing perimenopause.................................................................26
Meeting menopause .............................................................................28
Seeking Out Support ......................................................................................29

Chapter 3: Fooling Mother Nature: Early Menopause . . . . . . . . . . . . .31
Understanding the Lingo ..............................................................................32

Induced menopause.............................................................................32
Premature ovarian failure....................................................................33
Coping with Sudden Change ........................................................................34
Knowing when you hit menopause ....................................................34
Getting the help you need for your body and mind ........................35
Prepping for Surgical Menopause ...............................................................36
Taking Advantage of Assisted Living ...........................................................37
Estrogen alone ......................................................................................37
Combination therapy ...........................................................................38
Alternatives to HT ................................................................................39
Finding Support: Birds of a Feather ............................................................40

Chapter 4: Getting In Sync with the Symptoms . . . . . . . . . . . . . . . . . . .41
Kicking Things Off with Perimenopausal Symptoms ................................42
Getting physical....................................................................................42
Playing head games..............................................................................46
Visiting the Menopausal Symptoms ............................................................48
Figuring out the physical facts ...........................................................48
Discovering that it’s more than skin deep ........................................50
Understanding That It’s Not Your Imagination...........................................51

Part II: The Effects of Menopause
on Your Body and Mind ...............................................53
Chapter 5: The Business of Your Bones . . . . . . . . . . . . . . . . . . . . . . . . . .55
Homing In on Bone Health ............................................................................56
Growing big bones and strong bones ................................................56
Understanding peak bone density .....................................................56
Keeping Pace with Bone Reconstruction....................................................57
Making the calcium connection..........................................................58
Recognizing the role of sex hormones...............................................60

Boning Up on Osteoporosis ..........................................................................60
Linking osteoporosis and women ......................................................61
Defining and diagnosing osteoporosis ..............................................61
Looking at causes .................................................................................63
Avoiding the effects..............................................................................63
Preventing Osteoporosis by Managing Your Risk Factors........................66
Blaming your genes: Genetic factors and family background ........67
Reviewing your personal health history ...........................................67
Looking to your lifestyle......................................................................69


Table of Contents
Finding Out Whether You Have Osteoporosis............................................73
Doing the DEXA ....................................................................................74
Opting for another type of test...........................................................75
Treating Osteoporosis ...................................................................................76
Battling bone loss with medication ...................................................76
Using hormones ...................................................................................77

Chapter 6: Getting a Handle on Heart Health . . . . . . . . . . . . . . . . . . . . .79
Keeping Up with All Things Cardio ..............................................................80
Revealing estradiol’s role in heart health .........................................80
Linking cardiovascular disease and the menopausal woman ........80
Considering Cholesterol................................................................................82
Breaking down the types of cholesterol............................................82
Decoding your numbers ......................................................................83
Looking at the factors ..........................................................................84
Regulating estrogen’s role ...................................................................84
Connecting the dots between cholesterol and
cardiovascular disease ....................................................................85

Understanding Cardiovascular Diseases ....................................................87
Containing coronary artery disease ..................................................87
Avoiding angina ....................................................................................87
Holding off heart attacks .....................................................................89
Fending off hypertension ....................................................................89
Staving off stroke..................................................................................90
Checking Out Your Risk Factors for Cardiovascular Disease...................91
Being Smart about Your Heart......................................................................93
Weighing an ounce of prevention.......................................................93
Treating what ails you .........................................................................94

Chapter 7: Dealing with Vaginal and Urinary Changes . . . . . . . . . . . .95
Understanding the Normalcy of Vaginal and Urinary Changes................95
Talking Shop with Your Doc..........................................................................96
Overcoming Vaginal Changes .......................................................................97
Understanding what vaginal atrophy is and what it isn’t ...............97
Looking at what less estrogen means for your vagina ....................98
Doing something about vaginal atrophy ...........................................98
Talking about Urinary Problems ..................................................................99
Getting a grip on types of urinary problems ..................................100
Tracking urinary-tract infections .....................................................101
Covering interstitial cystitis..............................................................102
Encountering incontinence ...............................................................104

Chapter 8: Examining Your Skin and Hair on Menopause . . . . . . . . .107
Getting the Skinny on Skin ..........................................................................108
Making the skin and hormone connection......................................108
Shining a light on the sun’s dangers ................................................109
Preventing premature skin aging ...............................................................112


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Menopause For Dummies, 2nd Edition
Handling Hairy Issues..................................................................................112
Losing it — your hair, that is.............................................................113
Taking care of your hair.....................................................................113

