Back in chapter 4, you learned that FSH kicks in at puberty to cause the follicles to mature and the eggs to ripen. At menopause after all the eggs are gone, FSH starts sending stronger and stronger signals. You might think of this as though the FSH is frustrated because there's no response! The high level of FSH is normal and it's not harmful at all.
By now menopause is no longer shrouded in secrecy and women who would never have discussed their periods in polite company wisecrack about their hot flashes anywhere from the office to cocktail parties. However, all the empowering bravado about "red-hot mamas" aside, the infamous symptoms can be truly disabling for plenty of women. You probably already know about the hallmark complaints. Along with hot flashes, women experience erratic periods, sleep disturbances, night sweats, memory lapses, and mood swings. Some women also have heart palpitations, "pins and needles" or "crawly" skin, joint pain, headaches, and breast tenderness. Another postmenopausal symptom is facial hair that sprouts when estrogen levels drop and androgens predominate. My postmenopausal sister-in-law was only half joking when she told her daughters to pluck out her chin hairs if she's ever too frail or demented to do it herself!
Reduced libido can also happen. However, the reason you're not in the mood may have more to do with physical issues such as a dry vagina and the thinning skin of your labia than with an actual lack of desire. Sex during menopause is such an important topic that I've devoted a whole section of this chapter to it. (Okay, skip ahead if you can't wait, but promise me you'll come back and read all of the other life-enhancing information I have for you as well!)
Hormone Therapy (HT): Boon or Bane?
As you know by now, I am against thinking of any medication as a magic bullet that gets you out of the need to take what I call the "Lifestyle Pill." Later in this chapter I'll go over what you can do not only for symptomatic relief during menopause but also for a lifetime of good health in your new postmenopausal body. However, as a physician and as a woman myself, I strongly believe that there is also a place for safe and effective hormone therapy in the lives of vast numbers of women. I've already discussed testosterone therapy for low libido in chapter 2. Now I'm going to explain estrogen and progesterone therapy for menopausal symptoms and as protection against certain health problems. I know that you may well be confused about whether or not HT is a good option for you. HT's history has always been fraught with controversy.
To clarify the salient issues for you in the most succinct manner possible, I'm going to present them first as a list. After you've studied the bullet points and absorbed a basic understanding of this complex and often confusing topic, you can go on to read my in-depth explanation that follows the list.