National Institutes of Health

U.S. Department of Health & Human Services

TIME FOR A CHANGE
AN INTRODUCTION TO MENOPAUSE . . . . . . . . . 2

Understanding the transition through 

menopause and why menopause 

happens early in some women

SIGNS OF THE MENOPAUSAL TRANSITION . . . . 7

Hot flashes and other symptoms 

during mid-life

WHAT YOU CAN DO FOR HOT FLASHES

AND OTHER MENOPAUSAL SYMPTOMS . . . . . . 11

How some women find help

POSTMENOPAUSAL HEALTH CONCERNS . . . . . 18

Osteoporosis, cardiovascular 

disease, and urinary incontinence

STAYING HEALTHY . . . . . . . . . . . . . . . . . . . . . . . . . 26

Nutrition, health care, and lifestyle 

suggestions to follow during and 

after menopause

FOR MORE INFORMATION . . . . . . . . . . . . . . . . . . 35

Table of Contents
1

you are a woman in her mid forties or early fifties,

you may feel like your body is changing, but you

may not know what is happening. Maybe your

periods are not the same. You don’t sleep 

as well as you always have. Or your waist is getting 

thicker. You may not be paying much attention to 

these changes until one day, if you’re like many 

women, it happens—a hot flash! One minute you feel

perfectly comfortable, and the next you are sweating and

flushed—for no apparent reason. You may be surprised.

You may feel “too young.” You ask yourself—could this

be the start of my transition through menopause? 

This booklet begins with an explanation of what 

is happening during the menopausal transition. It will

tell you about some of the common signs that you are

beginning this transition and give you information about

handling bothersome symptoms. There is a discussion of

some health problems that become more common after

menopause, as well as suggestions for staying healthy.

There is a resource list for more information. This booklet, based on research conducted by scientists, represents

what we know now about the menopausal transition. 

If
2

Menopause, also known as “the

change” or “change of life,” is a

normal part of a woman’s life. 

It is a point in time—the last

menstrual cycle, the last period.

The years leading up to that 

last period, when women might

be experiencing menopausal

symptoms like changes in their

monthly cycles or hot flashes, are

called the menopausal transition. 

It is a common mistake to use 

the word menopause to describe

this whole transition.

MAN INTRODUCTION TOenopause
3

menopausal transition

occurs at a time in a woman’s 

reproductive life when the production 

of estrogen and progesterone, two 

hormones made by the ovaries, may 

vary dramatically and unpredictably. 

The ovaries are two small glands found 

on either side of the top of the uterus or

womb. Before menopause, they hold 

eggs, one or more of which are released

during a menstrual cycle. If the egg then

joins with sperm following sexual intercourse and attaches itself inside the uterus,

pregnancy is the result. Ovaries also 

produce chemical substances known as

hormones, which travel through the blood

to other tissues to control how cells work.

One of these, estrogen, has effects on cells

in many parts of the body including the

reproductive organs, brain, heart and 

blood vessels, and bone. 

Usually in her forties, a woman’s body

starts changing. Some differences, such as 

a thickening waist, can happen because 

she is getting older, but others, like vaginal 

dryness, are caused by changes in her 

hormone levels. As a woman ages and

especially as she gets closer to menopause,

her ovaries get smaller. This time of changes

in hormone levels and menstrual cycles 

is called the menopausal transition. You

might also hear it called perimenopause. 

It usually lasts several years until 12 months

after your last period. Once a woman has

gone a full 12 months without a period, 

she can be fairly sure that she has been

through menopause and is now in postmenopause. The chart on page 5 shows 

how the patterns of hormone production

change as women go from their reproductive

years through the menopausal transition to

postmenopause. Postmenopause lasts the

rest of a woman’s life. 

Going through menopause is a little

like driving on an unfamiliar, twisting road

with an unclear destination. You may not

be sure of all that is happening, where you

The

AN INTRODUCTION TO MENOPAUSE
REPRODUCTIVE AGING IN WOMEN

are going, or what’s coming next. In fact,

you won’t realize you have reached your

destination (menopause) until you are past

it and see it in your rearview mirror.

The average age of menopause is 51.

That means that almost half of all women

have their last period and reach menopause

before that age, and some women may not

have even started perimenopause yet. 

It’s not easy to know when you are in

the menopausal transition. Menopausal

symptoms, along with a physical examination,

medical history, and maybe some blood

tests, may provide useful clues. But, it is not

possible to correctly predict when a woman’s

final period will be. Your doctor could test

the amount of estrogen in your blood or

the level of FSH (follicle-stimulating 

hormone), another hormone that changes

at this time. But, levels of both estrogen and

FSH normally go up and down during your

menstrual cycle. So, these test results alone

cannot be used to predict or confirm

menopause. 

Levels of two other female hormones,

progesterone and luteinizing hormone (LH),

also rise and fall during your menstrual cycle.

Progesterone levels drop after menopause,

and LH levels go up (see chart on page 5).

Even though your monthly periods are

not regular anymore, you can get pregnant

during the menopausal transition. In fact,

the irregular periods common in menopause

make it harder to predict when an ovary is

releasing an egg, the time when sexual intercourse is most likely to result in a pregnancy.

MENOPAUSE: TIME FOR A CHANGE

4

Reproductive Years Menopausal Postmenopause

Transition

Average 9-15 16-30 31-42 Early transition Late transition 51 50s

Age* 40s late 40s, and 

early 50s beyond

Menstrual Variable Regular Regular Lengths of cycles 2 or more No No

Cycles vary increasingly skipped periods period** periods

Signs and Fertility Hot flashes, Same as Vaginal dryness,

Symptoms progressively irritability, previous bone loss. Hot flashes

declining and sleep can persist. For a few

disturbance. women, hot flashes

Bone loss continue into their

begins. 60s and 70s.

*These are average ages. Women vary a great deal in the age at which they go through each of these stages. 

**Menopause is said to have occurred after twelve months without a period.

Copyright © 2007 by the American Society for Reproductive Medicine. All rights reserved. No part of this presentation may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,

recording or by any information storage and retrieval system without permission in writing from the American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216.

First Period Final Period
AN INTRODUCTION TO MENOPAUSE

5

Do not assume that a couple of missed 

periods mean you are beginning the

menopausal transition. Check with your

doctor to see if you are pregnant or if 

there is another medical cause for your

missed periods.

OTHER CONDITIONS SIMILAR 

TO NATURAL MENOPAUSE

At any age before natural menopause, an

operation to remove both ovaries or the

uterus results in “surgical menopause.” 

The medical term for the operation is 

a hysterectomy (surgery to remove the

uterus) or bilateral oophorectomy (surgery

to remove both ovaries). Removing either

both ovaries or the uterus stops monthly

periods right away. If the surgeon removes

the uterus but is able to leave one or both

ovaries, estrogen and progesterone might

still continue to be made for a while

longer. However, research suggests that,

after a hysterectomy, the ovaries may stop

making these hormones sooner than might

normally be expected.

A woman who has either a hysterectomy

or both ovaries removed often faces more

intense menopausal symptoms than a

woman who reaches menopause naturally.

