,M5OPAUSE ,GUIDEBOOK
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      DECI.NS >.D M5OPAUSE & 2Y
              #F? ,EDI;N

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       ,,BOOK ,,JACKET ,,9=M,N    ;III

  ,? GUIDEBOOK IS PUBLI%$ 0,! ,NOR?
,AM]ICAN ,M5OPAUSE ,SOCIETY 7,,NAMS7
6PROMOTE "U/&+ (! PHYSICAL & EMO;NAL
*ANGES T A3OMPANY ! TRANSI;N "?
M5OPAUSE Z WELL Z ! H1L? ISSUES LAT] 9
A WOMAN'S LIFE T MAY 2 RELAT$
6M5OPAUSE4
  ,,NAMS RECOGNIZES T M5OPAUSE IS A
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            ,TA# ( ,3T5TS

               ,"P ,"O

                                 ,PAGE
,M5OPAUSE ,BASICS """"""""""""""""" #A
  ,TIM+ & ,T]M9OLOGY """""""""""""" #D
  ,3FIRM+ ,M5OPAUSE ,/ATUS """"""" #AB
,! ,*ANG+ ,BODY """""""""""""""""" #AE
  ,*ANGES 9 ,M5/RUAL ,P]IODS """"" #AG
  ,REDUC$ ,F]TIL;Y """"""""""""""" #BC
  ,HOT ,FLA%ES """"""""""""""""""" #BI
  ,SLEEP ,4TURB.ES """"""""""""""" #DA
  ,C5TRAL ,N]V\S ,SY/EM ,*ANGES "" #DC
    ,H1DA*E """""""""""""""""""""" #DD
    ,MEMORY & ,3C5TR,N ,*ANGES """ #DF
    ,MOOD ,SW+S1 ,DEPRES.N1 &
        ,ANXIETY """"""""""""""""" #DH
  ,VULVOVAG9AL ,SYMPTOMS """"""""" #EF
  ,*ANGES 9 ,SEXUAL ,FUNC;N """""" #FB
  ,UR9>Y ,3C]NS """""""""""""""""" #GD
  ,O!R ,POT5TIAL ,*ANGES """"""""" #HE
    ,WEI<T ,GA9 """""""""""""""""" #HE
    ,HE>T ,PALPIT,NS """"""""""""" #HG
    ,JO9T ,PA9 """"""""""""""""""" #HH
                                    ;V
    ,SK9 ,*ANGES """"""""""""""""" #HI
    ,HAIR ,*ANGES """""""""""""""" #IB
    ,EYE ,*ANGES """"""""""""""""" #ID
    ,M\? & ,D5TAL ,*ANGES """""""" #IE

               ,,"P #B

,PO/M5OPAUSAL ,H1L? """""""""""""" #IG
  ,HE>T ,41SE """""""""""""""""""" #IH
  ,DIABETES """"""""""""""""""""" #AJG
  ,O/EOPOROSIS """""""""""""""""" #AAJ
  ,C.ER """"""""""""""""""""""""" #ABF
,! ,HORM"O ,!RAPY ,/ORY """"""""" #ADD
  ,E/ROG5 ,!RAPY 7,,ET7 """"""""" #ADF
  ,PROGE/OG5 & ,,EPT """""""""""" #AEA
  ,CU/OM-,COMP.D$ ,HORM"OS """""" #AEH
  ,BIOID5TICAL ,HORM"OS """"""""" #AFA
  ,3TRA9DIC,NS """""""""""""""""" #AFB
  ,SIDE ,E6ECTS """"""""""""""""" #AFD
  ,RISKS """""""""""""""""""""""" #AFH
  ,WEI<+ ,B5EFITS & ,RISKS (
      ,,EP/,,EPT """""""""""""""" #AGB
  ,DI6]5T ,WOM51 ,DI6]5T ,NE$S "" #AGD
,A*IEV+ ,OPTIMAL ,H1L? """""""""" #AGD
  ,LIFE/YLE ,*ANGES """"""""""""" #AGE
  ,:5 ,M ,HELP IS ,NE$$ """"""""" #AHF
,A ,"T ( ,NEW ,2G9N+S """"""""""" #AHH

