FSM 314	DO/TS
A Positive Change! Research on Menopause!

Tips to Help You Go Through the "Change of Life" Victoriously!

Copyright © 1997 by The Family -- June 1997

TABLE OF CONTENTS

	Introduction	2
	Unveiling Its Secrets	4
		Gaining a Better Understanding	4
		Coping with Menopause	6
	What Diet Is Best?	9
	Menopause Basics (How Do I Know If I've Started Menopause?)	10
	Menopause: Signs of the Times	12
	Who Wants to Be Forever Young?	13
	Menopause: 21 Ways to Stay Symptom-Free	13

Introduction by Chloe (WS)
	Are you a woman nearing the fabled 40-year mark, knowing that something called menopause will be happening sometime in the next 10 or so years and wondering what it will be like? Will you experience radical mood changes? Will you or others at this age whom you know suddenly need more rest? Or maybe you've had the alarming thought, "Is there sex after 50?"
	As a woman who's nearing 50, I had many of the same questions. When my body began to do funny things a few years ago, and I began to experience hot flashes and insomnia regularly, I wondered if I was going through menopause. It was a big help to me to read information about it that had been sent to WS. Although not all of it was faith-based, it was encouraging for me to see that I wasn't going crazy imagining things, but that I was experiencing what millions of other women my age feel. Having a better understanding of what my body was doing was a relief! And as I have prayed about these changes, and gotten prayer from my sweet Home members, the Lord has been so faithful to help me with any difficulties or adjustments. Thank the Lord! He's so good to us!
	With the help of Mary Mom, Sharon and others in WS, I've been able to compile some FSMs of both System material and personal testimonies, in the hope of making things easier for you or helping you to better understand someone you know who is going through this often big adjustment in their lives. The System information is drawn from booklets on health, sent to WS, from articles on the Internet, and from medical books and CDs. A team of us here in WS worked on editing it, and prayed about whether it was the right thing to give the Family.
	In addition, a group of us asked the Lord for insight and encouragement for our women going through this stage in their lives, as well as for their mates and others in their Homes. After reading material from so many System experts, it was wonderful to hear this very encouraging and faith-building counsel from the Expert of all experts! You'll find these messages from the Lord in the GNs of menopause prophecies (GN 738 and 739).
	When selecting articles for the FSMs of System material, we looked for ones that present the facts from a positive perspective. The medical establishment usually recommends taking the hormone estrogen during menopause. As women get older, our bodies produce less and less of this hormone. The lack of estrogen is often what causes the troublesome menopause symptoms. However, as there are definite downsides to using estrogen replacement therapy, we wanted to find as many natural remedies and helps as possible.
	I knew that the Lord wouldn't want any of us to fear or worry or even expect that all the difficult symptoms of menopause would happen to us. So I pray that no one becomes fearful from reading about what might happen or could happen, but rather that this material gives you insight as to what is going on and that it helps you take these things to the Lord.
	There's lots about menopause that is not fully understood and which there are varying opinions about. So it's also good to remember that some of what is included in this compilation of System info may be someone's personal opinion and not necessarily corroborated by others. As a reminder of what comes from a System author, and not from WS or anyone in the Family, I've tried to always give the source of the articles or bits of information, when available.
	When reading this FSM of System counsel, it is important to remember to balance it with the faith-building prophecies in the menopause GNs, as well as His Words to you personally. I've found that it's such a wonderful blessing and help to have His direct and personal leading and comfort through this time of change. So to begin this FSM, I'd like to share a short excerpt of the prophecies received about menopause, published in GN 738. In this one, Jesus explains how to look at the System information shared here.

	(Jesus speaking:) I say unto you regarding the counsel that is given in these pubs: Every situation must be judged on its own merits. Wisdom is the ability to apply knowledge to the current situation. These things [in your body] are all in a fine balance, like a watch, ticking carefully, with each part dependent upon the various jewels, springs, screws and workings within the watch. It is all balanced very carefully, so that the watch ticks properly at the right intervals to keep the proper time.
	So is your body and so are your emotions, and so are your hormones. So are your reactions to these things -- your spiritual reactions and your emotional reactions. It is all in a very fine, delicate balance, and it can be easily knocked off balance by an emotion, by a hormone, by a thought, by a fear, by a worry, even by a concern.
	Therefore, the most important thing is to look to Me and to stay calm and realize that I am the Prince of Peace. Remember that great peace have they which love Me. To claim your peace, the most important thing is to keep your eyes upon Me. The second most important thing is to take the various points of information given in your pubs [on health and menopause] and decide which apply to you.
	For there are many views and many attitudes that apply to many different situations. Each clock works slightly differently, and is built with a different set of springs and a different set of screws and a different set of parts. Though they all tick the same, and though they all perform the same function, yet each one is balanced slightly differently, depending upon your make-up, how I made you. It also depends on how you have lived your life and how you have taken care of your "watch." But nevertheless, all of these things are in My hands.
	Therefore, take these different points of knowledge and apply them correctly in a just balance and with a just weight. Ask Me for wisdom and decide whether this applies to you or whether it doesn't. For many things will not apply, but some things will apply. It is up to you, for this is what I am teaching you in this stage of your life -- the wisdom of how to apply knowledge to your own circumstances and to your own situation.
	Take the good and eschew that which does not apply to you. Use that which does apply, tempering it with wisdom, bringing it before Me in prayer and asking Me to show you what applies in your particular situation and what doesn't apply.
	For even as childbirth is easy for some women and they tell others that births are easy, and then with others it is more difficult, so it will be with this. It will be different for each one. Therefore you cannot necessarily rely on the counsel of others. You must take in what they have to say, but remember that you must pass it through My filter.
	In other words, don't take in all the fears, phobias and worries that come along with the counsel. Don't let those go through the strainer. Simply take in the facts, and bathe it all with My Spirit, with My peace.
	As I have said many times, fear is one of the main devices of the Enemy of your soul, who wishes to get you off balance. But I do not get you off balance. The wisdom that comes from Me is pure and peaceable, full of mercy -- that is, it has mercy on you, it loves you, it understands you. It doesn't knock you off balance, and it bears good fruit.
	Therefore, this is what I am teaching you in this stage -- how to apply knowledge with wisdom, bathed within the framework of peace, held within the bubble of peace and stability, to teach you how to stand upon the waters. (End of prophecy excerpt, GN 738, ML #3127:78-87.)
		Many thanks to those of you who have sent in testimonies, tips, or literature related to menopause. We'll be including more in upcoming FSMs, DV! And if you have an encouraging lesson or helpful point to share, please send it in so that we can all learn with you! God bless you and help you have a happy "change." The Lord has told us it can herald the most fruitful time in your life ever!
	Lots of love,
	Chloe
	P.S. The first article below is by the Jehovah's Witnesses, who often write about health and nutrition in their magazine Awake! It's a helpful basic summary, and most of what is said here is echoed by doctors and other experts.