Removing both ovaries abruptly cuts off

hormone production. If you are having 

this surgery, discuss how to manage your

symptoms with your doctor before your

Premenopause (180 days)

Perimenopause (180 days)

Postmenopause (180 days)

CHANGES IN HORMONE

LEVEL PATTERNS

OVER SIX MONTHS

Estrogen Progesterone

FSH LH

Excerpted from the September 1999 issue of the Harvard Women’s

Health Watch, ©1999, President and Fellows, Harvard College.
MENOPAUSE: TIME FOR A CHANGE

6

operation. Without treatment, symptoms

may begin soon after surgery. Surgical

menopause also puts you at early risk for

bone loss and heart disease. Stay in touch

with your doctor as you recover.

Usually menopause happens naturally,

but some women develop symptoms of

menopause and stop having menstrual

cycles much earlier than expected. Before

age 40, a menopause-like condition can

happen for no known reason, or it can be

caused by radiation treatment, some medicines like those used in chemotherapy, an

autoimmunity (some of a woman’s own

body cells attacking her ovary or ovaries),

or genetic errors. Radiation can make 

your ovaries stop working, as can some

treatments like chemotherapy for cancer. 

In the past when menopausal symptoms developed before age 40, it was

referred to as “premature menopause.”

However, the term “premature menopause”

is no longer considered scientifically

accurate. That’s because some women with

this condition have ovaries that produce 

hormones irregularly and a return of 

menstrual periods, and some can even 

become pregnant after the diagnosis. 

The terms “premature ovarian failure” 

or “primary ovarian insufficiency” are 

now used to describe this condition.

Women with this problem may experience

symptoms of menopause like hot flashes

and vaginal dryness.
Signs

7

OF THE MENOPAUSAL

TRANSITION

Many things can happen in a woman’s body because of 

the changes in hormone patterns (see chart, Changes in Hormone Level

Patterns, on page 5) that begin during the menopausal transition. Some

women are bothered by only a few symptoms during perimenopause.

Others are very uncomfortable, while the rest hardly feel any different.

Scientists are trying to understand how the hormone changes during

the menopausal transition may affect a woman’s periods and

menopausal symptoms. 

There are several common symptoms around this time of life, which

may be caused by the shifting hormone levels of the menopausal 

transition. To learn more about managing these symptoms, see the

chapter, What You Can Do for Hot Flashes and Other Menopausal

Symptoms, starting on page 11.
Menstrual cycle changes. The first

thing many women notice is a change in

their periods. They might start coming 

farther apart or closer together. They might

last longer or end sooner. The flow could

be heavier or lighter. 

Hot flashes and night sweats. Many

women also start to be bothered by hot

flashes or flushes and/or night sweats. 

The medical term is vasomotor symptoms.

During a hot flash, your face and upper

body begin to feel hot. Your skin gets

flushed or red because blood vessels close

to the surface are expanding. You might

start sweating a lot, sometimes followed 

by cold shivering. Some hot flashes leave

you with only a slight feeling of warmth 

or a light blush. Others may drench your

clothes. Night sweats are hot flashes with

sweating that happen during your sleep.

They can be strong enough to wake you 

up at night. 

Hot flashes can happen several times 

an hour, a few times a day, or just once or

twice a week. They usually occur for just a

few years and then stop, but about one

woman in every ten women might have 

hot flashes into her sixties and seventies.

Some studies suggest that as many as

three-fourths of white women have hot

flashes and/or night sweats. A different study

found that African-American women are

more likely to report having hot flashes 

and night sweats than are Hispanic or white

women. Japanese and Chinese women were

the least likely to report this symptom. 

MENOPAUSE: TIME FOR A CHANGE

8
SIGNS OF THE MENOPAUSAL TRANSITION

9

Your skin and other tissues. As you

age, your skin becomes drier. You might

also start to lose fatty tissue and a protein

material known as collagen under your

skin and also in the areas near your vagina

and urinary tract. These losses can make

your skin thinner and less elastic. If your

vaginal tissues are affected, these changes

can make them drier and more likely to

tear and become infected. Sexual intercourse may become painful.

Sleep and fatigue. Many women report

having problems sleeping and feeling tired,

especially in the years just before menopause

and during postmenopause. But, it is 

difficult to know if sleep changes are 

a part of growing older, the result of 

hormone changes, or both. 

Sometimes, it is night sweats that wake

you in the middle of the night, or it might

be that you have to go to the bathroom.

Either way, once awake, you can then have

trouble getting back to sleep. Perhaps you

can’t fall asleep in the first place, or you

find yourself waking too early in the morning. When this happens over and over, you

will become very tired. And feeling tired

can affect everything you do during the day.

OTHER CHANGES

Scientists are working to understand how

hormonal changes lead to menstrual cycle

irregularities, hot flashes, night sweats, and

vaginal changes. They are also trying to

learn more about other changes around 

the menopausal transition that you may

experience. Some may be the result of

changes in the amounts of hormones 

made by your body as you go through

menopause; some may be related to 

growing older. 

Sexuality. You might notice changes in

your interest in having sex (called libido) or

in your ability to become sexually aroused.

After menopause, some women say that

freedom from concerns about pregnancy lets

them feel more open to sex and

more relaxed in general. Other

women report losing interest

in sex. If such changes

bother you, talk to a 

doctor to make sure there

is no other cause. For

example, medicines, such

as those prescribed to treat

high blood pressure, depression, and 

cholesterol problems, might play a role. 
Mood. There is some evidence that stress, 

a history of depression, and poor general

health are more likely to contribute to

mood changes, anxiety, and irritability 

during mid-life than do hormonal 

fluctuations. So, while women at mid-life

are sometimes portrayed as having extreme

mood swings, this may not be a true picture.

The specific connection of mood to the

hormone changes of menopause is not clear.

Physical changes. Mid-life is a time

when you may see changes in your body,

especially in its shape and makeup. Your

joints or muscles might ache or feel stiff.

Your waist might be getting thicker, and

you could be gaining weight. Shifts in your

body makeup such as the loss of muscle

and increases in fatty tissue also take place.

Muscle helps us burn a lot of calories, so

losing muscle mass over time can make 

it harder to burn off calories and easier 

to gain weight. 

Memory. Often, people start worrying

about their memory as they get into their

forties and fifties. Sometimes, it’s that “tip

of the tongue” problem—you can’t think of 

a familiar word, or you can’t remember the

name of someone you know. Then a couple

of hours later the missing word just pops

into your head. Or you walk into another

room for something and, once there, can’t

remember what you wanted. Both middleaged men and women describe short-term

memory problems. Problems like these are

probably normal, but other types of memory

loss might not be. For example, forgetting

where you put the car keys is normal, but

forgetting how to drive the car is not. 

Mid-life is a time that may bring new or

greater sources of stress, and this stress can

also add to memory problems. Stress is

how the body responds to changes (both

good and bad) and challenges in order to

prepare to protect itself if needed. Some

experts suspect that when you have a lot

going on in your life, it can be harder to

remember as much as you once did.

Although mild, short-lived stress actually

may improve learning in some situations,

the complicated sources of stress in mid-life

might interfere with your learning something new in the first place. So, sometimes,

it’s not that you forgot things that happened

recently, it’s that your brain never recorded

it as something to remember.