Chapter 9: Maintaining Your Sex Life Through Menopause . . . . . . .115
Looking at Menopause and Your Libido....................................................116
Letting your feelings be your guide .................................................116
Turning up the heat............................................................................117
Dealing with a lowered libido ...........................................................118
Talking Turkey about Testosterone ...........................................................121
Keeping Sex Sexy..........................................................................................121
Flirting with Fertility ....................................................................................124
Staying fertile after all these years . . ..............................................124
Taking one more chance on the stork .............................................125
Taking the good with the bad ...........................................................127

Chapter 10: Mental and Emotional Issues . . . . . . . . . . . . . . . . . . . . . . .129
Understanding the Mental and Emotional Stresses of Menopause .......130
Finding the link to menopause .........................................................130
Separating menopausal symptoms
from psychological disorders .......................................................131
Deciding Whether You’re Depressed.........................................................131
Understanding the differences .........................................................131
Knowing the signs ..............................................................................133

Dealing with the Head Games.....................................................................133
Knowing the symptoms .....................................................................133
Looking at the research .....................................................................134
Beating the memory game ................................................................135
Straightening Out the Commotions with Your Emotions........................136
Feeling your way through the symptoms........................................137
Understanding the physiology and getting relief ...........................138
Managing life changes........................................................................139

Part III: Treating the Effects ......................................141
Chapter 11: The Basics of Hormone Therapy . . . . . . . . . . . . . . . . . . . .143
Defining Hormone Therapy ........................................................................143
Slaying the symptoms........................................................................145
Preventing serious health problems with hormone therapy .......145
Ticking Through the Therapies..................................................................146
Unopposed estrogen therapy ...........................................................147
Combination therapy .........................................................................149
Selective Estrogen Receptor Modulators (SERMs) ........................151
Prescribing Pills, Patches, and Pomades ..................................................153
Popping pills .......................................................................................153
Pasting on a patch..............................................................................153


Table of Contents
Applying creams ................................................................................154
Slipping on a ring................................................................................155
Searching for Sources ..................................................................................156
Synthetic versus natural hormones.................................................156
Estrogen...............................................................................................156
Progestin..............................................................................................158

Combinations of estrogen and progestin ........................................158
Androgens ...........................................................................................159
Doing the Dosing ..........................................................................................159

Chapter 12: Understanding Hormone Therapy and Your Heart . . . . .161
Meeting the Players: Hormones and Your Heart......................................162
The star: Estrogen ..............................................................................162
The supporting actor: Progesterone................................................163
The assistant: Testosterone ..............................................................163
Understanding the Difference Between Hormones
and Hormone Therapy.............................................................................163
Using estrogen plus progestin ..........................................................164
Taking unopposed estrogen..............................................................165
Identifying the Heart Disease Culprit ........................................................165
Considering the age of menopause..................................................165
Factoring in other factors..................................................................166
Skimming the Fat: Hormone Therapy and Your Blood............................167
Combating hypertension...................................................................167
Cleaning out clots and clogs .............................................................168
Oiling the Pump: HT and Your Heart .........................................................170
Slowing the pace.................................................................................170
Keeping angina away .........................................................................170
Avoiding the big one ..........................................................................171

Chapter 13: Checking Out Hormone Therapy and Breast Cancer . . .173
Beginning with Breast Basics .....................................................................173
Defining Breast Cancer ................................................................................174
Taking Care of Your Breasts........................................................................175
Examining your breasts every month..............................................175
Making time for mammograms.........................................................176

Determining Estrogen’s Role ......................................................................176
Checking the Link between HT and Breast Cancer..................................177
Assessing Your Risks ...................................................................................178
Recognizing risks you can’t control.................................................179
Recognizing risks you can control ...................................................180
Using Hormones as Therapy ......................................................................181
Counting the ways..............................................................................182
Reviewing the risks and benefits......................................................182
Choosing Your HT Regimen .......................................................................183

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Menopause For Dummies, 2nd Edition
Chapter 14: Reviewing Reproductive Cancers and
Hormone Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
Colorectal Cancer.........................................................................................185
Recognizing the signs ........................................................................187
Finding out for sure: Screenings and tests ......................................187
Determining the role of hormone therapy ......................................189
Assessing your risks ..........................................................................189
Endometrial (Uterine) Cancer ....................................................................189
Recognizing the signs ........................................................................191
Finding out for sure: Tests.................................................................191
Determining the role of hormone therapy ......................................192
Assessing your risks ..........................................................................192
Ovarian Cancer.............................................................................................193
Cancers Unaffected by Hormone Therapy ...............................................195