* * *

Unveiling Its Secrets
Excerpts of an article from Awake! February 22, 1995)
	As women age, menopause is an occurrence in their lives. Yet, it has been greatly misunderstood.
	Magazines, newspapers, and books are focusing on menopause, providing explanations for questions that some were once embarrassed to ask. The medical profession, too, is more informed on the problems women may encounter.
	Why all the attention to this subject? Because a better understanding of menopause can remove the fears, the superstitions, and the frustrations that many women have. Women in many countries are living longer, and they want to break what has seemed to be a conspiracy of silence on the subject and to be informed. They want simple, straightforward answers. Rightfully so, since many of them have over one-third of their life to live after menopause.
	Such women desire to know about the health risks, the hot flashes (also called hot flushes), the mood swings, the discomforts, and the physical and emotional changes. Why do these things happen? Does a woman's productive life finish at menopause? Does menopause alter a woman's personality? The following articles will examine these questions.

Gaining a Better Understanding
	"I wouldn't say it's such a pleasant period in a woman's life," admitted one woman who had passed through menopause, "but I think you can learn from it. I have learned how to respect my limits. If my body needs to have a little more care or rest, I listen and give it the respect it's due."
	Many women have reported that "not knowing what to expect" was the worst thing about menopause. However, women who came to understand menopause to be a natural transition felt "less anxious, depressed, and irritable and more hopeful about their lives."

What It Is
	Webster's Ninth New Collegiate Dictionary defines menopause this way: "The period of natural cessation of menstruation occurring [usually] between the ages of 45 and 50." Menopause has also been identified arbitrarily as the final cessation of menstruation.
	With some women, the end of menstruation happens suddenly; one menstrual period finishes and another never occurs. For others, the periods become erratic, occurring at intervals of three weeks to several months. When one full year passes without a woman experiencing a period, she can reliably conclude that menopause occurred at the time of her last menstruation.

When and Why It Occurs
	Inherited disposition, illness, stress, medications, and surgery can influence the time of occurrence. In North America the average age when menopause occurs is about 51. The time of occurrence generally ranges from the early 40s to the mid-50s and rarely earlier or later.
	At birth a woman's ovaries contain all the eggs she will ever have, several hundred thousand in number. During each menstrual cycle, from 20 to 1,000 eggs mature. Then one, or occasionally more than one, is released from the ovary and is available for fertilization. The other mature eggs wither away. Also, in concert with the process of egg maturation, the levels of estrogen1 and progesterone2 hormones regularly increase and decrease.

	1 es·tro·gen also oes·tro·gen (ès¹tre-jen) noun
		Any of several steroid hormones produced chiefly by the ovaries and responsible for promoting estrus and the development and maintenance of female secondary sex characteristics.
	2 pro·ges·ter·one (pro-jès¹te-ron´) noun
		A steroid hormone, C21H30O2, secreted by the corpus luteum of the ovary and by the placenta, that acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of the mammary glands.

	As a woman passes her late 30s, the levels of estrogen and progesterone start to decline, either gradually or erratically, and egg release may no longer occur with every cycle. Menstrual periods become less regular, usually occurring at longer intervals; menstrual flow changes in pattern, becoming lighter or heavier. Eventually no further eggs are released, and the menstrual periods stop.
	The final menstruation is the culmination of a process of changes in hormone levels and ovarian function that may have taken up to ten years. However, smaller amounts of estrogen continue to be produced by the ovaries for 10 to 20 years after menopause. The adrenal glands and fat cells also produce estrogen.

Significant Changes in Life
	Tissues sensitive to or dependent on estrogen are affected as the estrogen level declines. Hot flashes are thought to result from hormonal effects on the part of the brain responsible for regulating body temperature. The exact mechanism is unknown, but it seems that the body's thermostat is adjusted downward so that temperatures previously felt to be comfortable suddenly become too warm, and the body proceeds to flush and perspire to cool itself.
	In her book, The Silent Passage -- Menopause, Gail Sheehy notes: "Half of all women who have hot flashes will begin feeling them while they are still menstruating normally, starting as early as age forty. Studies show that most women have hot flashes for two years. One quarter of women have them for five years. And 10 percent have them for the rest of their lives."
	At this time of a woman's life, vaginal tissues become thinner and less moist as estrogen levels decline. Other symptoms women experience, says Gail Sheehy, can include "night sweats, insomnia, incontinence, sudden bouts of waistline bloat, heart palpitations, crying for no reason, temper outbursts, migraines, itchy crawly skin, [and] memory lapses."