,A4I;NAL ,RES\RCES """""""""""""" #AIA




















        ,,M5OPAUSE ,,GUIDEBOOK      #A

          ,M5OPAUSE ,BASICS

  ,M5OPAUSE IS A NORMAL1 NATURAL EV5T
--DEF9$ Z ! F9AL M5/RUAL P]IOD & USU,Y
3FIRM$ :5 A WOMAN HAS MISS$ H] P]IODS
= #AB 3SECUTIVE MON?S 7IN ! ABS;E (
O!R OBVI\S CAUSES74 ,M5OPAUSE IS
ASSOCIAT$ ) REDUC$ FUNC;N+ (! OV>IES
DUE 6AG+1 RESULT+ 9 L[] LEVELS (
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P]MAN5T 5D ( F]TIL;Y4
  ,DUR+ ! TRANSI;N F ! REPRODUCTIVE
YE>S "? M5OPAUSE & 2Y1 A WOMAN
EXP]I;ES _M PHYSICAL *ANGES4 ,MO/ ( ^!
*ANGES >E NORMAL 3SEQU;ES ( BO?
M5OPAUSE & AG+4 ,"S NORMAL *ANGES
RELAT$ 6M5OPAUSE 9CLUDE PHYSICAL
4TURB.ES S* Z HOT FLA%ES1 : >E USU,Y
"T-LIMIT$4 ,"S (! PHYSICAL *ANGES
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PHYSICAL E6ECTS ( AG+ >E C\PL$ ) AN
9DIVIDUAL'S G5ETIC MAKEUP1 C]TA9
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TR\#"S SYMPTOMS1 ":AS O!RS MAY
NAVIGATE ! TRANSI;N ) FEW OR EV5    #C
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  ,=TUNATELY1 M5OPAUSE IS BETT] "U/OOD
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NE$$4 ,WOM5 J 5T]+ ! M5OPAUSE TRANSI;N
W B5EFIT F "K+ T WOM5 :O H -PLET$ !
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PASSAGEWAY 6A NEW "P ( LIFE4 ,MO/
REPORT T !Y N[ FEEL M 3FID5T1 EMP[]$1
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  ,:ILE EA* WOMAN'S EXP]I;E ( M5OPAUSE
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M5OPAUSE PRES5TS AN ID1L OPPORTUN;Y
6EVALUATE P]SONAL H1L? & IMPROVE H1L?
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TRANS=M & 5H.E E WOMAN'S S5SE (
WELL-2+1 N ONLY >.D M5OPAUSE B =! RE/
( H] LIFE4
  ,M5OPAUSE IS A NORMAL1 NATURAL EV5T
--N A 41SE4



    ,,TIM+ & ,,T]M9OLOGY
  ,S"EAL T]MS RELAT$ 6M5OPAUSE >E
DEF9$ 2L4

    ,NATURAL ,M5OPAUSE
  ,NATURAL M5OPAUSE IS A SPONTANE\S1
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0ANY M$ICAL 9T]V5;N4 ,9 ! ,WE/]N _W1
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  ,TWO FACTORS T C 9FLU;E ! TIM+ (
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    ,P]IM5OPAUSE
  ,PHYSICAL SIGNS ( M5OPAUSE 2G9 _M
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    ,9DUC$ ,M5OPAUSE
  ,9DUC$ M5OPAUSE1 : C O3UR AT ANY AGE
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UT]US 7HY/]ECTOMY7 DOES N CAUSE
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,:E!R OR N A WOMAN IS A# 6TAKE
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  ..,E6ECTS ( 9DUC$ .M5OPAUSE4
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LOSS ( E/ROG5 MAY RESULT 9 M SU45 &
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  ,! EMO;NAL IMPACT ( 9DUC$ M5OPAUSE
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O/EOPOROSIS ON PAGE #AAJ74 ,H["E1 2C A
M$ICAL 9T]V5;N MAY RESOLVE A *RONIC
H1L? 3DI;N1 "S WOM5 EXP]I;E IMPROV$
H1L? & WELL-2+ ) 9DUC$ M5OPAUSE4

    ,PREMATURE ,M5OPAUSE
  ,M5OPAUSE1 :E!R NATURAL OR 9DUC$1 IS
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#DJ OR "Y]4 ,PREMATURE M5OPAUSE C 2
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  ,WOM5 EXP]I5C+ PREMATURE M5OPAUSE T
IS N M$IC,Y 9DUC$ G "? P]IM5OPAUSE &
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6WOM5 :O R1* M5OPAUSE AT ! TYPICAL
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M YE>S )\T ! B5EFITS ( E/ROG5 & >E AT
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PSY*OLOGICAL 4TRESS = WOM5 :O GRIEVE !
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IMPACT ( PREMATURE M5OPAUSE1 Z WELL Z
EXPLOR+ OP;NS = HAV+ A *1 MAY 2 Z
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  ,= M AB 9DUC$ M5OPAUSE & PREMATURE
M5OPAUSE1 R1D ! ,,NAMS .,E>LY
.,M5OPAUSE .,GUIDEBOOK4            #AA

    ,PREMATURE ,OV>IAN ,FAILURE &
    ,TEMPOR>Y ,M5OPAUSE
  ,PREMATURE OV>IAN FAILURE 7,,POF7 IS
A T]M 6DESCRIBE A 3DI;N T O3URS AT AN
E>LI] AGE ?AN #DJ :5 ! OV>IES 8FAIL0
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P]IODS MAY /OP TEMPOR>ILY DUE
6LIFE/YLE FACTORS S* Z HI< LEVELS (
/RESS1 EXCESSIVE EX]CIS+ &/OR DIET+1
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TEMPOR>Y M5OPAUSE1 N PREMATURE
M5OPAUSE1 Z ONCE A WOMAN ADOPTS A
H1L?I] LIFE/YLE OR /OPS H] M$IC,N1 H]
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    ,PO/M5OPAUSE
  ,PO/M5OPAUSE REF]S 6ALL ! YE>S 2Y
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M5OPAUSE-RELAT$ SYMPTOMS 7S* Z VAG9AL
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,DUR+ ! YE>S 2Y M5OPAUSE1 A WOMAN'S
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DIM9I%$ E/ROG5 LEVELS1 9CLUD+
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ON PAGE #IG = M47

