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

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.

What Happens During "the Change"
In the 1970s when menopause was still a taboo topic, the groundbreaking television show All in the Family aired a now-classic scene in which Archie Bunker, a lovable working-class bigot, loses patience when his wife has a hot flash while eating soup:

Archie Bunker: I know all about your woman's troubles there, Edith, but when I had the hernia that time, I didn't make you wear the truss. If you're gonna have the change of life, you gotta do it right now. I'm gonna give you just thirty seconds. Now c'mon and change.

Edith Bunker: Can I finish my soup first?

If only menopause were so simple! Unfortunately, we don't have an inner switch that would turn off female fertility with one flick. Instead, the process is a gradual one during which the ovaries produce less and less estrogen, progesterone, and testosterone. Your adrenal glands do go on making a certain amount of testosterone and other hormones, some of which are then changed to estrogen in your fat cells—especially belly or "visceral" fat cells. However, this estrogen is not as potent as what you once had. All of these hormonal changes work together to precipitate a disruption of your previously regular cycle of ovulation so that your periods become unpredictable and often heavy. Over time, about ten years for most of us, any eggs and follicles that are still left in the ovaries degenerate. When the last available egg ripens and travels down one of your fallopian tubes, you have your final period. As I said, the last period usually happens at the age of fifty-two although smokers typically go through menopause several years earlier than that. Keep in mind, though, that you won't know you're no longer fertile until a full year has gone by with no periods, so do continue using birth control—and condoms even after that to protect against STIs if you have new partners.

Also, if you're taking birth control pills (see sidebar on birth control pills on page 189) or cyclic HT, you won't know when your egg production stops because you'll continue to experience "withdrawal bleeds" every month. However, the bleeds from HT will eventually lighten and may disappear altogether, especially if you're at a healthy weight and don't have excess belly fat. Still, you may want to get a blood test to confirm that you've gone through menopause and can safely stop using contraceptives. You will need to stop your hormones for five days or more before getting this simple blood test that will show that you are producing a very high level of follicle-stimulating hormone (FSH).

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