Periods of Depression
	Does the decrease in estrogen cause depression? This question has been the topic of much debate. The answer seems to be that it does in some women, such as those who had mood swings prior to their menstrual periods and those who suffer sleep deprivation as a result of night sweats. Women in these groups seem to be very sensitive to the emotional effect of hormonal fluctuations. According to Gail Sheehy, these women usually "experience great relief when they reach the postmenopausal period" and hormone levels stabilize.
	The severity and the type of symptoms experienced vary considerably from one woman to another, even among women related to one another. This is because hormone levels differ from one woman to another, and decline at varying rates. In addition, women bring differing emotions, stresses, coping abilities, and expectations with them as they approach menopause.
		The time of menopause often coincides with other stressful circumstances in a woman's life, such as caring for aged parents, entering the work force, seeing children grow up and leave home, assuming new responsibilities, and other mid-life adjustments. These stresses may cause physical and emotional symptoms, including memory loss, attention deficits, anxiety, irritability, and depression, which may be erroneously attributed to menopause.

A Stage of Life
	Menopause is not the end of a woman's productive life -- only of her reproductive life. After a woman's last menstrual period, her moods are usually more stable, not fluctuating with monthly hormone cycles.
	Puberty, pregnancy, and childbirth are also times of transition attended by hormonal, physical, and emotional changes. Menopause, then, is the last, but not the only, time of hormonally induced changes in a woman's life.
	Thus, menopause is a stage of life. "Perhaps," wrote a former editor in chief of the Journal of American Medical Women's Association, "people will stop viewing menopause as a crisis, and see it more appropriately as `yet another change.'"
	Reassuringly, the book Women Coming of Age says that the end of a woman's fertility "is as natural and inevitable as was its preordained beginning. Arriving at menopause is actually a sign of physical health -- a sign that [her] body's inner clock is humming along."
	What, though, can be done to make the transition as smooth as possible? And how can a spouse and family members be of support during this transition in life? Let us consider these matters.

Coping with Menopause
	Menopause is "a uniquely individual experience" and "the beginning of a new and liberating chapter in your life," say the authors of Natural Menopause -- The Complete Guide to a Woman's Most Misunderstood Passage. Research shows that the better you feel about yourself and your life -- your own sense of worth and identity -- the easier the transition will be.
	Granted, it is more difficult during this time of life for some women than for others. If you are having difficulties, this does not mean that you have self-esteem problems or that you are losing your mind, your femininity, your intelligence, or your interest in sex. The problem, rather, is generally biological.
	"Even women who suffered terrible symptoms during menopause say they emerged on the other side with a new sense of purpose and vigor," reports Newsweek. In the words of one 42-year-old: "I'm looking forward to the calm, to having my body quit playing tricks on me."

When Women Cope Better
	How older women are viewed is an important factor in how well they cope with menopause. In places where their maturity, wisdom, and experience are valued, the menopausal time is attended by far fewer physical and emotional ailments.
	For example, The Woman's Encyclopedia of Health and Natural Healing reports that in African tribes "where menopause is embraced as a welcomed passage in life, and postmenopausal women are respected for their experience and wisdom, women rarely complain of menopausal symptoms." Similarly, The Silent Passage -- Menopause says: "Indian women of the Rajput caste do not complain of depression or psychological symptoms" during menopause.
	In Japan, too, where elderly women are highly respected, hormone treatment for menopause is virtually unknown. Further, Asian women apparently have fewer and less severe symptoms of menopause than those of Western culture. Their diet appears to be a factor that contributes to this. (Editor's note: Tofu, soybean curd, a mainstay of the Asian diet, contains a vegetable form of estrogen, thus it appears it is very helpful to eat during menopause. See "Tofu and Menopause," WND 502.)
	Maya women actually looked forward to menopause, according to the studies of one anthropologist. To those women the menopause meant relief from continuous child-bearing. Undoubtedly, it also brought them freedom to pursue other interests in life.
	At the same time, the fears associated with menopause should not be lightly dismissed. In cultures that stress the value of youth and youthful appearance, women who have not yet experienced menopause often fear it. For such individuals, what can be done to alleviate the difficulties of transition?

What Women Need
	Janine O'Leary Cobb, author and pioneer of menopausal education, explains: "What a lot of women need is some sort of validation for the way they are feeling -- that they are not alone."
	Understanding, as well as a cheerful outlook, is vital. One 51-year-old mother going through menopause said: "I honestly believe that it's your general outlook on life that will guide how you go through menopause. ... I know aging is there. Whether or not we like it, it is going to happen. ... I decided that this [menopause] is not a disease. This is my life."
	So as this new chapter in your life approaches, make time for deep reflection on new, challenging interests. Not to be overlooked are the physical effects of menopause on the body. Doctors and other authorities recommend following general principles of good health in preparing for the transition -- wholesome food, sufficient rest, and good exercise.