    ,,3FIRM+ ,,M5OPAUSE ,,/ATUS
  ,P]IM5OPAUSE IS A DIAGNOSIS T C
USU,Y 2 MADE 0REVIEW+ A WOMAN'S M$ICAL
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#DJ'S NOTICE >E *ANGES 9 M5/RUAL
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,M5OPAUSE IS 3FIRM$ :5 A WOMAN HAS _H
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IS D"O 6*ECK SPECIFIC HORM"O LEVELS1
ESPECI,Y :5 F]TIL;Y IS AN ISSUE4 ,? C
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MIMIC P]IM5OPAUSE1 S* Z ?YROID     #AC
41SE4
  ,"S"TS1 ELEVAT$ FOLLICLE-/IMULAT+
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PITUIT>Y GL& T TRI7]S ! OV>IES
6SECRETE E/ROG54 ,Z ! OV>IES' PRODUC;N
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AN ELEVAT$ ,,FSH LEVEL IS N USU,Y 5
63FIRM M5OPAUSE4 ,M IMPORTANT1 A L[
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WOMAN IS US+ C]TA9 HORM"O !RAPIES 7S*
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    ,M5OPAUSE ,T]M9OLOGY
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  ,,PREMATURE ,,M5OPAUSE IS M5OPAUSE T
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  ,,PO/M5OPAUSE IS ALL ! YE>S 2Y
M5OPAUSE4

           ,! ,*ANG+ ,BODY         #AE

  ,EA* WOMAN'S M5OPAUSE EXP]I;E IS
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REQUIRES SPECIALIZ$ C>E4 ,_M WOM5 :O H
NATURAL M5OPAUSE REPORT NO PHYSICAL
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6WOMAN1 B =! MO/ "P1 !Y >E P]FECTLY
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M5OPAUSE & M$IC,N4                 #AG
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    ,,*ANGES ,,9 ,,M5/RUAL ,,P]IODS
  ,D N ASSUME T ALL MIDLIFE M5/RUAL
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& N"E H ANO!R P]IOD4 ,H["E1 AB #IJ@3P
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    ,NORMAL ,V]SUS ,ABNORMAL ,M5/RUAL
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_! P]IODS >E NATURAL & NORMAL1 & NO
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*ANGES 9 MIDLIFE WOM5 >E DUE       #AI
6APPROA*+ M5OPAUSE 7SEE PAGE #BA74
,T'S :Y X'S IMPORTANT 6H AN EVALU,N 0A
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  ,IF BLE$+ IS ABNORMAL1 ! CAUSE M/ 2
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REQUIR$4                           #BA

    ,BLE$+ ,AF ,M5OPAUSE
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!RAPY ON PAGE #ADD47

    ,POSSI# ,CAUSES ( ,ABNORMAL ,UT]9E
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9 M5/RUAL P]IODS4
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    ,,REDUC$ ,,F]TIL;Y
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9VOLVE "S RISKS1 & >E N ALW SU3ESS;L4
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    ,:AT ,DOES ,GOV]N;T ,APPROVAL
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                                   #BI
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  ,M5OPAUSE IS N ! ONLY CAUSE ( HOT
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  ,M ?AN TWO-?IRDS ( ,NOR? ,AM]ICAN
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,EVID;E 9DICATES T "S TYPES (
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7,SEE M AB HORM"O !RAPY ) E/ROG5 OR
PROGE/OG5 ON PAGE #ADD47
  ,/OPP+ PRESCRIP;N &/OR NONPRESCRIP;N
H1DA*E M$IC,NS C RESULT 9 REB.D
H1DA*ES4 ,IF H1DA*ES O3UR M ?AN TWICE
A WEEK1 DAILY PREV5TIVE M$IC,NS MAY 2
HELP;L4

