READ EXCERPT: 'Ask Dr. Marie,' by Marie Savard

ABC News medical contributor Dr. Marie Savard tackles the most intimate questions women have about the female reproductive system in her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions." In a tone a best friend or sister might take, Savard explains what's normal and what women should do when they believe they have problems.

Savard tackles issues according to life stages, moving from menstruation to menopause and beyond. She also describes how to get the health care you need and ways to make the most of the little time you have during a doctor's appointment.

Read an excerpt of the book below, and head to the "GMA" Library for more good reads.

Chapter 6

The Bonus Years
Making the Most of Menopause and Beyond

In This Chapter
What Happens during "The Change"
Hormone Therapy (HT): Boon or Bane?
Health Strategies to Help You Live Long and Well
Behind Closed Doors: The Best Sex Now

The average life expectancy of a woman born in 1900 was forty-nine. Since the age when most women have their final period is about fifty-two, she might not have reached that milestone. You, on the other hand, are statistically likely to be around to enjoy a substantial number of years when birth control is no longer necessary, the nest is empty, and retirement or an "encore career" has made the rat race a mere memory. In addition, the low-maintenance pleasures of grand-parenting may be yours. And if you're lucky enough to be among the estimated 20 percent of women who experience few or no menopausal symptoms, you may sail through this life event wondering what all the fuss is about when it comes to the debate over the various types of Hormone Therapy including bio-identical hormones. Still, no less a source than the National Institutes of Health reports that some 60 percent of women have symptoms bothersome enough to merit treatment. What's more, an additional 20 percent have symptoms that are severe and even disabling. In other words, menopause is no picnic for a great many women. I speak from experience! Also, even women who have an easy time of it need to learn to live well with the new reality of a postmenopausal body.

Lost in the chorus of conflicting claims about what women should or shouldn't do for symptomatic relief of menopausal symptoms is the fact that menopause ushers in lasting transformations in a woman's body. In other words, menopause really is a "change." After you have had your final period ever and the hot flashes— if any—simmer down at last, you are different in six important ways. Some of these are attributable solely to menopause while others also have to do with the effects of aging in general. Together they constitute that "new reality" I mentioned and they all need your attention if you're going to maintain your health.

Here is what will be new about your postmenopausal body.

1. The risk of heart disease increases. As estrogen levels decrease, we lose our edge over men when it comes to warding off cardiac problems and strokes.
2. Belly fat increases. Our fat distribution shifts from the protective "pear-shaped" zone around the hips and thighs to the more dangerous "apple-shaped" zone of belly fat typical of men. This puts us at higher risk for metabolic syndrome, type 2 diabetes, and the cascade of conditions this disease can engender.
3. Blood pressure goes up. Even women who have always had low blood pressure and who are not overweight or sedentary can experience an increase that puts the BP higher than the recommended 130/80.
4. Metabolism slows down, but mostly this happens if you slow down and lose fat-burning muscle mass.
5. Bone density decreases. Virtually all postmenopausal women eventually have a condition called osteopenia. The risk of fractures goes up and if osteoporosis develops, the risk of fractures goes up further still.
6. Vulvar tissues atrophy. All menopausal women experience a thinning of the tissues of the vulva including the vagina, urethra, and the labia that can lead to problems. Almost half develop a more advanced version commonly called atrophic vaginitis (discussed later in this chapter).

What Are the Definitions of "Perimenopause," "Menopause," and "Postmenopause"?
The term "perimenopause" first appeared in the Merriam Webster dictionary in 1962. The literal meaning is "around the menopause." Perimenopause refers not only to the years when ovulation has started to shut down, usually during the mid-forties, but also to the twelve months after the last period ever. This is because cessation of the menses can only be diagnosed retroactively. All the years after perimenopause are called postmenopause although symptoms may persist. Technically, the word "menopause"—and it's not a pause at all but a full stop!—refers only to the last menstrual cycle. Remember, you won't know for sure that it was the final one until twelve months have passed with no periods. However, in popular parlance "menopause" is most often used to refer to the whole process. For example, people say, "She's going through menopause." Even doctors often refer to "menopausal patients."

I, for one, find facing up to these realities of the postmenopausal body to be empowering rather than depressing. Knowing the truth about how we have changed inside gives us the opportunity to take preventive measures that will keep us well.

You won't be surprised to hear that I'm going to hit home once again my message about making wise lifestyle choices. In addition though, as you'll learn later in this chapter, my Five Factors for Selecting a Hormone Therapy Option can also help you as long as you are not on my list of those for whom HT is not a good option. Incidentally, HT is sometimes called hormone replacement therapy (HRT) or menopause hormone therapy (MHT). The terms are interchangeable.

Because I'm a doctor of internal medicine who treats the whole patient rather than a gynecologist who focuses on the reproductive system, my mission is to make you aware of how menopause and aging affect your entire system. A lot of us tackle the external markers of aging by coloring our hair, using "age-defying" or "rejuvenating" skincare products, or perhaps opting for plastic surgery. That's fine if those surface upgrades make you feel good about yourself. But how much better it is to team them with smart strategies to combat the effects of the internal transformations of the third age of our lives! I'll detail those strategies for you including a safe, effective, and protective HT regimen with FDA-approved bio-identical hormones. I use it myself. First, though, I want you to understand exactly what goes on as you progress through perimenopause.