Diet and Exercise
	The need for nutrients (proteins, carbohydrates, fats, vitamins, minerals) does not decrease as a woman gets older, but her need for calories decreases. It is important, therefore to eat foods that have a high concentration of nutrients and to avoid sugary, fatty foods that are "empty calories." (Note: See dietary suggestions in the article "What Diet Is Best?" on page 9.)
	Regular exercise enhances the ability to cope with stress and depression. It increases energy and helps keep weight off. The basal metabolic rate gradually declines with age, and unless boosted by exercise, the tendency is to gain weight gradually.
	It is most important for women to know that exercise combined with calcium supplementation can slow the development of osteoporosis, a bone condition producing porosity and fragility. The book Women Coming of Age states that "properly performed studio aerobics, walking, running, cycling and other aerobic sports" are thought to be especially good. Interestingly, osteoporosis is not found in certain remote communities where people remain physically active far into their old age. In such places women routinely live well into their 80s and 90s.

Coping with Hot Flashes
	For most women, hot flashes are a nuisance. For some, though, these become a real problem because either they are very frequent or they constantly disrupt sleep. What can be done?
	First of all, don't panic. Adding anxiety to the situation will only worsen it. Regular vigorous exercise is beneficial because it helps the body learn to cope with excess heat and to cool down more quickly. Also try the simple measure of drinking a glass of cold water or placing your hands in cold water.
	In addition, make a practice of wearing loose clothes in layers so they can easily be removed or added. Cotton and linen allow perspiration to evaporate better than synthetic fabrics. At night try the layered approach, with several blankets that can be individually added or removed as needed. Keep a change of sleepwear close at hand.
	Try to determine what seems to precipitate your hot flashes. Consumption of alcohol, caffeine, sugars, or hot or spicy foods can trigger them, as can smoking. Keeping a diary of when and where hot flashes occur may help you identify the food and activities that precipitate them. Then avoid these things.
		Physicians that specialize in nutritional medicine recommend various remedies to reduce hot flashes, such as vitamin E, evening primrose oil, and the herbs ginseng, dong quai, and black cohosh. (Editor's note: Although we haven't tried these herbs, they are the ones suggested by most herbalists for relieving difficult menopause symptoms. So if available where you are, they might be worth a try.)
	Vaginal dryness can be remedied by the application of vegetable or fruit oils, vitamin E oil, and lubricant gels.

What about Stress?
	At the same time that a woman must deal with the hormonal and physical changes that come with menopause, she often must face other stressful events at this time in her life, such as her children leaving home, etc. On the other hand, positive things like the birth of a grandchild or the pursuing of new activities after the children have grown up can counterbalance negative stress.
	In their book Natural Menopause, Susan Perry and Dr. Katherine A. O'Hanlan give some practical suggestions for handling stress better. They point to the need of identifying the sources of stress and then taking a break from time to time. This may mean getting help in caring for a chronically ill family member. "Pace yourself," they urge. "Try to avoid overscheduling. ... Listen to your body." They add: "Providing a service to others ... can be a great stress-reducer. ... Exercise regularly. ... Seek help if the stress in your life gets out of control."

Family Members Can Help
	A woman experiencing menopause needs emotional understanding and practical support. Describing what she would do when beset with periods of anxiety, one wife said: "I would talk matters over with my husband, and after his sympathetic understanding, I would see that the problems weren't as big as my anxious state of mind made them."
		(Note from Chloe: This section is addressed to husbands and children, however, the tips given here could be helpful for any Family members. As a single woman, I found that the prayers of loved ones in my Home made such a huge difference during menopause difficulties -- whether a roommate, work-mate, sharing partner or someone just passing down the hall, ha! It's so helpful and encouraging to feel that others are not condemning or judging you, but that they do understand and are praying for you and supporting you through this transition. Thank God for our Family!)
	A sensitive husband also recognizes that his wife will not always be able to keep the same pace while going through menopause. So he will be alert to take the initiative to assist with family responsibilities, perhaps doing the laundry, shopping for food, and so forth. Compassionately, he will put his wife's needs ahead of his own (Philippians 2:4). He might suggest going out for a meal occasionally or in some other way make a pleasant break in the daily routine. He will avoid disagreements as much as possible and support her efforts to maintain healthy eating habits.
	Most of all, a husband will fulfill his wife's need to be regularly reassured of his continued love for her. He should be discerning and should recognize that this is not a time to tease his wife about personal things. A husband who treats his wife in a loving way is following the Scriptural admonition to "dwell with [her] according to knowledge, giving honor unto the wife as unto the weaker vessel" (1Peter 3:7).
	Similarly, children should make a genuine effort to understand the reason for their mother's emotional swings. They need to recognize her need for private time. Exhibiting sensitivity to their mother's moods will send a reassuring message that they really care about her. On the other hand, joking about her unpredictable nature will only aggravate the situation. Ask appropriate questions to understand better what is going on, and help with household duties without being asked. These are but a few ways to give a mother support during this stage in her life.

Life After Menopause
	The wisdom and experience a woman has gained at this age is priceless. Author Gail Sheehy's studies of "sixty thousand adult Americans established that women in their fifties, by self-report, had a greater sense of well-being than at any previous stage in their lives."
	Yes, many women who have gone through these transitional years find renewed spirit. Their creativity is revitalized. They get on with living, involving themselves in productive activity. "I keep my mind active. I keep looking into new things and studying," said one woman who is past menopause. She added: "I may be a little slower, but I don't feel that this is the end of my life. I'm looking forward to many more years."
	Significantly, in interviewing women, Sheehy found that those "who enjoy a boost of postmenopausal status and self-esteem are those who perform roles in which intellect, judgment, creativity, or spiritual strength is primarily valued." There is a throng of such women who are happily devoted to expanding their knowledge of the Bible and are teaching others its worthwhile values.
	Besides keeping a positive outlook on life and performing meaningful work, women of all ages are wise to remind themselves that our loving Creator knows our feelings and truly cares for us (1 Peter 5:7).