MENOPAUSE: TIME FOR A CHANGE

10
11

Check with your doctor if you 

experience a troubling change in how you feel. 

Symptoms that might seem like the menopausal 

transition, even hot flashes, night sweats, and irregular periods, 

may have other causes.

Menopause is a natural stage of life. It is not something that 

you must take medicine for. If your doctor says you are in the

menopausal transition and the symptoms are not bothering you,

you don’t have to do anything about them. If your symptoms are

making you very uncomfortable, there are things you can do to

relieve your discomfort. Your treatment should be chosen based 

on your own symptoms and health risks. What your sister or 

friend does may not be the right choice for you. Talk to your 

doctor about the best approach for you.

HotFlashes

WHAT YOU

CAN DO FOR

AND OTHER

MENOPAUSAL

SYMPTOMS
Whatever approach you choose, if you

decide to treat your menopausal symptoms,

remember that it is not a permanent 

decision. At every checkup, talk with 

your doctor about your symptoms or 

concerns. Find out if there have been 

any new research findings or different 

treatments. If you are using menopausal

hormone therapy, maybe you need a higher

dose for more relief, or maybe you want 

to try a lower, perhaps safer dose. Discuss

whether you still need to treat your

menopausal symptoms.

HOT FLASHES AND NIGHT SWEATS

If hot flashes and/or night sweats are 

interfering with your daily activities, 

don’t hesitate to seek relief. There are 

some practical steps you can try to ease 

hot flashes and/or night sweats:

◗ Sleep in a cool room.

◗ Dress in layers, which can be 

removed at the start of a hot flash.

◗ Have a drink of cold water or juice

when you feel a hot flash coming on.

◗ Use sheets and clothing that let your

skin “breathe.” 

◗ Don’t smoke.

You could try to keep a written record 

of what you were doing just before a 

hot flash started. This might reveal 

some triggers for your hot flashes which

you could then try to avoid.

There are also lifestyle changes you can

try. Exercise can improve your quality of life

and may help with hot flashes. It will also

help reduce your risk of heart disease and

osteoporosis. Stopping smoking and losing

weight might lower your risk of hot flashes.

Studies in small groups of women suggest

that slow, deep breathing, known as relaxation breathing, may also help reduce hot

flashes.

MENOPAUSE: TIME FOR A CHANGE

12

What is relaxation breathing?

Deep breathing, relaxation breathing, and

paced respiration all refer to a method used

to reduce stress. It involves breathing in

(inhaling) deeply and breathing out (exhaling)

at an even pace. Do this for several minutes

while in a comfortable position. You should

slowly breathe in through your nose. With a

hand on your stomach right below your ribs,

you should first feel your stomach push your

hand out, and then your chest should fill.

Slowly exhale through your mouth, first

letting your lungs empty and then feeling

your stomach sink back. You can do this

almost anywhere and several times during

the day, whenever you feel stressed. You can

also try this if you feel a hot flash beginning

or if you need to relax before falling asleep.
WHAT YOU CAN DO FOR MENOPAUSAL SYMPTOMS

13

Your doctor might recommend certain 

prescription medicines to help manage 

hot flashes. For example, studies suggest

that gabapentin, a medicine used for

epilepsy, pain, and some mood disorders,

might ease hot flashes in some women.

There are a few antidepressants that might

also help, even if you aren’t depressed or

don’t have mood problems. However, none

of these drugs have been approved by the

U.S. Food and Drug Administration (FDA)

for relieving hot flashes, and there are 

many questions that scientists are still 

working on answering.

More than sixty years ago, experts found

that giving estrogen to a woman going

through the menopausal transition could

relieve some of the annoying symptoms

like hot flashes. Estrogen remains the 

most effective medicine approved by 

the FDA for hot flashes, night sweats, 

and vaginal dryness. But, now we 

know that a few women who use 

estrogen may develop serious health 

problems as a result. This approach, now

known as menopausal hormone therapy

(MHT), used to be called hormone 

replacement therapy or HRT.
enopausal hormone therapy (MHT)

uses hormones to ease the symptoms of

menopause or to prevent osteoporosis. 

The hormones are estrogen alone for a

woman who no longer has her uterus or

estrogen with progesterone or a progestin

(a progesterone-like medicine) for a woman

with a uterus. When a woman is taking

estrogen, progesterone or a progestin is

needed to protect the lining of the uterus,

the endometrium. This lowers the chance 

of unwanted endometrial thickening and 

of endometrial cancer, an uncommon, but

possible result of using estrogen alone. 

Estrogen and progesterone/progestin

come in many different forms—pills, creams,

or skin patches, for example—and a variety

of types and doses. The FDA recommends

that MHT be used at the lowest dose that

relieves symptoms for the shortest time

needed.

Similar to the effect of using low-dose

birth control pills before menopause, using

menopausal hormone therapy before your

last period can make it difficult to know

when menopause has occurred. That is, 

you might continue to have a period because

of the hormones you are taking even after

your ovaries are no longer making estrogen

and progesterone. 

If you have had a hysterectomy with your

ovaries removed also, your doctor might

suggest that you start using estrogen right

after the operation. This may prevent hot

flashes and other symptoms. If, later, you

decide to stop using estrogen, however,

bothersome menopausal symptoms could

still start, even years after the surgery. 

Many women find MHT relieves their

menopausal symptoms, but not all women

should use this therapy. If you are considering

using MHT for troublesome menopausal

symptoms or to prevent osteoporosis, you

can read an up-to-date discussion of MHT,

including the benefits and risks of both MHT

and bioidentical or natural hormones, in the

Hormones and Menopause tip sheet from

the National Institute on Aging (NIA). Contact

the NIA Information Center, listed in For

More Information, for a free copy.

14

What about hormones for symptoms of menopause?

M
WHAT YOU CAN DO FOR MENOPAUSAL SYMPTOMS

15

MENSTRUAL CYCLE PROBLEMS

If you are having a problem with heavy

bleeding during your period, your doctor

might suggest that you use a low-dose birth

control pill. This will make your menstrual

cycle and flow more regular, prevent pregnancy, and help with hot flashes. However,

using the pill could make it hard for you to

know when you have reached menopause—

you will probably continue to have periods,

even after your ovaries are no longer making estrogen and progesterone, because of

the hormones in the pills. If you are the

right age for menopause, you might need

to stop the birth control pill for 12 months

to see whether or not you have a period. If

you don’t want to become pregnant during

that time, you will need to use some other

method of birth control.

VAGINAL DRYNESS

Vaginal dryness can be very uncomfortable

and may get in the way of a normal sex life.

A water-based lubricant, but not petroleum

jelly, may relieve your vaginal discomfort. 

