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Technically, menopause begins after a woman’s final menstrual period. But, of course, she doesn’t know if a given period is final until after the fact—which usually means after a year of not having periods.

The average age at which women reach menopause is 51. When menopause occurs before 40, it’s called premature menopause, which happens to about 1% of women.

During the period of months, or years, leading up to menopause (called perimenopause), a woman’s periods may become irregular and they may become either heavier or lighter.  Her ovaries produce less and less estrogen, and this reduction in estrogen may cause physical as well as emotional reactions.

Many women experience hot flashes, and others may also have night sweats, vaginal dryness or irritation, urinary problems, and fatigue. There may be changes in hair growth and the skin, and she may experience more irritability and nervousness because of poor sleep.

Back in the 1990s, hormones were often recommended to relieve menopause symptoms. They were also thought to help prevent heart disease and other conditions. But in 2002, a large federal study concluded that the overall risks of hormone therapy outweighed the benefits. The therapy—a particular type of estrogen plus progestin—led to fewer bone fractures and less risk for colon and rectum cancer. But it also raised the risk for breast cancer, heart attack, stroke and blood clots in the legs and lungs.

It may be that the timing of hormone use affects whether it is beneficial or puts a woman at higher risk. New studies are being conducted to test the idea that using hormones at a time that is early or close to menopause may benefit heart health and reduce mortality.

If your loved one is nearing or in the midst of menopause, learn what you can about the transition. Each woman is different, and so any therapies must be personalized.

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