The following publications also may help; you'll need to order them:
A U.S. government publication, Menopause, may be ordered from the U.S. Government Bookstore, Room 118, Federal Building, 1000 Liberty Avenue, Pittsburgh, PA, 15222. It costs $3.25.
A pamphlet, Taking Hormones and Women's Health: Choices, Risks, and Benefits, may be ordered from the National Women's Health Network, 514 Tenth Street N.W., Ste. 400, Washington, D.C., 20004. It costs $8 for members and $10 for nonmembers.
Additional reading
Belford-Courtney, Kosalba. ``Comparison of Chinese and Western Uses of Angelica sinensis.'' Australian Journal of Medical Herbalism 1993, 5(4): 87 - 91.
Brown, Donald J. ``Vitex agnus castus''. Clinical Monograph. Quarterly Review of Natural Medicine Summer 1994: 111 - 120.
Okker, Eva-Maria, et al. ``Effects of Extracts from Cimicifuga racemosa on Gonadotropin Release in Menopausal Women and Ovariectomized Rats''. Planta Medica 1991, 57: 420 - 424.
Kaiser, Kyra. ``Cross-cultural Perspectives on Menopause''.
Annals of the New York Academy of Sciences 1990, 592: 430 - 432.
Kronenberg, Fredi. ``Giving hot flashes the cold shoulder--without drugs''. Menopause Management April 1993: 20 - 27.
----. ``Hot flashes: Phenomenology, quality of life, and search for treatment options''. Experimental Gerontology 1994, 29(3 - 4):319 - 336.
Estrogen's role
Menopause, the cessation of menstruation, marks the end of a woman's childbearing years, but hormonal changes leading up to this milestone have begun several years earlier. Each month for some thirty-five or forty years, follicle-stimulating hormone (FSH) from the pituitary gland stimulates the ripening of an egg in the ovary and an increase in the ovarian hormone estrogen. The increase in estrogen signals the uterine lining (endometrium) to thicken in preparation for receiving a fertilized egg and also stimulates the production of luteinizing hormone (LH) in the pituitary. LH triggers ovulation and production of a second ovarian hormone, progesterone, which continues preparing the endometrium for implantation of the egg. If the egg is not fertilized, however, the production of progesterone declines, and the endometrium is shed as menstrual fluid.
During these years, a feedback system involving the hypothalamus and pituitary (both in the brain) and the ovaries keeps production of the various hormones in balance. At some point, however, usually in a woman's midforties, the amount of estrogen and progesterone secreted by the ovaries declines. Ovulation and menstrual periods become irregular. When ovulation ceases completely, progesterone no longer is produced, but some estrogen is, so the endometrium continues to build up as usual. Without progesterone to regulate the cycle, however, it grows and grows until it breaks down, causing spotting. Not until estrogen levels become too low to stimulate endometrial growth does menstruation stop once and for all.
What are hot flashes?
Hot flashes usually affect women who are in the transition to menopause or in menopause, either naturally or because of medical intervention. They often occur during the first two years of menopause and decrease over time; for some women, hot flashes begin during menstruation.
The frequency and intensity of hot flashes vary from woman to woman. A "typical" hot flash lasts three to six minutes; it can last thirty. Hot flashes can occur over six months to two years--or up to forty years. They occur spontaneously and without warning signs, although some women link them to psychological stress, a hot environment, and caffeine or alcohol consumption.
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