    ,MEMORY & ,3C5TR,N ,*ANGES
  ,MEMORY & O!R COGNITIVE 7M5TAL7
ABILITIES *ANGE "?\T LIFE4 ,AG+ IS
ASSOCIAT$ )A TR5D ( DECL9+ P]=M.E4 ,"!
IS NO FIRM EVID;E T MEMORY OR O!R
COGNITIVE SKILLS ACTU,Y DECL9E 2C (
NATURAL M5OPAUSE4 ,H["E1 DI6ICULTY
REMEMB]+ & 3C5TRAT+ >E -MON -PLA9TS
DUR+ P]IM5OPAUSE &! YE>S "R AF
M5OPAUSE4 ,^! DI6ICULTIES (T5 F"R5
WOM51 :O MAY ?9K !Y H E>LY SYMPTOMS (
,ALZHEIM]'S 41SE OR O!R DE;TIA 7SEV]E
LOSS ( 9TELLECTUAL ABILITIES74 ,? IS
R>ELY ! CASE4 ,M RESE>* IS NE$$    #DG
6DET]M9E ! CAUSE ( ^! -PLA9TS4 ,AL?
/UDIES >E LACK+ 6PROVE ! ASSOCI,N1
SLEEP 4TURB.ES & HOT FLA%ES MAY
3TRIBUTE 6^! SYMPTOMS1 Z WELL Z D1L+ )
V>I\S MIDLIFE /RESSORS4 ,REMA9+
PHYSIC,Y1 SOCI,Y1 & M5T,Y ACTIVE MAY
HELP PREV5T MEMORY LOSS4
  ,! ROLE ( HORM"O !RAPY IS UNCLE>1
EV5 ?\< LEVELS ( OV>IAN HORM"OS A6ECT
BRA9 FUNC;N4 ,! EVID;E IS 9SU6ICI5T
6PROVE A COGNITIVE RISK OR B5EFIT (
HORM"O !RAPY />T$ DUR+ P]IM5OPAUSE OR
E>LY PO/M5OPAUSE4 ,= HORM"O !RAPY />T$
AT AN OLD] AGE 7AF #FE71 S"EAL /UDIES
%[ LL OV]ALL COGNITIVE B5EFIT OR H>M4
,"O /UDY F.D T PO/M5OPAUSAL WOM5 :O
/>T ORAL HORM"O !RAPY AT AN OLD] AGE H
AN 9CR1S$ RISK ( DE;TIA )9 #E YE>S (
USE4 7,SEE M AB HORM"O !RAPY ON PAGE
#ADD47
  ,! SITU,N MI<T 2 DI6]5T = "Y] WOM5
"UGO+ SURGICAL M5OPAUSE4 ,SMALL /UDIES
H %[N T EXP]I5C+ M5OPAUSE ABRUPTLY HAS
M ( AN ADV]SE E6ECT ON MEMORY1 &
HORM"O !RAPY MAY B5EFIT COGNITIVE
SKILLS1 AT L1/ 9 ! %ORT RUN4
  ,WOM5 "S"TS USE NONPRESCRIP;N
REM$IES 9 AN EF=T 6IMPROVE MEMORY &
O!R COGNITIVE SKILLS4 ,SUPPLE;TS 3TA9+
! BOTANICAL G9KGO H BE5 %[N 6H NO
E6ECT ON MEMORY1 AT L1/ AF AGE #FJ4 ,!
E6ECTIVE;S ( MO/ O!R PRODUCTS IS N
PROV54 ,M RESE>* IS NE$$ 2F ANY
SUPPLE;T C 2 RECOMM5D$ = ? PURPOSE4
,WOM5 :O >E 3C]N$ AB DECL9+ COGNITIVE
P]=M.E >E ADVIS$ 63SULT ) _! H1L?C>E
PROVID]4

