First some definitions. Menopause is officially designated when a women has stopped having menstrual periods for one year or when blood tests show that there are very high levels of pituitary hormones called gonodatropins. Gonoadotropins are hormones that are released by the pituitary gland in the brain to signal the ovary to mature and release an egg each month. The hormone levels have a patterned rise and fall each month during a woman's reproductive years. Levels become very high once the ovary is no longer able to respond to these hormones and ovulation no longer occurs.

Perimenopause is the term given to the years that lead up to menopause. In these years, the ovary is starting to decline in function and an egg is no longer released consistently each month. Sometimes months go by without a normal ovulation. If hormone levels are checked in these years, the gonadotropins can be normal to mildly elevated. The associated symptoms can be hot flashes, night sweats, fatigue, mood changes and weight gain. Perimenopause may last for years.

The symptoms of hot flashes and night sweats can be explained by the erratic fluctuations in hormones that occur in these years. Physicians have been able to treat women who seek relief from these symptoms with hormone replacement therapy. Hormone replacement therapy has long been controversial and has been more so since the Women's Health Initiative trial published in 2002 showed that women who took the synthetic hormone prempro were more likely to experience heart attacks or strokes. Prior to this study, the thought had been that hormones protected a woman's heart because women experience more heart attacks and strokes after menopause but have a much lower incidence of these cardiovascular conditions compared to men in their premenopausal years. At this time, the recommendations are for women to use hormone replacement therapy if needed in the years of menopause if the physical symptoms are unbearable but try to use hormones for as short a time frame as possible. And it is no longer recommended that women take hormone replacement therapy to prevent heart disease, which was what many physicians had recommended prior to the WHI.

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). Dr. Cederquist is the founder of Bistro M.D., a home diet delivery program that specializes in low calorie gourmet food that is delivered to your home or office. Bistro M.D. serves as culmination of Dr. Cederquist's expertise and experience in the world of medical weight loss.