context: These are some frequently asked questions and answers about menopause to discuss with your doctor. While hot flashes (or flushes) are very common in perimenopause, not all women experience them, and not all flashes are of the same intensity. Hot flashes can be as mild as a light blush or severe enough to wake you from a sound sleep and be associated with perspiration (called night sweats). Most hot flashes last 30 seconds to five minutes. They usually disappear within a few years after menopause, but in some women they can continue for decades. You will know for sure that you have experienced menopause when you have not had your period for an entire year. Until you have gone one year without a period, you should still use birth control if you do not want to become pregnant. After menopause, you should continue to practice safe sex techniques by using latex condoms to reduce the risk of sexually transmitted infections. It is common in perimenopause to be given medications to regulate cycles and a common medication given is the lower dose birth control pill. Compared to regular birth control pills, the lower dose of estrogen in very-low-dose pills may be safer for perimenopausal women. ( Perimenopause typically begins several years before your final period.) While regular birth control pills contain 30 to 50 micrograms of estrogen, these low-dose pills contain only 0.3 to 0.45 micrograms and can be increased as needed. In addition to preventing pregnancy, the pills can often regulate heavy or irregular menstrual periods and may provide protection from ovarian and uterine cancer. The pills may also prevent bone loss, which can lead to osteoporosis. However, women with a history of breast cancer, blood clots, or heart disease, or women who smoke, should not take these pills. Hormone replacement therapy ( HRT) is designed to help women whose menopausal symptoms -- hot flashes, night sweats, insomnia, mood swings, vaginal dryness -- are severe and affecting her quality of life. These symptoms can go on for years after your last period. HRT replaces or supplements the hormones your body doesn't make anymore. Most women who use it take a combination of estrogen and progesterone. Estrogen is what helps most with symptoms like hot flashes and vaginal dryness; progesterone is added to protect against uterine cancer and bone loss (osteoporosis). While HRT relieves hot flashes for many women, there are other drug treatments that may offer relief. These include both over-the-counter and prescription therapies you may recognize for their more common medical uses. Over-the-counter therapies include various vitamins, ibuprofen products, and soy protein found in foods. Prescription treatments include: HRT Low-dose depression drugs fluoxetine ( Prozac), paroxetine ( Paxil), or venlafaxine ( Effexor) Clonidine, blood pressure medication Gabapentin, anti-seizure drug Brisdelle, a paroxetine formula specifically for hot flashes Duavee, a conjugated estrogens/bazedoxifene formula designed to treat hot flashes Natural or bioidentical supplements containing compounds that act like estrogens -- such as soybeans or wild yams -- may provide some of the benefits of estrogen in relieving menopausal symptoms. They commonly include estradiol, estrone, estriol, progesterone, testosterone, and dehydroepiandrosterone ( DHEA). These products are notregulated by the US Food and Drug Administration ( FDA and the dose of hormones can vary from batch to batch. Other botanicals, including black cohosh, have shown some promise for reducing menopausal sweats, or hot flashes. You should always check with your doctor before using any of these supplements. The pain you are experiencing during sex is may be due to vaginal dryness associated with declining estrogen levels during menopause. Talk to your doctor about possible causes of painful intercourse. There are a number of lubricants you can try to relieve the symptoms. Ask your doctor or pharmacist for a suggestion. There are also local estrogen treatments -- cream, tablets, and an estrogen ring -- that treat vaginal dryness. A oral drug taken once a day, Osphena, is also available. The drug makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex. The majority of women do not experience a voice change during menopause, although this may be a problem for some. Botanical supplements containing compounds that act like estrogens -- such as soy -- may provide some of the benefits of estrogen in relieving menopausal symptoms, but research results are contradictory. Other botanicals, including black cohosh, have shown some promise for reducing menopausal sweats, or hot flashes. However, more research is needed to define the benefits and risks of these alternative treatments, and you should always check with your doctor before using them.