    ,MOOD ,SW+S1 ,DEPRES.N1 & ,ANXIETY
  ,FEW SCI5TIFIC /UDIES SUPPORT !
2LIEF T M5OPAUSE 3TRIBUTES 6TRUE
CL9ICAL DEPRES.N1 SEV]E ANXIETY1 OR
]RATIC 2HAVIOR4 ,H["E1 "S P]IM5OPAUSAL
WOM5 REPORT SYMPTOMS ( TE>;L;S1 MOOD
SW+S1 & FEEL+ BLUE OR 4C\RAG$4
  ,X IS UNCLE> :E!R ^! MOOD SYMPTOMS
>E RELAT$ 6! GRADUAL DECL9E 9 OV>IAN
HORM"O LEVELS1 B SLEEP DEPRIV,N
ASSOCIAT$ ) NI<T SW1TS (T5 RESULTS 9
FATIGUE1 IRRITABIL;Y1 & MOODI;S4   #DI
,ABRUPT HORMONAL FLUCTU,NS DUR+
P]IM5OPAUSE MAY H AN IMPACT ON ^!
SYMPTOMS Z WELL4 ,DUR+ _! REPRODUCTIVE
YE>S1 MO/ WOM5 2COME A3U/OM$ 6_! [N
HORMONAL RHY?M4 ,DUR+ P]IM5OPAUSE1 ?
RHY?M *ANGES1 &! ]RATIC HORMONAL UPS &
D[NS--AL? NORMAL--C CR1TE A S5SE (
LOSS ( 3TROL T C 2 UPSETT+4
  ,DEPRESS$ MOOD DUR+ P]IM5OPAUSE IS
(T5 ASSOCIAT$ )A HI/ORY ( DEPRESS$
MOOD 79CLUD+ ,,PMS7 E>LI] 9 LIFE1 A
L;G] M5OPAUSE TRANSI;N1 OR SEV]E
M5OPAUSE-RELAT$ SYMPTOMS S* Z HOT
FLA%ES4 ,O!R CAUSES ( MOOD 4TURB.ES
DUR+ P]IM5OPAUSE 9CLUDE ?YROID 4ORD]S1
M$IC,N SIDE E6ECTS1 & LIFE /RESSES4
  ,MIDLIFE WOM5 >E N UNA3U/OM$ 6/RESS4
,H["E1 "S MAY 2 ESPECI,Y VULN]A#
6SITU,NS T (T5 >ISE DUR+ MIDLIFE1
9CLUD+ FL.D]+ REL,N%IPS1 DIVORCE OR
WID[HOOD1 /RU7LES ) ADOLESC5TS1 RETURN
( GR[N *N 6! HOME1 UNDESIR$ *ILD.S;S1
3C]NS AB AG+ P>5TS1 & ELD] C>EGIV+
RESPONSIBILITIES 9 A4I;N 6C>E] &
F9ANCIAL ISSUES4 ,AG+ C AL 2 DI6ICULT
9 A SOCIETY T VALUES Y\?4 ,MIDLIFE
WOM5 (T5 EXP]I;E *ANGES 9 SELF-3CEPT1
SELF-E/EEM1 & BODY IMAGE4 ,!Y MAY 2G9
63TEMPLATE _! [N MORTAL;Y & 2COME
9TROSPECTIVE AB ! M1N+ OR PURPOSE ( _!
LIVES4
  ,? "T C 2 AN OPPORTUN;Y = POSITIVE
TRANS=M,N & GR[?1 B "S WOM5 MAY FEEL
OV]:ELM$1 \ ( 3TROL1 ANGRY1 OR NUMB4
,!Y MAY SEEK REFUGE 9 ALCOHOL OR DRUGS
& ?US -P.D _! PRO#MS4 ,9 FACT1 WOM5 >E
M LIKELY ?AN M5 6DR9K ALCOHOL Z A WAY
( D1L+ ) BLUE MOODS1 LOSS OR DIVORCE1
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  ,AL? PSY*OLOGICAL PRO#MS >E N CAUS$
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GET WORSE AT ? "T4 ,SUPPORT &
5C\RAGE;T C HELP WOM5 F9D _! WAY "?
ANY DI6ICULTY 6?RIVE ONCE AG DUR+ :AT
C 2 ! BE/ YE>S ( _! LIVES4
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DESCRIBE S\RCES ( T5.N &           #EA
SYMPTOMS ( /RESS1 B MAY / F9D X
DI6ICULT 6TAKE "T = !MVS4 ,RECOGNIZ+ A
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DEVELOP+ COP+ ME*ANISMS4 ,AL? _M
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WOM5 6MEET LIFE'S *ALL5GES 7SEE PAGE
#EA7 & CR1TE A RENEW$ S5SE (
SELF-3FID;E1 BAL.E1 & H>MONY4