The hormone estrogen can also help

with vaginal dryness. Women who are

using MHT—a patch or pill, for example—

for hot flashes should also find relief from

their vaginal dryness. For women who are

only bothered by vaginal symptoms, 

inserting a vaginal estrogen tablet or vaginal

ring containing estrogen or applying an

estrogen cream in the vagina will probably

relieve symptoms locally. With estrogen

cream, some of the estrogen may enter

your bloodstream from the vagina and 

travel elsewhere in your body as estrogen

does before menopause or when you 

swallow an estrogen pill or use an estrogen

patch. We don’t know if estrogen cream

could relieve hot flashes or cause serious

side effects. Both seem to be less likely with

a vaginal estrogen tablet, which has a lower

dose of estrogen.
MENOPAUSE: TIME FOR A CHANGE

16

SLEEP PROBLEMS

Because different things can cause sleep

problems, the solutions vary. If night sweats

are disrupting your sleep, treating them

could help you sleep better. If you find

yourself getting up to go to the bathroom,

try limiting fluids shortly before bedtime

unless you need a cool drink to handle a

hot flash. If you aren’t sure what is keeping

you from getting to sleep or causing you to

wake during the night or early in the morning, there are still some things you can do

to get a good night’s sleep.

◗ Be physically active most days of 

the week but not within 3 hours 

of bedtime.

◗ Go to bed and get up at the same time

every day, even on weekends, and

avoid naps, if possible, in the late

afternoon and evening.

◗ Have a bedtime routine that you follow

each night—read a book or magazine,

take a bath, watch television. 

◗ Make sure your bedroom and bed are

comfortable for sleeping. 

◗ Don’t eat a large meal close to 

bedtime, and stay away from caffeine

later in the day. 

◗ After turning off the light, give yourself

about 15 minutes to fall asleep. If you

don’t go to sleep, get out of bed, and

only go back when you feel sleepy.

◗ Try relaxation breathing 

(see box on page 12).
Do dietary supplements help?

17

any people use dietary supplements hoping to improve their nutrition

and/or health. Maybe you wonder whether

you should use a supplement, such as soy, 

black cohosh, or wild yam, to relieve your

hot flashes instead of using menopausal

hormone therapy. 

According to the FDA, dietary supplements are products taken by mouth that

contain a “dietary ingredient” intended to

add to or supplement the diet. These may

seem safe because they might come from

plants and are “natural.” But the truth 

is we don’t know enough about these 

supplements to know whether they are

indeed safe and if they will really ease

menopausal symptoms. Supplements are

not medicines. They are sold without getting

FDA approval for safety and effectiveness as

is required for prescription or over-thecounter medicines. 

Some herbal substances can have 

very serious, possibly fatal side effects, 

like liver damage. And some just don’t

work as they claim. In 2006 a large, oneyear study of black cohosh showed that

it did not relieve hot flashes in women

approaching menopause.

Plants like soy contain estrogen-like 

substances called phytoestrogens. Scientists

don’t know whether phytoestrogens carry

the same benefits and risks as prescription

estrogens, some of which are made from

plants like soy. 

Learn as much as you can about a dietary

supplement before trying it. Some supplements can change how other medicines

work by increasing or weakening their

effect. Talk to your doctor before using any

supplements, and make sure he or she

knows everything you are taking, even 

vitamins and minerals. 

M
How will you feel when you are

several years past your last period?

Most of your menopausal symptoms

are likely to have disappeared. Some,

like vaginal dryness, may be an

ongoing problem. And for a few

women, hot flashes and night

sweats continue. 

Some other health problems

important for women to know

about are:

• Osteoporosis 

• Cardiovascular disease

• Urinary incontinence

Postmenopausal

18

HEALTH CONCERNS
POSTMENOPAUSAL HEALTH CONCERNS

19

OSTEOPOROSIS

Osteoporosis is a condition in which bones

become very weak and can break easily.

Often, the first sign of osteoporosis is a

bone that cracks, sometimes after just

straining or twisting. Bone is constantly

changing, removing old bone and adding

new bone. Because estrogen plays an

important part in building new bone, 

the decline in estrogen starting with

menopause leaves many older women 

at risk for developing osteoporosis. 

In fact, half of American women over

the age of 50 will probably have a bone

break or fracture later in life because of

osteoporosis. For too many, the broken

bone, especially if it is a hip fracture, will

mean they can no longer live independently.

Broken bones because of osteoporosis 

are also common in the wrist and spine.

Breaks in bones of the spine (vertebrae) 

are especially serious as this can lead to

curvature of the spine, loss of height, 

and pain. A broken hip or wrist is often 

the result of a fall, but for a woman with

osteoporosis in her spine, bending over 

or coughing strongly can be enough to

cause a broken vertebra.

Some women are more at risk of 

developing osteoporosis than others. 

Risk factors, things that increase your

chance of developing a health problem,

include:

◗ a family history of osteoporosis

◗ a broken bone while an adult

◗ surgery to remove both ovaries 

before natural menopause

◗ early menopause

◗ insufficient calcium throughout life 

◗ extended bed rest

◗ smoking

◗ long-term heavy drinking

◗ using certain medicines, such as 

glucocorticoids or some anticonvulsants, for long periods of time

◗ being thin or having a small body frame

If you have any of these risk factors or are

concerned about the health of your bones,

talk to your doctor about what you can do

to protect them.

Normal Bone Bone With

Osteoporosis
There are steps you can take to prevent

osteoporosis after menopause. The first step

in preventing osteoporosis is to build as

much bone density as possible by age thirty.

After that age, some people may begin to

lose bone strength. In women, bone loss

picks up speed around the time of menopause and slows again a few years later. But

bone loss continues into old age. So, if you

have daughters or granddaughters, encourage

them to exercise and get plenty of calcium

and vitamin D while they are younger. 

Keeping the bone strength you have at

menopause is the next step in preventing

osteoporosis. Exercise and a proper diet

helped build bone early in life. Those same

actions can help maintain its strength or

slow its loss now. Regular weight-bearing

exercise (such as walking, running, stair

climbing, or using weights to exercise) at

least three or four times a week can help

keep your bones strong. Strengthening 

and balance exercises can help you avoid 

falls which could cause a broken bone. 

You can also preserve bone density by

eating foods rich in calcium and vitamin D

or, if needed, taking calcium and vitamin D

supplements. Foods high in calcium include

milk and milk products (low-fat ones are

probably best), canned fish with soft bones 

such as salmon, dark-green leafy vegetables, 

and foods with calcium added, like orange

juice, bread, and cereals. 

If you think you may not be getting

enough calcium in your diet, talk with your

doctor before trying a calcium supplement.

But be careful. Too much calcium can also

cause health problems.

Your body uses vitamin D to absorb 

calcium. Getting between 5 and 30 minutes

of sunlight outdoors twice a week will help

your body make the vitamin D it needs. But

people over the age of 50, especially those

who live in northern urban areas, may not

be exposed to enough sunlight year round

to make enough vitamin D. Cereals and milk

fortified with vitamin D, as well as eggs and

fatty fish, are good sources of this vitamin.

MENOPAUSE: TIME FOR A CHANGE

20

Calcium: 1,200 mg (milligrams) 

not more than 2,500 mg

Vitamin D: Age 51-70, 400 IU** 

not more than 2,000 IU

Age 70 and older, 600 IU 

not more than 2,000 IU

*Total recommendation—from food, drinks, 

and, if needed, supplements—each day.

** International units

CALCIUM AND VITAMIN D

recommendations from the National

Academy of Sciences*
POSTMENOPAUSAL HEALTH CONCERNS

21

Lifestyle changes can also help protect

your bones. If you smoke, preventing bone

loss is yet another reason to stop. Women

who smoke also seem to go through

menopause about 11

/2 to 2 years earlier

than those who don’t smoke. And, if you

drink alcoholic beverages, be careful how

much you drink. Having too much alcohol

might cause you to fall and break a bone in

addition to other serious health problems.