* * *

What Diet Is Best?
	The following suggestions are from the book Natural Menopause -- The Complete Guide to a Woman's Most Misunderstood Passage, by Susan Perry and Dr. Katherine A. O'Hanlan. Some additional explanations on nutrition from the book Pregnant and Beautiful and other sources are summarized in editor's notes.

Protein:
	* Reduce your protein intake to no more than 15 percent of your total caloric intake. (Editor's note: The book "Pregnant and Beautiful," as well as other sources on nutrition, explains that protein is a major nutrient and important food group, but protein foods are often also high in fat and contain concentrated sources of extra calories. Poultry and fish are lower in fat content than beef, pork or lamb. Plain, fresh or frozen meats are preferable because they are lower in additives, fats and preservatives than processed luncheon meats, most canned meat, processed ham and frozen dinners in sauces.)
	* Get more of your protein from vegetable sources (such as tofu, miso, soybeans and other beans, nuts, peanut butter, sunflower seeds, etc.) and less from animal sources.

Carbohydrates:
	* Eat more complex carbohydrates, such as whole grains (breads, flours, cereals), pastas, wheat germ, dried beans and peas, nuts, brown rice, potatoes in their skins, vegetables, and fruits.
	(Editor's note: Refined and/or simple carbohydrates, like white bread, white rice, sugars, refined cereals, cakes, cookies, etc., are nutritionally weak, supplying calories but little more. However, unrefined and/or complex carbohydrates such as those listed above supply essential B vitamins, trace minerals, protein and important fiber.)
	* Eat less sugar and fewer foods containing large amounts of sugar.
	* Eat more food rich in fiber.
	(Editor's note: Fiber is the material that surrounds and supports the cell walls of plants. It has a noticeable effect on the digestive tract and elimination. High-fiber food choices are green and yellow vegetables [raw, with skins, or lightly cooked], fresh fruits, wheat germ, bran, whole grain breads and cereals, beans and peas, seeds and nuts.)

Fats:
	* Reduce your total fat intake to no more than 25 to 30 percent of your total calorie consumption.
	* As you decrease your total fat intake, increase the ratio of "good fats" (polyunsaturated, monosaturated) to "bad fats" (saturated).
	(Editor's note: Saturated fats, so-called bad fats, are fats from animal sources [such as butter, chicken fat, beef drippings, lard], or hardened, hydrogenated, vegetable fats [where an unsaturated oil is combined with hydrogen to produce a solid fat, as in many forms of margarine]. Examples of good fats are olive oil, canola oil, and polyunsaturated vegetable oils.)
	(Note from Chloe: With all the talk about fat these days, did you ever wonder what the difference is between "good fats" and "bad fats"? Microsoft's Encarta Encyclopedia on CD explains it like this: "When saturated solid fats are added to the diet, the amount of cholesterol in the blood increases, but when liquid, unsaturated fats or oils [particularly the polyunsaturated type] replace solid fat, the amount of cholesterol decreases. High cholesterol levels in the blood appear to promote the deposition of hard, fatty materials in the arteries, causing the arteries eventually to clog. When the coronary artery around the heart becomes clogged in this manner, blood supply to the heart is interrupted and a heart attack occurs."
	(Scientists don't understand all there is to know about why fat and cholesterol cause these problems, but it does appear that some types of heart disease are caused by too much fat in the diet.)

Water:
	* Drink six to eight eight-ounce glasses of water each day. (Editor's note: The "Family Medical Doctor" CD [The Creative Media Corp.] says, "While your body may require about eight glasses of liquid a day, this represents the intake from all sources, not merely water. Juices, milk, soft drinks, even the fluids contained in food all contribute to the total amount. Most people only drink about two to three glasses of water a day, and that may be just enough to make up all that is required. Besides, trying to add more water than is needed can give you a full feeling that prevents you from consuming all the nutritious foods you should be eating now. In addition, too much water will keep you running to the bathroom more than you might wish.")

Vitamins and Minerals:
	* Eat a variety of vegetables and fruits each day.
	* Milk and other dairy products [preferably low-fat, such as skim milk, low-fat cottage cheese and yogurt], tofu, canned fish with bones like sardines or salmon, cooked dried beans, oranges, molasses, shelled almonds, turnip greens, broccoli, and other green leafy vegetables are good sources of calcium.