    ,B1T+ ,/RESS
  -- ,"PICIPATE 9 PL1SURA# ACTIVITIES4
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  -- ,EAT ?REE NUTRITI\S M1LS A "D4
,FOCUS ON A DIET T IS L[ 9 FAT1
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ACTIV;Y T FULFILLS M5TAL &/OR _SUAL
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  -- ,5JOY SELF-C>E ACTIVITIES S* Z A
MASSAGE1 P$ICURE1 OR EV5 A LEISURELY
BA?4
  -- ,TRY /RESS REDUC;N & RELAX,N
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  -- ,SEEK PROFES.NAL HELP1 IF NEC4
  ..,:5 M HELP IS .NE$$ 4 ,"S"TS1 COP+
SKILLS & LIFE/YLE *ANGES >E N SU6ICI5T
6RELIEVE SYMPTOMS ( /RESS4 ,^!
SYMPTOMS MAY 2 A SIDE E6ECT ( M$IC,N1
A SYMPTOM (A M$ICAL 3DI;N1 OR ! RESULT
( CL9ICAL DEPRES.N OR ANXIETY4 ,A
H1L?C>E PROVID] C HELP DET]M9E ! CAUSE
( M5TAL H1L? /RESSORS1 ASSESS OP;NS1 &
PRESCRIBE APPROPRIATE TR1T;T4 ,=
EXAMPLE1 MOOD 4TURB.ES BR"\ ON 0SLEEP
DEPRIV,N RESULT+ F HOT FLA%ES USU,Y
IMPROVE :5 HOT FLA%ES >E TR1T$4
  ,DUR+ P]IM5OPAUSE1 :5 LEVELS (
HORM"OS >E ]RATIC1 HORM"O DRUGS S* Z
L[-DOSE ,,OC'S MAY HELP /ABILIZE MOOD
7SEE M AB 3TRACEPTIVES ON PAGE #BD74
,? MAY 2 "PICUL>LY TRUE = WOM5 ^: MOOD
HAS BE5 PREVI\SLY A6ECT$ 0HORM"O
FLUCTU,NS 9 "Y] YE>S1 9CLUD+ ^? :O
SU6]$ F PO/"PUM DEPRES.N OR        #EC
,,PMS4 ,H["E1 NO HORM"O DRUG IS
GOV]N;T APPROV$ = RELIEF (
PSY*OLOGICAL SYMPTOMS4
  ,"S WOM5 USE REM$IES AVAILA# )\T A
PRESCRIP;N 9 AN ATTEMPT 6IMPROVE MOOD
& MILD EPISODES ( DEPRES.N4 ,SUPPLE;TS
3TA9+ ! H]B ,/4 ,JOHN'S WORT MAY 2
HELP;L4 ,SIDE E6ECTS 9CLUDE
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S5SITIV;Y 6SUNLI<T4 ,:5 TAK+ ? H]B1
WE>+ SUNSCRE51 A HAT1 & WRAP>.D
SUNGLASSES IS ADVIS$ :5 9 ! SUN4
,SUNBA?+ M/ 2 AVOID$4 ,/4 ,JOHN'S WORT
RAISES O!R 3C]NS 79CLUD+ N US+ ! H]B )
DRUGS T ALT] BLOOD CLOTT+ S* Z ASPIR9
OR ,C\MAD974 ,3SULT+ )A H1L?C>E
PROVID] IS ADVIS$ 2F USE4 ,_M
PRACTI;N]S AVOID US+ ? H]B = M ?AN #B
YE>S4
  ,ANO!R NUTRI5T1 OMEGA-#C FATTY ACID1
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S\RCES 9CLUDE FATTY FI% 7S* Z SALMON &
TR\T72 SUPPLE;TS >E AL AVAILA#4
  ,M SEV]E DEPRES.N & ANXIETY REQUIRE
SPECIAL ATT5;N4
  -- ,CL9ICAL DEPRES.N4 ,(T5 A
P]IM5OPAUSAL WOMAN W SAY %E FEELS
8DEPRESS$40 ,X'S IMPORTANT T A H1L?C>E
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3DI;N ASSOCIAT$ )A *EMICAL IMBAL.E 9 !
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LA/ = M ?AN #B WEEKS C 9DICATE ?
3DI;N4 ,CL9ICAL DEPRES.N IS N CAUS$
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  ,= SEV]E DEPRES.N1 ANTIDEPRESSANT
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USU,Y NE$$ 6EXP]I;E A DRUG'S FULL
E6ECT1 MO/ WOM5 %[ A M>K$ IMPROVE;T )
^! M$IC,NS & RELATIVELY FEW SIDE
E6ECTS4 ,ANTIDEPRESSANT M$IC,N IS MO/
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PSY*O!RAPY4 ,AL? PROV5 E6ECTIVE = MILD
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E6ECTIVE = CL9ICAL DEPRES.N4       #EE
  -- ,ANXIETY4 ,? IS ! AGITAT$ S5SE (
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0"EY"O AT "O "T OR ANO!R4 ,M5OPAUSE
DOES N CAUSE ANXIETY1 B WOM5 MAY
EXP]I;E M ANXIETY 2C ( H[ !Y REACT
6PHYSICAL & PSY*OLOGICAL *ANGES DUR+
P]IM5OPAUSE C\PL$ ) O!R MIDLIFE
/RESSORS4 ,AL? ANXIETY USU,Y RESOLVES
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8PANIC ATTACK0 9CLUDE %ORT;S ( BR1?1
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  ,ANXIETY C 2 RELAT$ 6DEPRES.N4
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RELIEV$ "? "O ( S"EAL !RAPEUTIC
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  .,SEEK+ .HELP4 ,AL? "S 9DIVIDUALS
FEEL EMB>RASS$ OR EV5 A%AM$ AB REV1L+
_! M5TAL H1L? PRO#MS1 NO "O %D SU6] 9
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(T5 "KL$GEA# & HELP;L4 ,3SULT,N )A
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4ORD]1 IS BE/ PROVID$ 0A C\NSELOR )
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    ,,VULVOVAG9AL ,,SYMPTOMS
  ,DUR+ _! LIFE1 AT L1/ "O-?IRD ( ALL
WOM5 W EXP]I;E "S TR\BL+ SYMPTOMS 9 !
VULVOVAG9AL >EA 7EXT]NAL FEMALE
G5ITALS & VAG9A74 ,^! SYMPTOMS RANGE 9
SEV];Y F MILDLY ANNOY+ 6DEBILITAT+--&
9CLUDE VAG9AL 4*>GE1 IRRIT,N1 BURN+1
DRY;S1 IT*I;S1 & PA9 7BO? )& \TSIDE (
SEXUAL ACTIV;Y74
  ,"! >E _M POSSI# CAUSES (
VULVOVAG9AL SYMPTOMS1 9CLUD+ ! FOLL[+3
                                   #EG
-- ,VAG9AL 9FEC;NS1 S* Z ^? CAUS$ 0A
  Y1/ FUNGUS2
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  C]TA9 VAG9AL BACT]IA T CAUSES A FI%Y
  ODOR & 4*>GE2
-- ,SEXU,Y TRANSMITT$ 9FEC;NS
  7,,STI'S71 9CLUD+ GONORRHEA1
  *LAMYDIA1 OR H]PES1 : MAY CAUSE
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  IT*+2
-- ,SK9 3DI;NS1 S* Z VULV> ECZEMA OR
  LI*5 SCL]OSUS 7CRU/Y1 SCALY SK9 ON
  EXT]NAL G5ITALS7 T >E ASSOCIAT$ )
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-- ,C]TA9 41SES1 S* Z ,CROHN'S 41SE1
  AN 9FLAMMATORY B[EL 4ORD]2
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  SEV]E VAG9AL DRY;S & IRRIT,N2
-- ,9JURY 6PELVIC N]VE FIB]S1 L1D+
  6VULV> BURN+ OR PA9 7"S"TS CALL$
  VULVODYNIA72
-- ,ALL]GIC REAC;NS 6*EMICALS 9 SOAPS1
  BUB# BA?S1 SP]MICIDES1 3DOMS1 FEM99E
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  & PADS2
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  CAP1 LEFT 9SIDE ! VAG9A TOO L;G4

