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Why me? Why have the years when I was having children been so well orchestrated for the preservation of the species, only to leave me feeling like this? When I see my doctor, my first thoughts are “What has happened to my memory, why am I gaining weight, why is my skin drying up, what is bone loss, why is intercourse painful, in fact why do I not care for sex at all and why do I go from urinary tract infection, to vaginal yeast infection, to other infections around my vagina, and then back to urinary tract infection? What are these bursting moments of hot flashes, why do my moods swing so widely, and what are these new awkward aches? Why does my doctor talk to me about my cardiac risks when fear of breast cancer is my mountain to climb, and what are my options for management of these problems? If my doctor talks about hormonal management, I am really confused regarding what are bioidentical hormones, should I go on hormones and for how long, and what are the differences between the estrogen patch and the pill?”

These are some of the questions that women from the ages of 40 years to 70 years bring to the primary care physician’s and gynecologist’s office each day. Are these women looking for a cure? Are they looking to understand what is happening to their bodies? In general, yes. For most of them, when presented with current information regarding the biology of menopause, they are willing to accept the fact that this is just another phase of a normal life. Yet it is the obligation of the primary care physician and gynecologist to help women find solutions for these issues.

What is clear is that the term, menopause, once considered that one year in which a woman no longer has a menstrual period, today is thought of as a more comprehensive and lengthy part of life . We now understand that changes in hormonal production from the ovaries usually begins between years 40 and 45 leading to the mean age of 51 years for that final menstrual period. More importantly, that one year without menstruation is only part of a process extending from around 40 years to 70 years. In that period of nearly 30 years, scientists have helped us to understand that there are specific biological events that explain most of the symptoms that women describe, including mood swings, hot flashes, pain of intercourse, loss of libido, skin dryness, changes in bone structure, breast cancer risk, cardiovascular health, and aging.

Over the next many months, we will provide short discussions regarding aspects of the menopause transition. To accomplish this task, we will be drawing from information generated by scientists in this field, since it is now clear that our current and future knowledge of the symptoms women encounter in this phase of their lives can be explained by specific biological events. And it is alterations in these same biological events that encourage us to return to the basic roles of hormones in the body, how these hormones change as the menopause transition is approached, and how the benefits and risks of the many options for hormonal management participate in the care of women’s health. We look forward to your input and questions regarding this important aspect of life and hope that you will enjoy our discussions.

James Woods | 8/1/2014

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