What if I don't choose to take hormones? There are several important considerations if you choose not to take hormones which, I feel, is a very viable option. First, what is your risk of osteoporosis? If it is extremely high or you are unwilling to follow the recommended dietary and lifestyle recommendations, estrogen may be your best bet. In my experience, hot flashes are not difficult to treat. Vitamin E (assuming you don't have high blood pressure) may work for you). If not, constitutional homeopathy is extremely effective. Vaginal dryness often responds to Vitamin E suppositories. Several of my patients have recommended a product called Slippery Stuff, which I know nothing about, to ease their vaginal dryness during intercourse. I always assess a woman's Ayurvedic body type (a 5000 year-old, extremely comprehensive form of medicine from India)to individualize recommendations for menopause. There are also a number of herbs which have estrogenic (Burdock, Sage, Dong Quai, Cimicifuga, and others) or progesteronic (Licorice, WIld Yam, Smilax) properties. Supplementation with a high-quality multi-vitamin and mineral, calcium (best in the form of calcium citrate which is significantly better absorbed than other forms of calcium), vitamin D, and boron (a trace mineral which has been shown recently to significantly reduce urinary excretion of calcium and magnesium and to cause an increase in serum beta-estradiol, a form of estrogen). It is important for women not on estrogen, particularly those who don't follow the above dietary recommendations carefully, to take between l200 and l500 mg. of calcium daily, preferably half with meals (hydrochloric acid stimulates calcium absorption) and halfat bedtime (because phytates, found in some high complex carbohydrates, interfere with calcium absorption). It is important to realize, however, that calcium supplementation by itself, has not panned out, in recent studies, to significantly prevent osteoporosis. Magnesium increases calcium absorption and should also be taken daily. I also use another supplement containing Vitamin K and parathyroid which further enhances calcium absorption. Regular aerobic exercise for at least 20 minutes 4 to 5 times a week is, for post-menopausal women, an absolute necessity to prevent osteoporosis. It can also be very helpful to support the woman's liver during this time, since the liver is responsible for breaking down estrogen and a sluggish liver will make estrogen less available in the body. This can be done through herbs, lipotrophic factors, and liver cleansing.

The psychological and spiritual aspects of menopause. The post-menopausal years can be a truly wonderful and gratifying period of a women's life, maybe even the best ever. It is a time, for most women, when they no longer have to attend to children and can focus more love and attention on themselves and their own needs. There is no longer the concern about becoming pregnant, which is a relief to many women, and make make sex a freer experience. And there is the opportunity to enjoy the fruits of one's professional, personal, and spiritual wisdom. In India, the time when one's children are grown is considered the beginning of sanyas or renun-ciation for men or women who so choose. They are encouarged to spend the rest of their life seeking their Oneness with God. If you find yourself, during or after menopause, filled with despair, resentment, fears about the future, get help so that this can be the beautifully rewarding change in your life that you have waited for and so fully deserve.