Menopause: A Healthy View

Menopause is in the midst of a makeover. The National Institutes of Health (NIH) plans to issue a scientific consensus statement soon that will urge women and their doctors to stop thinking of menopause--technically, the year after the last menstrual cycle--as some kind of disease. If that conclusion seems obvious to you, perhaps you missed all the medical drama and debate about the benefits, or lack thereof, of trying to replace the body's faltering production of hormones over the long term. Some believe that anyone who takes estrogen is a dupe of the pharmaceutical companies, while others insist that it's a miracle drug that fights aging.

Here's a healthier way to look at menopause. It's one of those facts of life, like bipedalism, that set Homo sapiens apart from the nonhuman primates. Their females decline pretty rapidly after they stop being fertile. Ours continue to thrive for decades. Scientists still argue about the details, but women have long taken advantage of nature's largesse to help rear grandchildren, start new ventures and, with any luck, pass on some accumulated wisdom.

As always, transitions are tricky. Problems with hot flashes, night sweats and vaginal dryness vary in intensity. They're generally most severe in women who have had their ovaries surgically removed, say, in conjunction with a hysterectomy. Some women will experience symptoms for the rest of their lives. But relatively few women are debilitated.

The evidence linking menopause to mood swings and fuzzy thinking, despite lots of anecdotal reports, is less clear. "One of the challenges of this research is teasing out which symptoms are associated with menopause and which are simply the result of aging," says Dr. Carol Mangione, the UCLA professor of medicine who led the NIH panel. The point is, if you need relief, hormone replacement is worth considering. It's best to start with as low a dose as is effective. But many women find they do just fine without it. --By Christine Gorman