Menopause may occur as early as 35, or as late as 60. There are no hard and fast rules. But most women will stop menstruating in their mid forties to early fifties. A few women simply stop having periods, but this is rare. Most women start to get signs of menopause many months before it actually happens.

The first sign is often a change in your menstrual cycle. Your periods may become irregular or less frequent, or they may become longer or shorter. Usually the menstrual flow lessens, but very often a light period will be followed by a heavy one, or you may even get "flooding." Sometimes there is a gap of months between the last few periods. You may think they have stopped--then be surprised by another. During this time it is possible to become pregnant so, to be safe, do not abandon contraception until you have not had a period for at least two years.

Estrogen not only regulates reproduction but it also affects your body temperature, mood and bones and ligaments. So hormone changes at menopause can have wide-ranging effects such as fatigue, night sweats and mood swings.

These usually start a few months before menopause and end a year or two after it. You may get just one hot flash a day, or several an hour. Each one feels as though you have been plunged into a sauna for a few minutes. When they happen at night you may wake up bathed in sweat. Flashes may be accompanied by dizziness, nausea and heart palpitations. These may scare you, but they are simply the natural response to a sudden rise in body temperature.

Wearing loose clothing and avoiding synthetic fabrics, which trap perspiration, may help you feel more comfortable. It's also a good idea to keep your rooms well ventilated, especially your bedroom at night.

Are also common, and so is a peculiar feeling "crawling" under the skin called fornication. Pains in the joints and muscles are also reported during menopause, and some women get swollen hands, ankles and feet. Regular exercise will help keep you more flexible and your muscles strong.

In menopausal women used to be dismissed as a psychological reaction to getting older. Now researchers believe that fluctuating hormone levels directly affect the part of the brain that controls moods and feelings. Relaxation exercises like yoga, progressive relaxation exercise and meditation may make it easier to cope but if the feelings get really bad, talk to your doctor.

There is no reason for your sex life to decline after menopause. The fall in estrogen may cause the inside of your vagina to become dry, making sexual intercourse painful. But lubricating gels purchased over the counter or estrogen creams and hormone replacement therapy prescribed by your doctor may restore moisture and elasticity.

After menopause, lack of estrogen allows calcium to leave your bones, and in time this may make the bones brittle and fragile, a condition called osteoporosis. You can help to avoid this by exercising regularly with weight bearing exercises ( weight training, walking, etc.), and eating calcium-rich foods like spinach, broccoli, cheese, sardines and peanuts, and drinking skim milk. Or you can talk to your doctor about taking calcium supplements or going on hormone replacement therapy.

Because menopause marks the end of your child-bearing years, you may expect it to be a time of sadness. But there is another way of looking at it. If you have had a family, the ties of child-rearing will be behind you. You may at last be free to do what you want to do, and often the maturity signaled by menopause brings greater confidence. When the hormonal changes have settled, you may experience a surge of new energy. And once you are free from worrying about contraception, you might discover a new relaxation and satisfaction in your sex life.

Hormonal Replacement Therapy effectively treats most menopausal symptoms. It will also help to keep your skin and hair looking good and, more importantly, it will give some protection against osteoporosis, heart disease and strokes. HRT does have its drawbacks though. Some women experience belatedness, sore breasts and cramps. And prolonged use can increase the risk --very slightly- of breast cancer. For this reason, it is important that your doctor be consulted before you make a decision on whether or not you should use HRT.
Some doctors start prescribing HRT at the first signs of menopause. This may be up to a couple of years before menstruation actually stops. Others prefer to wait until periods have ceased altogether.

HRT usually means that you continue to experience a monthly blood loss, although a few types of HRT will prevent bleeding. Blood flow is usually less than a normal period.

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