Vaginal and vulvar cancers ...............................................................195
Cervical cancer ...................................................................................196

Chapter 15: Considering Hormone Therapy and
Other Health Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Dealing with Deep Vein Thrombosis .........................................................197
Recognizing the signs ........................................................................198
Determining the role of hormones ...................................................198
Dissecting Diabetes......................................................................................199
Recognizing the signs ........................................................................200
Determining the role of hormones ...................................................200
Facing the Facts about Fibromyalgia.........................................................201
Recognizing the signs ........................................................................201
Determining the role of hormones ...................................................202
Getting the Goods on Gallbladder Disease ...............................................202
Recognizing the signs ........................................................................202
Determining the role of hormones ...................................................203
Thinking about Your Thyroid .....................................................................203
Recognizing the signs ........................................................................203
Determining the role of hormones ...................................................204
Looking at Lupus..........................................................................................204
Recognizing the signs ........................................................................205
Determining the role of hormones ...................................................205
Monitoring Migraines ..................................................................................206
Recognizing the signs ........................................................................206
Determining the role of hormones ...................................................206
Considering Cognition .................................................................................207
Recognizing the signs ........................................................................207
Determining the role of hormones ...................................................207


Chapter 16: Making the Decision about Hormone Therapy . . . . . . . .209
Outlining Attitudes about HT .....................................................................209
Taking Everything into Consideration.......................................................210


Table of Contents
Weighing the Benefits and Risks of HT......................................................212
Rounding up the benefits .................................................................212
Corralling the risks.............................................................................214
Getting to the Heart of Cardiac Health ......................................................214
Going along on estrogen alone .........................................................215
Assessing Your Personal Risk.....................................................................217
Summing Up the Studies .............................................................................218
Presenting the Options for Perimenopause..............................................219
Option 1: The lifestyle solution ........................................................219
Option 2: The herbal solution...........................................................220
Option 3: The HT solution.................................................................220
Quitting HT....................................................................................................220
Recognizing Whether HT Is for You ...........................................................221
Deciding that HT may not be for you...............................................221
Thinking you may be ready for HT ..................................................222

Chapter 17: Taking an Alternate Route:
Non-Hormone Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Weighing the Pros and Cons of Herbs .......................................................226
Considering conventional concerns ................................................227
Seeking safety in herbal therapy ......................................................227
Relieving Your Symptoms with Plants.......................................................228
Cataloging herbal therapies by symptom .......................................228
Getting the scoop on individual herbs ............................................229

Getting Touchy about Acupuncture ..........................................................233
Soothing Symptoms with Mind-Body Therapies......................................234
Tuning in to biofeedback...................................................................234
Getting your yoga groove on.............................................................234
Slip Sliding Away with Topical Treatments...............................................235
Offering Options for Bone and Heart Health ............................................235
Battling bone loss with medication .................................................235
Controlling cardiovascular disease..................................................236

Part IV: Lifestyle Issues for Menopause and Beyond ....239
Chapter 18: Eating for the Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
Eating to Promote Good Health..................................................................242
Getting the right mix of nutrients.....................................................244
Rethinking how you eat .....................................................................248
Eating to Prevent or Contain Problems.....................................................249
Strengthening your bones .................................................................251
Pumping up your cardiovascular system........................................253
Weighing in on the Weight Issue ................................................................254
How much weight is too much? .......................................................254
Eating to control body weight ..........................................................256

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Menopause For Dummies, 2nd Edition
Chapter 19: Focusing on Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
Recognizing the Benefits of Exercise.........................................................261
Tweaking your attitude......................................................................262

Flashing less — sleeping more .........................................................262
Shedding pounds................................................................................263
Keeping your heart healthy ..............................................................263
Shoring up your bones ......................................................................264
Doing without diabetes......................................................................265
Steering clear of colon cancer ..........................................................265
Sharpening your memory..................................................................265
Living long and prospering ...............................................................265
Focusing on Fitness Fundamentals ...........................................................266
Getting started ....................................................................................266
Fitting in fitness ..................................................................................267
Planning your program ......................................................................267
Scheduling fitness fun time ...............................................................268
Flexing through stretching ................................................................270
Warming up and cooling down .........................................................271
Exercises for Women with Osteoporosis ..................................................274
Strengthening bones and toning muscle .........................................275
Adding balance to your routine........................................................280
Exercises to Protect Your Heart .................................................................281
Working on and working up to heart health ...................................281
Walking for fun and fitness................................................................282

