women, usually in their late 40s or early 50s.

The most noticeable happening is that the periods cease, sometimes abruptly and sometimes gradually, with the interval between each period becoming longer and longer. Eventually they stop all together and if you have not had a period for a year or more than you are, by definition, experiencing the menopause.

At this time, your ovaries greatly reduce the production of the female hormones. While stopping your period is the most obvious side-effect, other body functions can be influenced too. Four out of five women experience `hot flashes' and many women also complain of headaches, loss of sleep due to night sweats, rashes, irritability and even depression. While these symptoms can be distressing they can, often, be tolerated without recourse to medication.

However, many women do find that they become very uncomfortable and moody so they, sensibly, go to their family doctor for advice.

Nowadays, many doctors prescribe a combination of replacement hormones to alleviate the symptoms and also to protect their patients against the onset of osteoporosis and cardio-vascular disease. Many women who are taking this combined therapy will experience bleeding every month, similar to a period.

In any case, whether or not you are interested in hormone replacements, you should at this time of your life go to your doctor annually for a physical check up. This will usually include a pap smear, an internal pelvic examination and a breast examination as well as any other appropriate laboratory tests or investigations. In your 50s, the risk of serious disease of the ovaries and breasts increases. It is therefore, advisable to learn to examine your breasts carefully and to have an annual mammogram. This is particularly important if there is a family history of cancer of the female organs.

While you are `going through the change' you should continue to use some form of reliable birth control, until your periods have stopped for one year. A barrier method such as a diaphragm, condom, spermicide cream or foam or gel are very suitable at this age. Sometimes a woman for various reasons, loses her interest in sex at this changing time of her life. This can often be reversed when the underlying cause is identified.

Vaginal irritation due to dryness, caused by hormone loss, can be treated with a cream which your doctor can prescribe. Emotional dismay caused by the fact that her family is now fully adult and independent, can be helped by counselling and by trying to find new outlets for her interest. Perhaps the fact that her children are gone from the home will now allow the woman and her partner to have more time for each other and to develop a stronger relationship.

It is now more important than ever to implement a good exercise programme and good eating habits. The bones are being depleted of calcium during the menopausal years, and regular exercise will help to improve the overall strength of the body framework. Brittle bones are much more liable to fracture so do try to replace calcium in your diet. This is a good habit to start in young adulthood anyway. Calcium can be taken in tablet form or in milk products. Menopausal women need 1500 mgs. per day to slow down this bone loss especially if not taking any replacement female hormones.

Your middle years can be very enjoyable with much to look forward to health problems can be successfully treated when dealt with early so do seek advice from your doctor or health professional.

Nowadays, women in their 50s and 60s (and beyond) can lead vital and satisfying lives while appreciating each decade as a special and unique time in their lives.

Public Health Nurse Department of Health HEALTH HTH