How will you know if exercise, diet, and

lifestyle changes are protecting your bones?

If you are over age 65 or if you are 60 to 64

and have any of the risk factors described

earlier, don’t wait for a broken bone to find

out if you have osteoporosis. Talk to your

doctor about a bone density test, perhaps a

DEXA-scan (dual-energy x-ray absorptiometry),

to find out how solid your bones are. Two

spots at high risk for fracture will probably

be checked—hips and spine.

Sometimes exercise, diet, and lifestyle

changes are not enough, and medicines 

are needed. Medications include bisphosphonates, raloxifene, estrogen, calcitonin,

and parathyroid hormone. Some of these

build up bone density. Others prevent further bone loss. Talk to your doctor to find

out which would be best for you. Contact

the National Institute of Arthritis and

Musculoskeletal and Skin Diseases, listed 

in For More Information, to learn more. 

CARDIOVASCULAR DISEASE

Common cardiovascular diseases include 

a narrowing and hardening of the arteries

(atherosclerosis), chest pain that happens

when not enough blood is getting to the

heart (angina), heart attack, and stroke.

High blood pressure (hypertension) is 

a strong risk factor for cardiovascular 

disease and stroke.

Many women think, wrongly, that only

men need to worry about cardiovascular

disease. Heart disease and stroke affect

women too. Women seem to be protected

from these diseases until after menopause
when this protection fades. While many

women fear breast cancer, in fact heart 

disease kills 11 times more women every

year. That is why it is so important for

women to take steps to reduce their risk. 

Make sure your blood cholesterol 

(a fatty substance in the blood), blood

pressure, and blood sugar are at normal

levels. Regular medical checkups will show

whether your results are at normal levels

(see chart below). If your blood pressure 

or blood sugar is too high, follow your 

doctor’s advice to control it. Uncontrolled

blood pressure or blood sugar can also lead

to heart disease, including a heart attack.

Blood sugar that is too high also puts you

at risk for diabetes, another strong risk 

factor for cardiovascular disease. 

Around the time of menopause, total 

cholesterol, LDL (low-density lipoprotein)

cholesterol, and triglyceride levels may go

up, and your HDL (high-density lipoprotein

—the so-called “good” cholesterol) level

may go down. High levels of LDLs can, 

in time, lead to blocked arteries. In turn,

blocked arteries can result in a heart attack

MENOPAUSE: TIME FOR A CHANGE

22 Reprinted with permission, www.goredforwomen.org, ©2007, American Heart Association, Inc.

KNOW YOUR NUMBERS

The First Step to Heart Health

Factor Goal

Total Cholesterol Less than 200 mg/dL

LDL (“Bad”) Cholesterol Goals vary:

Less than 100 mg/dL, optimal

100 to 129 mg/dL, near optimal/ above optimal

130 to 159 mg/dL, borderline high 

160 to 189 mg/dL, high

190 mg/dL and above, very high

HDL (“Good”) Cholesterol 50 mg/dL or higher for a woman

Triglycerides Less than 150 mg/dL

Blood Pressure Less than 120/80 mmHg

Fasting Glucose (Blood Sugar) Less than 100 mg/dL

Waist Measurement Less than 35” for women

Body Mass Index Less than 25 Kg/m2

Exercise Minimum of 30 minutes most, if not all days of the week
POSTMENOPAUSAL HEALTH CONCERNS

23

or stroke. High triglycerides can be another

sign that you are at risk for heart disease or

diabetes. HDLs (think of H as in healthy)

help keep your arteries clear, so that blood

can flow freely. Get treatment for high LDL,

cholesterol, and triglyceride levels to lower

your risk of having a stroke or heart attack.

High triglycerides can also be a sign of

metabolic syndrome, a group of conditions

that put people at risk for heart disease and

diabetes. These include obesity, low HDL

level, high blood sugar, insulin resistance

(a condition in which the muscle, fat, and

liver cells do not properly use the insulin

produced by the pancreas), and high blood

pressure. Metabolic syndrome is also sometimes called syndrome X. If your doctor

says you have metabolic syndrome or if he

or she is worried that you might be at risk

for it, consider changing your lifestyle. 

At a regular checkup your doctor will

look for five signs of metabolic syndrome:

◗ Waist size greater than 35” in women 

◗ Blood pressure reading of 130/85 

or higher

◗ Fasting blood sugar of 110 mg/dL 

(milligrams/deciliter) or higher

◗ High triglycerides (over 150 mg/dL)

◗ Low HDLs (less than 50 mg/dL 

in women)

Having only one of these signs can put you

at risk for heart disease or for diabetes. If

you have at least three of these, you have

metabolic syndrome. People with metabolic

syndrome are now known to be at much

greater risk of heart disease, stroke, and

type 2 diabetes. 

Lifestyle changes—not smoking, avoiding

second-hand smoke, exercising, and following a healthy diet—can also help prevent

heart disease. Not smoking or quitting, if

you do, will also protect your bones and

greatly lower your risk for cancer, especially

lung cancer. Work with your doctor to set

up a plan to lower your risk of heart disease.
Being physically active at least 30 minutes almost every day will help lower your

risk of heart disease. You don’t have to be

active all at one time. For example, try 

ten-minute intervals three times a day.

Exercise should include endurance, also

known as aerobic, activities—the kind that

gets your heart pumping, like walking, 

running, swimming, tennis, or bike-riding.

If you are just beginning to exercise,

start slowly. Maybe begin 

by taking the stairs

whenever possible.

First walk up

one flight of

stairs and then

add more when

you can. When

shopping, don’t

look for the

closest parking

space—choose

one farther

away from the stores to add more walking

to your day. Or, don’t use the bus or subway

to go one stop—walk instead. Almost anyone,

at any age, can start being more physically

active. You might check with your doctor if

you aren’t used to energetic activity or you

have a chronic health problem or a family

history of early heart disease. 

Heart-healthy nutrition starts with less

fat in your diet and more fruits, vegetables,

and whole-grain foods. 

By using nonfat or lowfat dairy products,

you can still get the

calcium you need

for your bones

while taking care of

your heart. Fruits and

vegetables are generally

low in unhealthy fats,

unless fat is added 

during cooking.

MENOPAUSE: TIME FOR A CHANGE

24
POSTMENOPAUSAL HEALTH CONCERNS

25

Keeping a healthy weight will also 

help prevent heart disease. Exercise and 

a heart-healthy diet should help you do

that. More than 30 minutes of moderate

physical activity on most days are needed if

you want to lose weight—experts recommend

60 minutes daily. Watching portion sizes

when you eat is important. So is limiting

added sugars, including drinks like sodas,

juices, fruit drinks, and alcohol. And get

enough sleep. Some studies show that women

who get the least sleep gain the most weight.

These lifestyle changes—exercise, a

heart-healthy diet, and weight control—

will also help prevent or reverse metabolic 

syndrome. This, in turn, will lower your 

risk for heart disease, stroke, or type 2 

diabetes—major causes of illness and 

death in older women. 