Chapter 20: Enjoying a New Lease on Life . . . . . . . . . . . . . . . . . . . . . .285
Going from Menopause to Infinity .............................................................286
Working and Playing Well with Others ......................................................287
Managing a family...............................................................................287
You and your partner ........................................................................288
Caring for aging parents ....................................................................289
Retiring Gracefully (or Not) ........................................................................290
Taking care of your body on the job ................................................290

Looking before you leap ....................................................................291
Finding Your Spirit in Whatever You Do....................................................292
Appreciating the upside ....................................................................292
Seeing things in a new light...............................................................293
Living Happily Ever After ............................................................................295

Part V: The Part of Tens .............................................297
Chapter 21: Ten Menopause Myths Exposed . . . . . . . . . . . . . . . . . . . .299
You’re Too Young to Be Menopausal in Your 30s and 40s ......................299
Menopause Is a Medical Condition That Must Be Treated
with Medicine............................................................................................300


Table of Contents
Menopause Isn’t a Disease, So There’s No Need to See a Doctor ..........301
You Lose the Urge to Have Sex after the Change .....................................302
Irregular Vaginal Bleeding Always Means Cancer ....................................303
Humps Accompany Old Age — End of Story............................................303
Only HRT Can Relieve the Symptoms........................................................304
Women Don’t Need to Worry about Heart Attacks..................................304
Most Women Get Really Depressed During Menopause .........................305
You’ll Break a Bone If You Exercise Too Hard...........................................305
A Blood Test Can Determine Whether You’re
Going Through Menopause .....................................................................306

Chapter 22: Ten Medical Tests for Menopausal Women . . . . . . . . . .307
Pelvic Exam and Pap Smear........................................................................307
Rectal Exam ..................................................................................................308
Colonoscopy .................................................................................................308
Bone-Density Screening...............................................................................309

Mammogram.................................................................................................309
Cholesterol Screening..................................................................................309
Fasting Blood-Glucose Test.........................................................................310
Thyroid Screening........................................................................................310
Ovarian Hormone Screening.......................................................................310
Stress Test .....................................................................................................311

Chapter 23: Ten Terrific Fitness Programs
for Menopausal Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .313
Core Strength Training ................................................................................313
Walking ..........................................................................................................314
Elliptical Training .........................................................................................315
Running .........................................................................................................315
Swimming ......................................................................................................315
Cycling ...........................................................................................................316
Yoga................................................................................................................316
T’ai Chi...........................................................................................................317
Pilates ............................................................................................................317
Water Aerobics .............................................................................................317

Chapter 24: Ten Powerhouse Foods for Menopausal Women . . . . . .319
Soy Joy...........................................................................................................319
Nuts to You....................................................................................................320
Catch of the Day ...........................................................................................320
I Yam What I Yam..........................................................................................321
The Berry Blues............................................................................................321
Flax Flying .....................................................................................................322
Orange You Glad . . ......................................................................................322
Tea for You ....................................................................................................322
It’s Easy Eating Greens ................................................................................323

Yo! Yogurt! .....................................................................................................323

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Part VI: Appendixes...................................................325
Appendix A: Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .327
Appendix B: Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .335
Fabulous Books about Menopause, Health, Fitness, and
Related Issues ...........................................................................................335
Wonderful Web Sites for Women ................................................................337
American Herbalist Guild ..................................................................337
Yoga.com .............................................................................................338
Dietary Guidelines for Americans ....................................................338
FitDay.com...........................................................................................338
National Center for Complementary and
Alternative Medicine Clearinghouse ............................................338
National Osteoporosis Foundation ..................................................339
National Women’s Health Information Center ................................339
North American Menopause Society ...............................................339
Third Age .............................................................................................339
WebMD.................................................................................................340
Women and Cardiovascular Disease................................................340
Women’s Cancer Network .................................................................340
The Study Sites.............................................................................................340
Women’s Health Initiative..................................................................341

The Nurses’ Health Study..................................................................341
Kronos Early Estrogen Prevention Study ........................................341
The Framingham Heart Study...........................................................341

