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

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.

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