* * *

Menopause Basics (How Do I Know If I've Started Menopause?)
-- By Barbara Hvilivitzky Taken from femme, published monthly by Barbara Hvilivitzky. Courtesy of Women's Connection Online, McLean, Virginia.
	Before we can begin our journey through this exciting phase of our lives, let's define what menopause is. Simply put, it's the end of menstruation. But as most of us know, it's not "simple" at all.
	The years leading up to the end of menstruation are what concern most of us. These are the years when our bodies begin producing less of the hormones needed for ovulation, conception and menstruation. For about 15% of women, monthly periods gradually become fewer and farther between and then just end. Hooray!
	For others, the gradual hormone loss is not as gradual, as in cases of "surgical menopause" brought on by the removal of the ovaries (whether the uterus is removed or not). These women are thrust into the world of menopause overnight and may experience the sudden onset of hot flashes, changes in lubrication during intercourse, changes in mood (usually not for the better!), lessening of sexual drive, and sleep disturbances among others.
	For most of us, however, these symptoms let us know over a much longer period of time that our middle years are going to be interesting, to say the least!
	Let's look closer at the process of gradual hormone loss. The hormones involved are estrogen, progesterone (both produced by the ovaries), also follicle stimulating hormone (FSH) and luteinizing hormone (LH) which are produced by the pituitary gland. Another hormone, further up the line in the hypothalamus, sends FSH and LH to stimulate the ovaries to produce their hormones, estrogen and progesterone.
	These four hormones do a little dance each month -- one drops, another increases, which causes another to decrease, which causes the first one to increase again, and round and round it goes. Of course, the process is much more complicated than that, but for now just realize that like most hormonal activity in our bodies, the activity of these four is a cycle repeated month after month until midlife.
	Estrogen is responsible for menstruation because it causes the buildup of the lining of the uterus each month. Progesterone is responsible for preparing the uterus lining for implantation of a fertilized egg. If a fertilized egg is not implanted in the lining which the progesterone has made all nice and cozy, the progesterone "gives up" and its level drops sharply. The lining begins to shed and you have a period.
	Your monthly cycle chugs along like this year after year until: During midlife (the exact timing is very specific to each woman and can vary widely), the hormones we've talked about are produced in lower quantities. Because they and others like them are responsible for many functions in our bodies, we can begin to have symptoms of menopause.
	Many women ask, "How will I know if what I'm feeling is the start of menopause?" This is a simple question, but there is no simple answer. It's hard to know if we are just getting older, or if what we feel is a menopause symptom. Some health writers, like Sandra Coney who wrote The Menopause Industry: How the Medical Establishment Exploits Women, insist that the only genuine symptoms of menopause are hot flashes and vaginal dryness.
	She says that hot flashes (also called night sweats) are bound to disturb sleep and can cause many of the other effects women may feel, such as irritability or depression. She says vaginal dryness can cause discomfort during intercourse and thus may cause women to avoid sex -- which in turn fuels the reports that indicate a loss of sex drive in pre-menopausal women.
		Other writers and researchers list many symptoms, such as changes in menstruation, hot flashes (or night sweats), skin aging, loss of sex drive, offensive menstrual odor, memory loss, changes in eyesight, tingling of the skin, backache, emotional upheavals, vaginal dryness, disturbed sleep patterns, and headaches. There is a definite struggle going on between what women feel and what we're told we feel (or should feel), and why we feel it!

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Climacteric and Menopause
-- By David L. Hoffman, M.N.I.M.H.
	Menopause = the cessation of menstruation and the termination of fertility. These two are not the same thing, and may occur at different times.
	Climacteric = a transition phase that lasts for 15-20 years during which ovarian function and hormone production decline and the body re-adapts. Menopause is one event within this process.

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	While the controversy rages, women look for an answer to the original question: "How will I know if I'm starting menopause?"
	If you are over 40 and have experienced any or all of the symptoms listed above, you should consider the possibility that they are related to the pre-menopause phase. It can't be emphasized strongly enough that even though all women eventually go through menopause, each and every one of us will have different experiences. There is no right or wrong, it's not all in your head, you don't have to feel guilty because none of the midlife women in your family are "suffering," you don't have to make excuses for yourself, and you don't have to hide what you feel!

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Menopause: Signs of the Times
-- By Barbara Hvilivitzky
	Change in the menstrual cycle seems to be one of the first signs that menopause may be on the horizon, and this "symptom" is often one of the most bothersome. For some of us this is a long process that can begin when we turn 40. Others may not notice any change until they are almost 50.
	Before we talk about "change," let's look at what's average and what's normal in menstrual cycles.
	Many of us can get confused when we hear that a 28-day cycle is average. We need to realize that 28 days is the average because it is a statistical average, taken years ago, of cycle lengths of thousands of women which was then divided by the total number of those women. If 50% of women had 15-day cycles and 50% had 41-day cycles, the average would be 28 days, yet none of the women would have had a 28-day cycle. So wherever you fit on the average scale, as long as it's usual for you, is fine.
	That brings us to what's normal. Again, each woman must judge for herself if her periods are not what she normally experiences. For example, if your periods are further apart than they usually are, you could say your cycle was not normal -- normal for you, that is. Or if your periods became much heavier and closer together, you could say the bleeding pattern was not normal -- normal for you!
	Some women skip periods altogether, once in a while. This happens because your ovaries don't release an egg. If you don't ovulate, your body does not produce progesterone and your uterus will not shed its lining.
	So far so good. Aside from changes in your cycle caused by the hormone levels in pre-menopause, there are other causes for more frequent, heavier bleeding which your doctor may diagnose.
	The good old "hot flash" -- more has been made of this particular sign than any other, and no wonder! Ever been in a meeting, or in the lineup at the supermarket, or sitting quietly with your family at church, and have a fuscia flush spread over your face and neck, to be followed by lots of sweat over nose, upper lip and chest? We can feel somewhat undignified, and certainly uncomfortable.
	What happens is this: The brain gets a signal that the body is overheating (scientists don't yet know why the brain gets this signal). The brain does what it always does when the body overheats: It dilates the blood vessels in the skin to expose more blood to the outside of the body for cooling. The pores release sweat, which is also exposed to the cooler outside air. The sweat evaporates, causing the skin temperature to decrease, and the blood carried to the surface is cooled.
	Apparently up to 85% of women experience some hot flashes but the experience is very different in each case. Some don't feel uncomfortable enough to be troubled, others can barely function without help from prescribed hormone replacement.
	It seems our old pals estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) are acting up and the hot flash is the result -- although, again, science does not have all the answers. Apparently women who experience the sudden onset of menopause have more severe hot flashes than those women who have a long lead time up to menopause. As well, thin women have a harder time with "the flash."
	When hot flashes happen at night they are called night sweats. Sleep disturbances common in the menopause phase are often caused by these sweats. Waking up, even if only enough to know you're hot, is disturbing to a good night's sleep and can play havoc with mood the next day. Is it any wonder we're called "crabby" at this time of life? We should also remember that fatigue is often the response to unrealistic expectations in and outside the home -- we just have too much to do and we get tired!