  ,9 A4I;N1 M5OPAUSE C CAUSE
VULVOVAG9AL SYMPTOMS4 ,H["E1 N ALL
WOM5 DEVELOP SYMPTOMS1 OR ! SYMPTOMS
MAY N 2 TR\#"S UNTIL S"EAL YE>S AF
M5OPAUSE4 ,Z WOM5 R1* M5OPAUSE1
DECR1SES 9 E/ROG5 LEVELS MAY CAUSE
TISSUES (! VULVA &! L9+ (! VAG9A
62COME ?91 DRY1 & LESS ELA/IC--A 3DI;N
"KN Z ATROPHY4 ,VAG9AL SECRE;NS
DIM9I%1 RESULT+ 9 DECR1S$ LUBRIC,N4
,LOSS ( E/ROG5 AL RESULTS 9 AN 9CR1SE
9 VAG9AL P,H1 *ANG+ ! H1L?Y ACIDIC
5VIRON;T 6AN ALKAL9E "O T IS M
SUSCEPTI# 6VAG9AL 9FEC;N4
  ,)\T TR1T;T1 ! PRO#M MAY WORS51 &!
VAG9AL TISSUES C 2COME 9FLAM$--A 3DI;N
CALL$ ATROPHIC VAG9ITIS4 ,FRAGILE
VAG9AL TISSUES >E PR"O 69JURY1 TE>+1 &
BLE$+ DUR+ SEXUAL 9T]C\RSE OR EV5 A
PELVIC EXAM9,N4 ,! RESULT+ PA9 C
9T5SIFY 6! PO9T ": SEXUAL          #EI
9T]C\RSE IS NO L;G] PL1SURA# OR
POSSI#4 ,WOM5 :O >E N SEXU,Y ACTIVE
MAY 2 BO!R$ 0VAG9AL DRY;S & IT*+1 & ^!
SYMPTOMS C 2COME M SEV]E )! PASS+
YE>S4
  ,WOM5 >.D ! "T ( M5OPAUSE %D N
ASSUME T VULVOVAG9AL PRO#MS >E DUE
6REDUC$ E/ROG5 LEVELS4 ,SYMPTOMS %D 2
9VE/IGAT$ 0A CL9ICIAN 6ID5TIFY !
CAUSE4 ,ALL WOM5 AT M5OPAUSE & 2Y %D H
A ?OR\<1 REGUL> EVALU,N ( VULVOVAG9AL
H1L?1 REG>D.S ( :E!R OR N !Y H
SYMPTOMS OR >E SEXU,Y ACTIVE4