Index........................................................................343


Introduction

W

e wrote this book to give women of all ages a clear view of the physical, mental, and emotional changes related to menopause. For generations, women of all ages have approached menopause without knowing
specifically what it would mean for them. Oh, you probably knew that
menopause and hot flashes go hand in hand, but even that information isn’t
always true. The truth is that you may never have a hot flash, and if you do, it
will probably be years before you’re menopausal. Common knowledge about
menopause is still too often dominated by myth and misinformation. (The
medical community didn’t even officially recognize the link between estrogen
and hot flashes until 1974!)
If menopause only concerned a small group of people on a desert island, this
lack of information might be understandable. But over half of the world’s
population will become menopausal one day. Menopause has been the misfit
family member of the research community for years: a collection of symptoms and a very real phenomenon, but not a disease. Even medical textbooks
pay scant attention to the topic. Today, one group is paying attention to
menopause. The pharmaceutical industry sees great opportunity in the field
of menopause, and more research is underway. If you’re looking for books to
help reasonably intelligent women navigate the journey of menopause, your
options are still somewhat limited to a choice between pretty, glossy pamphlets published by drug companies who may just be a tiny bit biased in
their recommendations, or books that promote the natural aspects of
menopause with such ferocity that you may feel guilty wishing for relief from

troublesome symptoms. If you’re really persistent, you will find some academic articles in medical journals, but your eyes could glaze over as you try to
pick out straightforward answers to your practical questions. We hope this
book can fill that void. Our goal is to help you digest the research so you can
make objective and informed health decisions based on your own experience
with menopause.
Menopause is not a disease — that’s true. No one is going to die from
menopause or its symptoms, but every day, women die from the medical
effects of low estrogen levels. Your risks of certain diseases and cancers rise
after menopause. Some folks may respond to that statement with one of
their own, “Well, that’s because women are older when they go through
menopause.” True again, but it’s also true that estrogen plays a role in an
amazing number of functions in your body, some of which protect your
organs, increase your immunity, and slow degeneration. This transformation
we call menopause impacts our health in very significant ways. This book
helps you understand the story behind the symptoms and the diseases.


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Menopause For Dummies, 2nd Edition
Some women choose to use hormone therapy to relieve symptoms associated with menopause and protect their body from disease. The choice of
whether to take hormones or not is quite controversial because hormone
therapy has its own significant set of risks. The debate goes on in the medical
community and media concerning the risks of hormone therapy. If you’re like
many women, your confusion only grows as you read more on the subject.
Each new study seems to contradict the findings of the last one. You’re an
intelligent person. But how can you know which study you should believe? In
this book, we try to provide enough information to enable you to make
informed decisions about your health.


About This Book
We have no agenda in writing this book. We’re not trying to sell you medications, alternative health strategies, or remedies. This book presents accurate
and up-to-date information from the most credible sources. It contains
straightforward information based on reliable medical studies without the
academic lingo common to medical journals. When no clear-cut answers exist
and when quality research shows mixed conclusions, we let you know.
Everyone’s time is limited, so we cut to the chase. We cover the questions
that are important to you during this phase of your life. If you want more
detail, we provide an appendix full of resources to help with your personal
research. We also try not to stray too far from the topic at hand. For example,
during the years leading up to menopause, women may have difficulty getting
pregnant. The same hormonal changes that cause those annoying symptoms
prior to menopause also stifle fertility. Many women in their late 30s who are
trying to get pregnant rely on hormone supplements. Despite the overlap in
hormonal terms, fertility is not a concern for many women going through the
change, so our discussion is limited.
Whether you’re going through the change, have already been there, or are
about to start off down that road, you’ll find the information you need
between these snazzy yellow and black covers. We cover all the health issues
and therapy choices that confront women during the menopausal years.

Foolish Assumptions
Every author has to make a few assumptions about her audience, and we’ve
made a few assumptions about you:


Introduction
ߜ You’re a woman. (But, believe it or not, your treatment choices can have
implications for the guy in your life, so we’ll talk just a tiny bit about his
health, too.)

ߜ You want to understand what’s going on with your body.
ߜ You’re looking for straight talk for real people as opposed to scientific
jargon and Medicalese (though we have a Medicalese icon to invite you
into short — optional — forays into this territory).
ߜ You want to evaluate your risks of disease as you pass through midlife
and move into your menopausal years.
ߜ You don’t want a book that claims to let you diagnose yourself or figure
out what medications you need. You have a medical advisor to discuss
these things with.
ߜ You want to be able to ask intelligent questions and discuss treatment
alternatives with your healthcare providers.
ߜ You want to feel more confident about the quality of your healthcare.
ߜ You buy every book that has a black and yellow cover.
If any of these statements apply to you, you’re in the right place.