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Who Wants to Be Forever Young?
-- By Pamela S. Jeanne, R.N., N.D. From Menopause.
	The menopause occurs during the climacteric period of a woman's life, which can span a 10- to 15-year period. (Editor's note: An earlier article in this magazine says that the climateric period spans 15-20 years. We've included differing info and views here to show that much of this counsel is not hard and fast facts, but attempts by doctors and researchers to explain body changes which defy precise definition, can vary from one person to the next, and which they don't completely understand themselves. All the more reason to tune in to the Lord and ask Him for personalized guidance and insight. -- He can help us understand things better than anyone else!)
	There are many myths and inaccurate beliefs around this time in a woman's life, compounded by cultural pressure to stay forever young. The medical profession communicates to women they no longer need their uteruses, should take hormones to stay young and healthy, and basically deny the aging process. The dread of passing into our older years that so many women feel needs to be re-examined and a refreshing outlook to our "golden" years must be acknowledged to maintain a healthy, positive future.
	Menopause is a transition, not a disease! Let us recognize menopause in this light. Centuries before us, older women were the respected and wise elders looked to for their knowledge, advice and aged kindness. Many traditions for healing were handed down from mother to daughter and passed from village to village to help one another stay well.
	Women can reclaim this tradition by becoming knowledgeable of the menopause process. We can also join other women to honor this wonderful time in our lives.

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Menopause: 21 Ways to Stay Symptom-Free
-- From The Doctors' Book of Home Remedies CD, Compton's New Media Inc., 1993.
	Do you have PMZ? No, not PMS -- that's premenstrual syndrome. When you say PMZ, think liberation, not liability!
	PMZ stands for postmenopausal zest, a phrase coined by anthropologist Margaret Mead. And what she meant was that women should seize this stage of life and live it to the fullest. You are now unencumbered with thinking about contraception and pregnancy and that once-a-month cycle that used to slow you down. This, she says, is freedom.
	"It's a time for exploring what it feels like to be a woman in the human sense, not just as someone who raises children," says Irene Simpson, a naturopathic practitioner in Arlington, Washington. "My friends and I are on the verge of menopause and we are finding it very empowering. We are finding personal growth at a time when women used to decline."
	Menopause begins when your ovaries no longer function, when estrogen secretion slows, then stops, and monthly menstruation becomes irregular, then ceases. Normally, women reach menopause by age 51.
	During the six months to three years of this cycle of your life, you may feel some of the traditional symptoms of menopause, including hot flashes and sudden chills, lowered sexual desire, vaginal dryness, emotional upset, and sleeping problems.

Getting a Better Outlook on Life
	The architecture of this cycle of life can be your design. Menopause can be bittersweet. Or, it can be a time of PMZ, with an emphasis on the zest. Here's how.
	Design Your Own Zest! Education about physiological changes and an adventurous outlook can make a big difference in handling the stresses that come with menopause, as well as the life changes (children moving out, parents moving in, for example) that many women are faced with in their late forties and early fifties, says Simpson.
	Research shows that today's woman spends a third of her life postmenopausal. So consider menopause a step forward in life and make a change for the better, Simpson says. Go back to school. Find a new hobby. Change careers. Take charge of your own health. Make life an adventure.
	Find Support: Support groups offer reassurance that menopause is a natural cycle, says Sadja Greenwood, M.D., a family physician in San Francisco, California, and author of Menopause, Naturally. Members can offer practical coping techniques that they've discovered, as well as sisterly support for new endeavors.
	(Note from Chloe: We are often left with the impression by the media that women's support groups are places where you can air gripes and murmur all together! Of course, this is not the type of support group that we want to promote, ha! But I have found it helpful to talk and pray together with others who are also going through menopause, as we've compared useful tips and encouraged each other to keep looking up to the Lord and see all He's doing in our lives during this time. From my experience, there are lots of Romans 8:28's which you can thank the Lord for, if you look for them. For example, I've found that although I have to go a bit slower, and can't stay up and work as late as I used to, it's led to me depending on the Lord more to anoint my work, and helped me lean on Him more instead of relying on my own strength, which has been a weakness I've battled for years. It can be very edifying to get together and discuss with others the good things the Lord is bringing about in your life at this time, and pray for His help and leading.)
	Exercise Daily: Walking, jogging, bicycling, jumping rope, dancing, swimming, or any other daily exercise can relieve a lot of the symptoms of menopause, according to a study at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School. Exercise can help prevent or lessen symptoms such as hot flashes and night sweats, depression, and other emotional problems, as well as vaginal problems.
	Improved physical fitness, of course, is the most obvious result of exercise. But exercise also improves psychological health by boosting brain concentrations of the neurotransmitters norepinephrine and serotonin, according to Gloria A. Bachmann, M.D., an associate professor of medicine.
	She recommends aerobics and stretching exercises for flexibility, muscle strengthening, and relaxation.