URINARY PROBLEMS

Urinary problems such as frequent infections

and urine leakage sometimes also develop

at this time. While these changes are not

unusual, they are not necessarily related 

to menopause. You should still see your

doctor, who may be able to help you 

control any of these problems.

When women have problems controlling their bladder, especially as they grow

older, that’s called urinary incontinence,

and there are several types. If you have

stress incontinence, you might leak urine

when you sneeze, laugh, cough, or step off

a curb. Overflow incontinence means there

is a problem emptying the bladder, so you

might leak urine because your bladder is

always full. Urge incontinence means you

can’t hold the urine until you get to the 

toilet. Somewhat similar is functional

incontinence, in which you can’t get to the

toilet in time because physical problems

keep you from moving quickly. 

Urinary incontinence is treatable—don’t

try to ignore it or to just live with it. Many

things cause urinary incontinence, including

muscle weakness, nerve damage, or infection. Your doctor can decide on the cause

and suggest the most effective treatment.

This might include bladder control training,

medicines, implants, or surgery. Contact

the National Institute of Diabetes and

Digestive and Kidney Diseases, listed in 

For More Information, to learn more.
26

The average woman today has more

than one-third of her life ahead of her

after menopause. That means the

menopausal transition is a good time

for lifestyle changes that could help

women make the most of the coming

years. You’ve already read some ways

to protect or improve your health

at this time of life—quitting

smoking, exercising daily, and

working toward a healthy

weight. But, there’s even more

you can do to stay healthy—other

lifestyle changes plus suggestions to

help you work with your health care

providers more effectively.

StayingHealthy
STAYING HEALTHY

27

GOOD NUTRITION

A balanced diet will give you most of the

nutrients and calories your body needs to

stay healthy. Eat a variety of foods from the

five major food groups. Look for foods that

have lots of nutrients, like protein and 

vitamins, but not a lot of calories. These 

are called nutrient-dense foods. As you

grow older, you need fewer calories for

energy, but just as many nutrients. 

The USDA Food Guide (see chart below)

is one eating plan suggested by the Federal

Government’s Dietary Guidelines for Americans,

2005. Another eating plan also suggested in

the Dietary Guidelines is DASH, Dietary

Approaches to Stop Hypertension. Contact

the National Heart, Lung, and Blood

Institute, listed in For More Information, for

more resources about this plan.

The number of calories a woman over

age 50 should eat daily depends on how

physically active she is. Basically you need:

◗ 1,600 calories, if your physical 

activity level is low

◗ 1,800 calories, if you are 

moderately active

◗ 2,000-2,200 calories, if you 

have an active lifestyle

The more active you are, the more calories

you can eat without gaining weight. 

Eating the foods recommended in the

USDA Food Guide or in DASH will help you

get needed nutrients. But, people over 50

have trouble getting enough of some vitamins

and minerals through diet alone, including

calcium and vitamin D (see page 20). Just

remember that these recommendations

include how much of each nutrient you 

get from food and drinks as well as any

supplement you use. Women past menopause

who are still having a menstrual cycle

because they are using menopausal hormone

therapy might need some extra iron over

USDA FOOD GUIDE

Daily Recommendations for Women 

Age 50 and Older*

Grains—5 to 7 ounces, at least half

of which are whole grains

Vegetables—2 to 3 cups with a variety

of colors and types

Fruits—11

/2 to 2 cups

Milk, yogurt, and cheese—3 cups of

milk or the equivalent

Meat, poultry, fish, dry beans, eggs, 

and nuts—5 to 6 ounces of lean meat,

poultry, or fish or the equivalent

*From the U.S. Department of Agriculture (USDA)
MENOPAUSE: TIME FOR A CHANGE

28

the 8 mg (milligrams) recommended for

women over age 50. Iron, important for

healthy red blood cells, is found in meat,

duck, peas, beans, and fortified bread and

grain products.

Women over 50 also need more of two 

B vitamins. Getting 2.4 mcg (micrograms) of

vitamin B12 per day will maintain the health

of your blood and nerves. Some foods, such

as cereals, are fortified with this vitamin.

Vitamin B12 is also found in red meat and,

to a lesser extent, fish and poultry. But, up to

one-third of older people can no longer

absorb natural vitamin B12 from their food.

Furthermore, common medicines taken to

control the symptoms of GERD (gastroesophageal reflux disease), also known as

acid reflux, slow the release of 

certain stomach acids and,

therefore, interfere with

the body’s absorption

of vitamin B12. You

might need a supplement if you have GERD. 

Another B vitamin, B6,

helps your body breakdown

proteins and make hemoglobin, a part of red blood

cells. Women should have

1.5 mg of vitamin B6 daily. This vitamin is

found in fortified cereals, as well as meats,

legumes, and eggs. 

Don’t forget to drink plenty of fluids,

especially water. If you drink alcohol, do 

so in moderation—for a woman, only 

one drink a day according to the Dietary

Guidelines for Americans. A drink could 

be one 12-ounce beer, 5 ounces of wine, or

11

/2 ounces of 80-proof distilled spirits.

HEALTH CARE

Eating well, exercising, and not smoking are

things you can do for yourself to stay healthy

as you get older. It is also important to discuss

your goals for healthy aging with your doctor.

He or she may be able to help you prevent

health problems or recognize problems early

when they are probably easier to manage.

See your doctor. Continue to visit

your doctor regularly. When 

you meet with any doctor, be

prepared to discuss your

family medical 

history. You might be at

increased risk for certain

diseases, like diabetes or

heart disease, if other close

family members had them.
STAYING HEALTHY

29

Knowing about this family history will help

your doctor decide whether you need any

screening tests, like cholesterol or blood

sugar tests, more often or earlier than other

people your age. 

You should have routine screening tests,

pelvic and breast exams, and a Pap test for

cervical cancer. After age 50, you need to 

be checked for colon cancer, and don’t 

forget your mammogram every 1 to 2 years, 

especially if you are still using menopausal

hormone therapy. And remember to talk to

your doctor about whether or not you are 

at risk for osteoporosis and what types of

physical activity are best for you.

Skin. Check your skin every month for

unusual blemishes, especially moles that

seem to change size, shape, or color. Have

your doctor look at your skin during checkups. Use sunscreen, SPF 15 or higher, when

you are outside during the day. Try to stay

out of the sun when it is strongest—from

about 11 a.m. until 3 p.m.

Teeth and mouth. See your dentist once

or twice a year. Not only will he or she clean

your teeth, but the dentist will also check for

cavities and gum disease. If you have dentures,

you should still see a dentist periodically to

check their fit and to look for gum problems.

Eyes. As you age, reading may become

harder. You may need to hold things farther

away in order to see them clearly. Reading

glasses might help. Start regular visits to an

eye care professional, who can check for

glaucoma. This eye problem becomes more

common after your forties. In glaucoma

there is increased pressure on the optic

nerve. The pressure can permanently damage

your vision before you realize you have 

glaucoma. Special eye drops often control it.

Medications. Make sure all your doctors

know which medications you are taking. 

This includes vitamins, minerals, other

dietary supplements, and over-the-counter

medicines like aspirin, antacids, or antihistamines. Some of these may change how your

prescription medicines work; others might

not be safe for you to use at all. 