How This Book Is Organized
We’ve organized this book into five parts so you can go directly to the topic
that interests you the most. Here’s a brief overview of each part:

Part I: The Main Facts about Menopause
The journey to menopause often catches women by surprise. You may not
have been expecting to take the journey, or you may have been wondering
when you would begin. In this part, we give you a quick overview of what
your hormones are doing before, during, and after menopause. If you haven’t
thought about things such as hormones and follicles for a while, don’t worry;
we refresh your memory. Your sixth-grade health-and-hygiene course probably never finished the story. In this part, you get the whole story from how
the egg makes its journey from the ovary to the uterus to what happens when
the ovary goes into retirement. We’ve also added a chapter to answer the special questions you may have if you’re among the small group of women who
(through illness, medical treatment, or some other factor) face menopause
more suddenly or much earlier than most women will.


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Menopause For Dummies, 2nd Edition

Part II: The Effects of Menopause
on Your Body and Mind
Want to know how hormones affect the health of your body and mind? You
can find the answers in Part II. We devote each chapter in this part to a specific body part or health issue. In each chapter, you get an overview of how
hormones function in relation to this part of your body and the types of
conditions that can develop, how to recognize them, and what you can do
about them.

Part III: Treating the Effects
You may want to evaluate the pros and cons of hormone therapy (HT) from
time to time during your journey through menopause. This part of the book
brings you up to date on what the medical community knows about HT. We
discuss the effects of HT so that you can make informed decisions. Reading
these chapters provides added benefits as well: You’ll probably find it easier
to evaluate the news about hormone research that comes out in future years.
We also include information about non-HT drugs and alternative treatments.
This will help you make informed decisions on treating menopause symptoms and helping to protect your health during the menopausal years without hormones. You may be one of many women for whom hormone therapy
isn’t medically appropriate, or you may just prefer not to take hormones, or
to take them for as short a period as possible.

Part IV: Lifestyle Issues for
Menopause and Beyond

Part IV is chock full of great ways to stay healthy and enjoy a long and active
life during and after menopause. Staying healthy and active is simpler than
you think. We discuss healthy eating habits and simple ways to stay fit.
Whether you’re looking for natural ways to lower your risk of specific diseases or for ways to slow the aging process, you can find the information you
need right here. We even get into the ways in which this new stage of your life
can be richer and more exciting than any you’ve experienced yet.

Part V: The Part of Tens
If you’re a fan of For Dummies books, you probably recognize this part. These
are short chapters with quick tips and fast facts. In Part V, we debunk ten


Introduction
menopause myths, review ten common medical tests you may encounter,
suggest ten terrific exercise programs for menopausal women, and give you
tips about ten powerhouse foods that will help keep you feeling your best —
now and in the years to come.

Part VI: The Appendixes
A glossary of menopause-related terms and a list of menopause-related
resources cap the book.

Conventions Used in This Book
We use our own brand of shorthand for some frequently used terms and
icons to highlight specific information.
As you read this book, you’ll discover that menopause is a process, with different stages characterized by similar symptoms. These stages are referred
to as perimenopause, the three to ten years prior to menopause when you
may experience symptoms; menopause itself, which you know you’ve reached
only after you’ve reached it because the definition of menopause is the
absence of periods for a year; and postmenopause, which is your life after

you’ve stopped having periods. In this book, we use perimenopause to describe
the premenopause condition, and we use menopause to refer to everything
after that just because the term postmenopause isn’t commonly used.
A major part of this book — the whole of Part III as well as sections in other
chapters — talks about hormone therapy (HT), which is used to alleviate
symptoms and address health concerns prompted by menopause. In literature and on Web sites, you can see hormone therapies referred to and abbreviated any number of ways, including hormone replacement therapy (HRT)
and estrogen replacement therapy (ERT). But we stick pretty closely to using
HT because we feel that it’s the most inclusive and accurate term. Just be
aware that HT means essentially the same thing as HRT.
And, speaking of hormones, a couple of the more important ones for
menopausal women have several subcategories:
ߜ Types of estrogen include estriol, estradiol, and estrone.
ߜ Progesterone is the class of hormone; the form used in hormone therapy is often referred to as progestin.
We sometimes use these terms interchangeably and only refer to the specific
hormone as necessary for clarity.

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