Away with Hot Flashes!
	Hot flashes are the body's response to lowered estrogen levels, says Dr. Greenwood. "There's a dysfunction in the temperature-regulating portion of the brain until the body gets used to the missed estrogen," she says.
	About 80 percent of all women have hot flashes. A typical hot flash lasts about 2.7 minutes. During a hot flash, your face and upper body feels as if it's been shoved into an oven. Your face reddens and you sweat heavily as your skin temperature suddenly rises 7 or 8 degrees. It usually returns to normal in about 30 minutes.
	The good news is, many women feel the flash coming just before they actually break into a sweat, so they can prepare for it. Here's how.
	Look Cool: A positive outlook can be an effective daily tool in combating hot flashes, says Marilyn Poland, R.N., Ph.D., an associate professor of gynecology and obstetrics at Wayne State University School of Medicine.
	When you feel a hot flash coming on, remind yourself of a couple of things: that hot flashes are normal, that they don't last long, and that you are able to do something about them. Most times that positive mind-set can make the flash more bearable.
	Learn to Relax: Women who can relax, Dr. Poland says, will be in better control. Learn meditation or relaxation techniques or just sit quietly, eyes closed, for a while every day to relax.
	Control the Triggers: Determine what triggers hot flashes for you, then avoid the triggers. For some women, emotional upset is a trigger. Others may find a hot meal, spicy food, a warm room, or a warm bed will trigger a flash.
	Go for the Layered Look: Wear sweaters and vests, then peel a layer off when a hot flash threatens, suggests Dr. Poland. Add a layer when the hot flash passes, because your body temperature actually falls a little below normal and can leave you feeling chilled.
	Wear Natural Fibers: Synthetic fibers trap heat and perspiration during a hot flash, making this symptom even more uncomfortable. Natural fibers, such as cotton or wool, will give your body more ventilation and keep it cooler by wicking moisture away from your body and cooling you naturally.
	Carry a Fan: Buy something pretty and keep it in your purse, says Dr. Poland. Or buy a small, battery-powered electric fan and keep it on your desk. Flip it on as the hot flash begins.
	Eat Small Meals: Rather than load your system three times a day, five or six small meals will help your body regulate temperature more easily, says Dr. Greenwood.
	Drink Lots of Water: Don't forget to refresh yourself with cool water or juice, especially after exercising, Dr. Greenwood says. This, too, keeps body temperature in check.
	Cut the Caffeine: Caffeine-containing beverages stimulate production of the stress hormones that trigger hot flashes, says Dr. Greenwood.
	Limit Your Alcohol: Some women find alcohol is another hot flash trigger, says Dr. Greenwood.
	Towel Off: Buy a purse-size package of moist towels and carry them with you. They'll take the edge off a hot flash, says Dr. Poland. You may want to mop your brow when the heat is most intense or you may want to remove the perspiration after the flash is over.
	Turn Down the Heat: Heat in any form may trigger hot flashes. Turn your thermostat down, leave a window open, and avoid hot foods and beverages.
	Don't Share the Bedclothes: You don't have to have a separate bed to keep from disturbing your husband with on-again, off-again nighttime sweats, says Dr. Poland.
	Use separate blankets on the bed or get an electric blanket with dual controls; then you can feel free to kick off the sheets when you need to cool down.
	Stay Sexy: Women going through menopause who continue to have intercourse on a regular basis (once a week or more) have fewer or no hot flashes compared to women who have sporadic sex, research shows. Norma McCoy, Ph.D., a professor of psychology at San Francisco State University, and Julian M. Davidson, Ph.D., professor of physiology at Stanford University, studied 43 women who were just beginning to enter menopause. They found that frequent sex helps moderate dropping estrogen levels, which reduces the occurrence of hot flashes.
	Dr. McCoy believes that the high estrogen levels help maintain a healthy interest in sex and that regular sexual activity indirectly stimulates failing ovaries, which helps moderate the hormonal system and prevents extreme swings in the estrogen level.

Overcoming Sexual Problems
	Our experts gave the following advice for continuing a fulfilling love life through menopause.
	Do the Kegel: You can strengthen your anal, vaginal, and urinary muscles with a special exercise called a Kegel, says Simpson. Stronger muscles can help you relax and use these muscles with less pain and more pleasure during intercourse. They are also good for preventing urinary incontinence, a problem for some menopausal women. Here's how to do it.
	Imagine you want to stop urine in midstream. Squeeze the muscles in your vaginal area firmly. Hold to the count of three, then relax. Practice with a rapid alternation between tightening and letting go. You can practice this exercise anywhere, anytime.
	Lubricate Your Love: Vaginal dryness from a lack of estrogen decreases interest in intercourse during menopause, says Dr. Poland. A water-soluble lubricant, such as Lubifax or K-Y Jelly, vegetable oils, and unscented cream or oil, are all good choices for lubrication, says Dr. Greenwood.
	Or break open a couple of capsules of vitamin E and massage them on as a lubricant, says Simpson.
	Make Talk: Talk to your partner, advises Simpson. Some libido-boosting comes with heart-to-heart talks about needs and feelings.
	Take High Adventure to the Bedroom: Couples may want to try new positions in intercourse to find the most comfortable, says Dr. Greenwood. Touching can be especially important at this time. She suggests more hugs and mutual massages for closeness and sensual pleasure.

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PANEL OF ADVISERS
	Gloria A. Bachmann, M.D., is an associate professor of medicine in the Department of Obstetrics and Gynecology at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School in Piscataway.
	Sadja Greenwood, M.D., is a family practice physician in San Francisco, California. She is on the faculty at the University of California Medical Center in San Francisco. She is author of Menopause, Naturally.
	Norma McCoy, Ph.D., is a professor of psychology at San Francisco State University in California.
	Marilyn Poland, R.N., Ph.D., is an associate professor of gynecology and obstetrics at Wayne State University School of Medicine in Detroit, Michigan. She is co-author of Surviving the Change: A Practical Guide to Menopause.
	Irene Simpson is a naturopathic practitioner in Arlington, Washington.

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Copyright (c) 1997 by The Family