If your health care professional prescribes

a medicine, take it as directed. Make sure

you understand the possible side effects of

the prescribed medicines. Some drug stores
MENOPAUSE: TIME FOR A CHANGE

30

or mail order services keep a computer file of

all your prescriptions so they can check for

possible drug interactions if a new medicine

is added. That is a benefit of getting all your

medicines from the same place. But the

pharmacist still doesn’t know what nonprescription medicines and supplements 

you are taking, so it is important to keep

your doctors informed.

Get vaccines. If you are over age 50, you

should get a flu shot every fall, especially 

if you have other health problems. The

Centers for Disease Control and Prevention

(CDC) recommends that people over age 65

get the pneumococcal pneumonia vaccine—

most need it only once. You should also

have a tetanus shot every ten years, or sooner

if you have an injury that puts you at risk 

for getting tetanus. Tetanus or lockjaw is a

serious, painful infection that causes muscles

all over the body to tighten. 

A vaccine to prevent shingles is now 

available. Most adults 60 years and older

should get one dose. Check with your 

doctor to see what you should do.

Listen to your body. Don’t wait for your

next checkup if you notice any suspicious

changes in your body—swelling, unexpected

weight loss or gain, persistent pain, unexplained

fevers, a cough that won’t go away, or recurring

headaches, for example. Check with your 

doctor about any of these symptoms.

Know the warning signs of a heart attack,

although the signs are sometimes less clear

in a woman. They include:

◗ Pain or an uncomfortable feeling 

in the center of your chest

◗ Pain or discomfort in other parts 

of the upper body, including the 

arms, back, neck, jaw, or stomach

◗ Other symptoms, such as shortness 

of breath, breaking out in a cold sweat,

nausea, or light-headedness

Call 9-1-1 if you feel chest discomfort, 

especially with any of the other signs. If 9-1-1

emergency service is not available where you

are, call the operator or get someone to drive

you to the hospital. 

You should also know the warning signs

of a stroke. In the case of a stroke, one or

more of these signs come on very suddenly.

◗ Numbness or weakness, usually in 

the face, arm, or leg, and often on 

just one side

◗ Strong headache for no reason

◗ Confusion or trouble speaking or

understanding

◗ Problems seeing with one or both eyes

◗ Trouble walking, feeling dizzy, losing

balance or coordination
STAYING HEALTHY

31

There are drugs that can help if you get to 

an emergency room fast enough. Call the

ambulance and get medical help as soon as

possible, so you can get treatment that may

lessen the damage. 

Ovarian cancer (cancer of the ovaries) 

is rare and difficult to diagnose in its early

stages, making it hard to treat. Ovarian 

cancer is more common in women who:

◗ Are older

◗ Have a family history of this disease

◗ Are overweight

The early symptoms are often similar to

signs of other illnesses. They might include:

◗ Pain in the abdomen or pelvis

◗ Urinating often or needing 

to urinate quickly

◗ Feeling full more quickly than usual

when eating 

◗ Frequent bloating in your abdomen

Normally these symptoms are nothing to

worry about. But, talk to your doctor if 

they happen frequently, perhaps more than

twelve times a month, or if they continue for

more than a few weeks.

PRACTICE SAFE SEX

After menopause, some women may think

they needn’t worry about sexually transmitted

diseases. But, any woman, regardless of her

age, who is not in a long-term relationship

with a faithful partner and has unprotected

sex, is at risk of sexually transmitted disease.

If you have more than one sexual partner or

have recently begun dating again, you need

to be aware of the risk of these diseases and

take necessary precautions to make sure you

don’t become infected. 

The list of familiar and unfamiliar 

sexually transmitted diseases includes

syphilis, gonorrhea, Chlamydia, genital 

herpes, human papillomavirus/genital warts,

and HIV/AIDS (human immunodeficiency

virus/acquired immunodeficiency syndrome).

Some can be cured—Chlamydia, syphilis,

and gonorrhea. But some—genital herpes,

human papillomavirus/genital warts, and

HIV/AIDS—can’t. Being informed about

HIV/AIDS is critical because an HIV infection

that develops into AIDS is life-threatening.

HIV/AIDS can be treated, although not

cured, and new drugs enable people to 

live longer with HIV/AIDS.
MENOPAUSE: TIME FOR A CHANGE

32

HIV is found in body fluids such as

blood, semen, and vaginal secretions. The

virus can enter your body through any 

opening in the skin. Postmenopausal

women are at special risk because of the

fragile tissues of the vulva (the external

female genital area around the opening 

of the vagina) and the lining of the vagina.

These delicate tissues may be more 

susceptible to virus-infected fluids.

Don’t be afraid to talk to your partner 

or potential partner about HIV/AIDS. Ask 

if he or she has been tested for HIV recently.

There are other ways women can protect

themselves. Check with the FDA and the

CDC. Contact the FDA and CDC, listed in

For More Information, to learn more. Be sure

you are making safe choices.

OTHER LIFESTYLE CHANGES

This new phase of your life can be as busy

and fulfilling as you would like to make it.

Stay active—not only physically, but also

mentally. If you don’t work outside of the

home, you might consider getting a parttime job or volunteering with a nonprofit

organization. You might find a hobby or

learn to play a musical instrument. Maybe

you would enjoy taking a class at a local

community college or even working toward

a degree. You could join a book group or

learn to garden. This is the time to do something you always wanted to try, but never

had the time before. Or maybe now is a

good time to reconnect with an interest 

you had when younger.

While exploring new things and keeping

active, try to avoid adding stress to your life.

Stress can make it harder to deal with the

symptoms of menopause. Mid-life can be a

complex time for many women. For example, if you have a family, there are probably

changes at home—maybe you now have an

“empty nest” because your children are 

leaving home for college, work, or marriage.

Maybe you have young children who are

still in need of attention, which can be extra

challenging if you are tired because you

aren’t sleeping well at night.

Other possible stresses come from outside

the home. If you work, you may be taking a

different look at your career, starting to think

about retirement, or feeling challenged by

younger coworkers. Or, your parents may be

having health problems that now need your

attention. Maybe a combination of such

challenges is causing you stress. 

How do you know you are feeling

stressed? Perhaps you feel overwhelmed by
STAYING HEALTHY

33

life, depressed, or anxious. Do your shoulder

muscles feel tight? Do you sometimes realize

your hands are clenched? Do you wake up

with a sore jaw because you are grinding

your teeth or tightening your jaw as you

sleep? Do you have headaches, stomach

problems, fatigue, trouble sleeping, or high

blood pressure? These can be signs of stress.

Avoid stress as much as possible. That

might be very hard to do if you are a caregiver—whether of a child or an adult. Try 

to identify the times when you feel overwhelmed so you can try to keep those 

situations to a minimum. Take time to relax,

eat well, exercise regularly to release tension

and feel better overall, and keep in touch

with family and friends. Try to find activities

that may help get your mind off things that

stress you. Maybe even try relaxation breathing (see box on page 12) or meditation. Get

enough sleep. Don’t be reluctant to ask for

help when you need it—from family or

friends or even from a professional counselor.

Keep in mind the possibility of saying no

when asked to do something that you think

will add to your stress, and try not to feel

guilty afterward. Some women find accepting the fact that there are some things in life

that they can’t change is helpful. Set realistic

goals for what you want to get done.

