Hot Flashes - This sudden feeling of heat that spreads over part or all of the upper body is the most common symptom of menopause, affecting an estimated 75-85 percent of American menopausal women. Hot flashes may cause you to blush red or break out in a sweat. A hot flash can last just a few seconds or go on for an hour. You may have as many as 10 in 24 hours. They're much more common at night. Interestingly, women going through menopause may experience hot flashes for a few months, a few years or not at all. Flashes can come on at any time, day or night and they vary greatly in frequency and severity. Some estimates say 10-15 percent of women are awakened by them hourly throughout the night and many experts now believe that the resulting lack of sleep may account for much of the irritability and emotional ups and downs usually blamed on hormonal changes.
	Vaginal changes - Lower levels of estrogen make the lining of the vagina thinner, less flexible and drier, which can cause pain during sex. Some women also have vaginal burning and itching, and others may feel discomfort in the clitoris (part of the female genitals involved in sexual stimulation). In some cases, the urethra (the tube that carries urine from the bladder) becomes irritated, and, as a result, you're more likely to have bladder and urinary tract infections after menopause. Sometimes you may have symptoms even without an infection - having to go to the bathroom often, feeling an urgent need to urinate, feeling a burning sensation when urinating, not being able to urinate or having to go often during the night
	Emotional swings - The most common perception of menopausal women is that they're depressed, irritable and sometimes irrational. Interestingly, a study of 2,500 middle-aged women by the Women's Research Institute in Massachusetts found that more than 70 percent of women experiencing menopause were either relieved that their monthly periods were coming to an end, or they felt neutral about the issue. In truth, population surveys consistently show that women are most likely to suffer from depression in their twenties and thirties, not at mid-life. Furthermore, neither suicides nor psychiatric hospitalizations increase among women in their late forties or early fifties. If nervousness, irritability or depression do occur, they may result from changing hormone levels, stress, or sleep deprivation due to hot flashes. Women may also get depressed if they believe that the end of their reproductive years equates the end of their usefulness or of their "womanhood."
	Bone loss - Dwindling bone mass is a normal part of aging, but at menopause this bone loss increases markedly. This may make bones fragile and increase the risk of broken bones and osteoporosis (thinning bone disease). As bones become fragile, they pose a major health hazard. The hip, wrist, and spinal bones are most often affected. Up to one in five patients dies within 6 months of hip fracture from complications, such as blood clots, stroke, heart attack, and pneumonia.
	Heart disease - The estrogen that women produce before menopause gives them a natural protection from heart attacks. Consequently, the risk of heart attack and stroke goes up after menopause when estrogen levels decrease.
	Sex - Many menopausal women complain that they enjoy sex less. However, this is more likely due to discomfort resulting from vaginal soreness or dryness than a loss of interest in sex. This irritation can be treated with topical lubricants available in any drug store.
	Other - Many other changes related to a decline in hormone levels may be hard to distinguish from the normal aging process. The skin becomes wrinkled, hair thins and its texture changes, some pubic hair is lost and some facial hair may be gained, the breasts lose some of their fullness, and the nipples become less erect, there is more body fat in some places and less in others.

	Individual expectations - A positive mental attitude is a must! Studies at the New England Research Institute and the University of Pittsburgh found that women who anticipate having a hard time during menopause do suffer more negative emotional and physical symptoms than women who expect it to be easier. While some women's bodies are especially sensitive to hormonal changes, the ingoing expectations may create a self-fulfilling prophecy - women who believe their symptoms will be bad are less likely to seek relief, thus making their experience more difficult.
	Cultural beliefs - Greek women who have hot flashes consider them trivial. Only a small percentage of Japanese women report hot flashes - they more frequently complain of head-aches and stiff shoulders. Why? Anthropologists who have compared menopause in different cultures find that the society's view of a woman during and after menopause can dramatically influence how she experiences this stage of life. Mayan women, for example, say they do not have hot flashes. In Mayan culture, women who have gone through menopause become respected elders and many of their household duties are then done by their daughters-in-law. Many American women, on the other hand, are convinced that menopause marks the end of their best years, adding to or creating stress that can aggravate symptoms.
	Surgically induced menopause - In the New England Research Institute study, women whose ovaries were removed were more likely to be depressed than those who underwent natural menopause. They were more negative about menopause in general and more likely to regret the loss of their periods. They also reported more hot flashes and more sleep disturbances, probably because their estrogen supply changed abruptly rather than gradually diminished. This may also explain the decline in sexual interest and ability to climax reported by some women whose menopause resulted from surgery.
	A history of depression - Women who seem especially vulnerable to mood disturbances at menopause include those who suffered from postpartum depression after giving birth, had bouts of depression at some point in their life, or have a family history of depression.

Reasons to Take Hormones: 1) You have significant menopausal symptoms. 2) You are at increased risk of osteoporosis because a) your diet is low in calcium or you have an eating disorder, b) you are slender, Caucasian or Asian, smoke or drink regularly, or have a family history of osteoporosis.

Reasons to Not Take Hormones: 1) You have minimal symptoms or are at low risk for osteoporosis. 2) You wish to do this holistically with supplements.

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