    ,TR1T;T
  ,A V>IETY ( NONPRESCRIP;N1
NONHORMONAL VAG9AL LUBRICANTS &
MOI/URIZ]S >E AVAILA# 6TR1T VAG9AL
DRY;S4 ,WAT]-BAS$ VAG9AL LUBRICANTS
7S* Z ;,K-;,Y ,P]SONAL ,LUBRICANT1
,A/ROGLIDE1 ,LUBR91 OR ,MOI/ ,AG7
DECR1SE FRIC;N & EASE 4COM=T DUR+
9T]C\RSE4 ,UNLIKE LUBRICANTS1 VAG9AL
MOI/URIZ]S 7S* Z ,REPL5S OR ;,K-;,Y
,L;G-,LA/+ ,VAG9AL ,MOI/URIZ]7 ACT
DIRECTLY ON TISSUE 6RELIEVE DRY;S4
,MOI/URIZ]S MAY 2 PREF]R$ 0WOM5 :O H
SYMPTOMS ( IRRIT,N & BURN+ T >E N
LIMIT$ 6SEXUAL ACTIV;Y4 ,2C MOI/URIZ]S
HELP MA9TA9 AN ACIDIC VAG9AL 5VIRON;T1
!Y MAY AL HELP PREV5T RECURR+ VAG9AL
9FEC;NS4
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USE %D 2 3SID]$4 ,MO/ H& LO;NS 3TA9
9GR$I5TS S* Z ALCOHOL & P]FUME T C
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6PROVIDE LUBRIC,N & RELIEF F
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  ,IF VAG9AL P5ETR,N IS DI6ICULT1 O!R
TE*NIQUES S* Z MASSAGE1 EXT5D$ C>ESS+1
& MUTUAL MA/URB,N 78\T]C\RSE07 MAY 2 M
-=TA# & PL1SURA#4 ,REGUL> SEXUAL
/IMUL,N1 : PROMOTES BLOOD FL[ 6!   #FA
G5ITAL >EA1 C AL HELP MA9TA9 VAG9AL
H1L?4
  ,V9EG> D\*ES OR VAG9,Y APPLI$
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,ANTIHI/AM9E PILLS1 USU,Y TAK5 =
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Z WELL Z ! NOSE4 ,X IS AL ADVISA#
6LIMIT ! USE ( SOAP1 BA? OIL1 & BUB#
BA?S4
  ,SEV]E VAG9AL DRY;S & ATROPHY T >E N
RELIEV$ 0LUBRICANTS OR MOI/URIZ]S MAY
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LACK ( E/ROG5 IS (T5 ! CAUSE (! PRO#M4
,PRESCRIP;N E/ROG5 !RAPY HAS BE5 PROV5
6RE/ORE ! ?ICK;S & ELA/IC;Y ( VAG9AL
TISSUES1 RE/ORE H1L?Y VAG9AL P,H1 &
RELIEVE VAG9AL DRY;S4 ,IMPROVE;TS
USU,Y O3UR )9 A FEW WEEKS ( />T+
!RAPY1 AL? RELIEF ( SEV]E ATROPHY C
TAKE M* L;G]4 ,ALL E/ROG5 DOSAGE =MS
>E E6ECTIVE & GOV]N;T APPROV$ = ? USE1
:E!R !Y >E SY/EMIC OR NONSY/EMIC
7APPLI$ 8LOC,Y0 DIRECTLY 6! VAG9A 9 L[
DOSES 6M9IMIZE BLOOD LEVELS & SIDE
E6ECTS74 ,SEV]E VAG9AL ATROPHY MAY
RESPOND M QKLY 6! VAG9AL =MS ( E/ROG5
7CR1M1 TA#T1 OR R+7 ?AN 6PILLS &
PAT*ES4
  ,VAG9AL E/ROG5 MAY AL 2 APPROPRIATE
= L;G-T]M USE1 Z ABSORP;N 96!
BLOOD/R1M IS M9IMAL4 ,%ORT-T]M VAG9AL
E/ROG5 !RAPY MAY EV5 2 AN OP;N = WOM5
FOLL[+ C.ER (! REPRODUCTIVE SY/EM1 AL?
X IS N E6ECTIVE 9 TR1T+ HOT FLA%ES OR
O!R NONVAG9AL 3DI;NS4 ,RISKS & B5EFITS
M/ 2 WEI<$ 9 EA* CASE4 7,SEE M AB
HORM"O !RAPY ON PAGE #ADD47 ,:5 US+
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#ADD47
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PAGE #ADD47
  ,"S WOM5 W EXP]I;E ACNE >.D
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TOO? S5SITIV;Y1 & DECR1S$ B"O M9]AL
D5S;Y 7,,BMD7 9 ! JAWB"O4 ,:ILE "S (
^! PRO#MS >E RELAT$ 6E/ROG5 DECL9E AT
M5OPAUSE1 O!R CAUSES 9CLUDE ADVANC+
AGE1 9ADEQUATE 9TAKE ( CALCIUM &
VITAM9S1 M$IC,N SIDE E6ECTS1 & M$ICAL
3DI;NS S* Z ANEMIA OR DIABETES4
  ,PRACTIC+ GD ORAL HYGI5E IS
EXTREMELY IMPORTANT4 ,BRU%+ & FLOSS+
DAILY1 REGUL> D5TAL *ECKUPS1 &
PROFES.NAL D5TAL CL1N+ TWICE YE>LY >E
ALL RECOMM5D$4
  ,A WOMAN'S PRIM>Y H1L?C>E PROVID] %D
2 ADVIS$ ( ANY *ANGES OBS]V$ 0H] D5TAL
PROFES.NAL1 Z "S ( ^! *ANGES C 2
9DICATORS ( S]I\S H1L? PRO#MS ELSE": 9
! BODY4 ,= EXAMPLE1 GUM 41SE 9CR1SES
RISK = HE>T 41SE1 & TOO? LOSS C 2 A
SIGN ( "ULY+ B"O 41SE1 9CLUD+
O/EOPOROSIS4

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