Talk to friends or family members who

might be going through similar life changes.

Sharing ideas about how to handle common

new responsibilities like taking care of aging

parents might be helpful to everyone.

Research is ongoing in many places.

One way people can help with medical

research is to take part in a clinical

study or trial. A clinical study or trial is

specially designed, health-related

research involving humans. Scientists

often seek participants for their research

studies. Some are people with the illness

being studied, called “patient volunteers.”

Sometimes participants are “normal or

healthy volunteers” who are not sick.

Scientists learn a lot by comparing and

contrasting the two groups, especially if

both have received the same treatment.

Are you interested in taking part in a

clinical study—either because of a

health problem you have or so you can

contribute to medical research? Consider

volunteering for a clinical trial. Learn

more at www.clinicaltrials.gov where 

you will see a listing of current clinical

studies and trials.

Would you like to help with

medical research?
Remember...

The menopausal transition is a natural stage for every woman who

is in her forties or fifties. If you have no symptoms or if you aren’t

bothered by the symptoms you have, there is nothing you need do.

But, if hot flashes, night sweats, or vaginal dryness are making you

uncomfortable, talk to your doctor about ways you can get relief. 

Mid-life can be an exciting period in your life. It is a time of change—

physical changes, of course, but possibly emotional and social

adjustments, too. It might also be a time of acceptance—of these

changes and of your evolving roles in life. This is also a time of

opportunity and promise—a chance to make healthy changes in your

lifestyle that will allow you to get the most out of the rest of your life.

So, don’t look back. This is the time to explore your world,

expand your horizons, and learn more about yourself. 

It’s time to enjoy yourself, friends 

and family, and your life!
35

To learn more about health and aging and

to order Hormones and Menopause, a tip

sheet on menopausal hormone therapy,

contact:

National Institute on Aging (NIA)

Information Center

P.O. Box 8057

Gaithersburg, MD 20898-8057

800-222-2225 (toll-free)

800-222-4225 (TTY/toll-free)

www.nia.nih.gov 

www.nia.nih.gov/Espanol

To sign up for regular email alerts about

new publications and other information

from the NIA, visit:

www.nia.nih.gov/HealthInformation

Visit NIHSeniorHealth 

(www.nihseniorhealth.gov), a senior-friendly

website from the NIA and the National

Library of Medicine. This website has health

information for older adults. Special features make it simple to use. For example,

you can click on a button to have the text

read out loud or to make the type larger.

To learn more about Alzheimer’s disease

and memory loss, contact:

Alzheimer’s Disease Education and

Referral (ADEAR) Center

P.O. Box 8250

Silver Spring, MD 20907-8250

800-438-4380 (toll-free)

www.nia.nih.gov/alzheimers

Other sources of useful information for

menopausal and postmenopausal women:

Federal Government Resources

Centers for Disease Control 

and Prevention (CDC)

1600 Clifton Road

Atlanta, GA 30333

800-311-3435 (toll-free)

www.cdc.gov

Department of Agriculture (USDA)

1400 Independence Avenue, SW

Washington, DC 20250

202-720-2791

www.usda.gov

www.mypyramid.gov

www.nutrition.gov

Food and Drug Administration (FDA)

5600 Fishers Lane

Rockville, MD 20857-0001

888-463-6332 (toll-free)

www.fda.gov

Menopausal Hormone Therapy

Information

National Institutes of Health

www.nih.gov/PHTindex.htm

National Cancer Institute

National Institutes of Health

6116 Executive Boulevard

Room 3036A

Bethesda, MD 20892-8322

800-422-6237 (toll-free)

800-332-8615 (TTY/toll-free)

www.cancer.gov

Information FOR MORE
MENOPAUSE: TIME FOR A CHANGE

36

National Center for Complementary 

and Alternative Medicine

National Institutes of Health

NCCAM Clearinghouse

P.O. Box 7923

Gaithersburg, MD 20898

888-644-6226 (toll-free)

866-464-3615 (TTY/toll-free)

www.nccam.nih.gov

National Eye Institute 

National Institutes of Health 

NEI Information Office

2020 Vision Place

Bethesda, MD 20892-3655

301-496-5248

www.nei.nih.gov

National Heart, Lung, and Blood Institute

National Institutes of Health

NHLBI Health Information Center

Box 30105

Bethesda, MD 20824-0105

301-592-8573

240-629-3255 (TTY)

www.nhlbi.nih.gov

National Institute of Allergy 

and Infectious Diseases

National Institutes of Health

6610 Rockledge Drive MSC 6612

Bethesda, MD 20892-6612

866-284-4107 (toll-free)

800-877-8339 (TTY/toll-free)

www.niaid.nih.gov

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

877-226-4267 (toll-free)

301-565-2966 (TTY)

www.niams.nih.gov

National Institute of Child Health 

and Human Development

National Institutes of Health

Box 3006 

Rockville, MD 20847

800-370-2943 (toll-free)

800-320-6942 (TTY/toll-free)

www.nichd.nih.gov

National Institute of Dental and

Craniofacial Research

National Institutes of Health

31 Center Drive MSC 2190

Bethesda, MD 20892-2190

301-402-7364

www.nidcr.nih.gov 

National Institute of Diabetes and

Digestive and Kidney Diseases

National Institutes of Health

Building 31, Room 9A-06

31 Center Drive MSC 2560

Bethesda, MD 20892-2560

301-496-3583

www.niddk.nih.gov
FOR MORE INFORMATION

37

National Institute of Mental Health

National Institutes of Health

6001 Executive Boulevard 

Room 8184 MSC 9663

Bethesda, MD 20892-9663

866-615-6464 (toll-free)

866-415-8051 (TTY/toll-free)

www.nimh.nih.gov 

National Institute on Alcohol Abuse 

and Alcoholism

National Institutes of Health

5635 Fishers Lane MSC 9304

Bethesda, MD 20892-9304

301-443-3860

www.niaaa.nih.gov

National Women’s Health 

Information Center

8270 Willow Oaks Corporate Drive

Fairfax, VA 22031

800-994-9662

888-220-5446 (TTY/toll-free)

www.womenshealth.gov

Office of Dietary Supplements

National Institutes of Health

6100 Executive Boulevard 

Room 3B01 MSC 7517

Bethesda, MD 20892-7517

301-435-2920

dietary-supplements.info.nih.gov

The National Library of Medicine has 

a website, www.medlineplus.gov, with 

information on many health subjects,

including menopause. Click on Health

Topics. Choose any topic you are interested

in, such as menopause, menopausal hormone

therapy, or osteoporosis, by clicking on the

first letter of the topic and scrolling down

the list to find it. 

Non-Profit and Professional Groups

American College of Obstetricians 

and Gynecologists

409 12th Street, SW

P.O. Box 96920

Washington, DC 20090-6920

202-638-5577

www.acog.org

North American Menopause Society

P.O. Box 94527

Cleveland, OH 44101

440-442-7550

www.menopause.org

Writer: Karin Kolsky, National Institute on Aging Designer: Jill Tanenbaum Graphic Design & Advertising, Inc.
National Institutes of Health

U.S. Department of Health & Human Services

January 2008

Publication No. 08-6143