Fear.

Men have it, when they think of their wives, mothers, or sisters suddenly becoming more emotional, less sexual, with the expanding waistline.Women have it, when they feel the hot flashes, the food cravings, the mood roller coasters.

But menopause isn't something people should fear, says one Utah doctor. It's actually a good thing.

"Menopause is a gift," said Kirtly Parker Jones, an associate professor of obstetrics and gynecology at the University of Utah. "Women would die if they had children late in life, say when they're 60."

Menopause is a mysterious thing, for women, men, and doctors. Data on the subject emerged for the first time not 100 years ago, which is just a blip on the time line of human evolution, Jones said.

In fact, the name itself is widely misused. "Menopause" is actually the last natural period in a woman's reproductive life and refers to a four-day process that signals the pause or stoppage of menses. For the average white American woman, the event occurs at about 51 years of age.

"When women say `menopause,' they really mean the transition from reliable reproductive function to the post-reproductive phase," Jones said. "It's generally a four to eight year transition period called `perimenopause,' or as I like to call it, `climacteric.' "

The most reliable indicator that the transition has begun is irregularity or stoppage of menstrual periods, Jones said. It is caused by a decline or failure of ovarian function.

Other changes commonly associated with "menopause" are less than universal. Hot flashes are often linked to menopause, though Jones said not all women experience them. They occur as a woman's body attempts to adjust to radical changes in its hormonal environment, a part of which includes the regulation of body temperature.

Mood disturbances, weight gain, memory loss, insomnia, decreased sexual desire, joint pain and headaches have also been associated with perimenopausal hormonal changes. But Jones said it's more difficult to identify a direct, causal link between these occurrences.

"Women tend to feel that all of them are related to their ovaries, when only some of them are," she said. "Some may be related to aging in general, or they may be related to certain psychosocial events surrounding a woman in midlife, or they may be biological in origin. It doesn't mean they're not real and troublesome."

What it does mean is that choosing a method of dealing with menopause is very personal. Some women find great relief from estrogen and other hormone therapies, Jones said. For many women, the reintroduction of hormones alleviates the hot flashes, migraines, and extreme mood fluctuations that are often the source of frustration.

Hormone replacement therapies (HRT) appear to have other benefits as well. Clinical studies indicate that women who have HRT generally have lower risk of osteoporosis and osteoporotic fractures, both crippling and potentially life-threatening conditions.

Estrogen taken after menopause has been shown to slow bone loss. And, one therapy that combines estrogen and androgen - a hormone produced in the ovaries and adrenal glands that play a key role in musculoskeletal health - was shown not only to slow bone loss, but may actually stimulate bone formation.

HRT may also decrease a woman's risk for coronary cardiac disease, Alzheimer's disease, macular degeneration (the most common cause of blindness in older women), colon cancer and dental disease.

Jones said there are even some new "designer estrogen" therapies on the horizon that promise the benefits of estrogen but without the increased risk for certain types of cancer that steers many women away from hor-mone replacement.

For some women, however, HRT is not an appealing option. The National Institute on Aging reports that doctors may warn against HRT for women who have high blood pressure, diabetes, liver disease, blood clots, seizures, gall-bladder disease or a history of cancer.

The NIA also said some women have side effects from HRT, including vaginal bleeding, headaches and nausea.

The primary concerns surrounding HRT, though, are the risks for cancers of the uterus and breast, which appear to be elevated in some women as a result of the therapy.

HRT isn't the only answer, though. There are other ways to handle the transition.

"Not everyone needs to take hormone replacements," said Jones. "Personally, I think estrogens are an excellent option for many women. But, there are lots of options out there for women who don't (think so)."

Jones offers three tips:

- Stay active - regular exercise is good for the body and soul, she said.

- Eat right - get proper nutrition, with adequate vitamin D and calcium for strong bones.

- Abstain from smoking.

- Have a purpose - having positive emotional and mental stimulation is absolutely key to getting through menopause, Jones said.

"The best predictor of having a difficult transition is believing you're going to have one," she said. "On the other hand, a good attitude is the best predictor of longevity."

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ADDITIONAL INFORMATION

Resources on menopause, hormone therapy

More information on menopause and hormone replacement therapy is available from the following organizations:

- The American College of Obstetricians and Gynecologists (ACOG) offers the following pamphlets: Hormone Replacement Therapy, Preventing Osteoporosis, and The Menopause Years. To obtain a copy, send a self-addressed stamped envelope to: ACOG, 409 12th St. S.W., Washington, D.C. 20024-2188.

- The North American Menopause Society (NAMS) answers written requests for information. Write: NAMS, 11100 Euclid Avenue, 7th Avenue, McDonald Hospital, Cleveland, OH 44105.

- The National Institute on Aging Information Center has information on menopause, osteoporosis, and a variety of topics related to health and aging. Write: P.O. Box 8057, Gaithersburg, MD 20898-8057. Or log onto their Web site at www.aoa.dhhs.gov/aoa/pages/agepages/hormone.html.