Q. If using antidepressants for symptom relief of hot flushes, for how long would these be required or is it once you start you have to keep taking them? how do they work.

Antidepressants can be taken to help control hot flushes for anywhere from a few months to several years. Their mechanism of action is uncertain.

Q. Are there any tests women should have on regular basis to check overall health including hormones' level, thyroid perhaps etc ...? Thank you.

General check ups become more important as we reach midlife and beyond. As well as a physical examination for blood pressure, etc. recommended tests include:

• fasting cholesterol
• glucose for diabetes
• pap smear
• mammogram
• faecal occult blood

Sometimes other tests such as thyroid, liver or kidney function are ordered. Hormones relating to menopause are rarely ordered because in the perimenopause they are so erratic and after menopause they do not give any extra useful information.

Q. Is there a male menopause?

The closest thing to a “male menopause” is the fact that testosterone levels (in men and women) tend to decrease gradually as we get older. There is no equivalent to the complete loss of ovarian function that occurs in midlife women.

Q. Do perimenopausal women tend to need more sleep?

Perimenopausal women often suffer from disturbed sleep and may need to sleep more to make up the difference in quality.

Q. Can premenstral dysphoric syndrome develop perimenopausally and how is it best treated ? Is it often just mistaken and diagnosed as depression ?

PMDS can develop in the perimenopause and can easily be mistaken for, or co-exist, with depression. Treatments include strategies that are used to help with the effects of depression such as healthy lifestyle including exercise, managing stress, counselling and antidepressant medications, in particular the SSRIs. In addition the oral contraception pill can help to prevent the hormonal changes that occur prior to menstruation.

Q. I used to be very clean in the house now I do not seem to care

Physical symptoms of menopause like hot flushes and fatigue often means we have less energy. First make sure that you are properly treating the physical symptoms that can impact on everyday tasks and motivation. If this is related more to mood it may be helpful to discuss these changes with your GP to make sure there isn't an underlying depression. If it is because of stress, try and deal with what is causing the stress and try writing down a few things to do each day that are achievable and manageable. Then you will have the satisfaction of achieving at least a few tasks towards a clean house. Some women get to this stage of life and decide the little things like the house don't matter and that is very enlightening. Decide how much distress you feel by not caring if the house is clean. If it is a problem then seek help. Take one task at a time and remember to look after your needs at this busy time of life.

Q. Why do you recommend we see our doctor if our periods get heavier?

In the perimenopause occasionally heavy periods are a sign that the lining of the uterus is becoming abnormally thickened and rarely may be a sign of a cancer of the uterus. These are the reasons why we recommend a woman to see her doctor to make sure she does not have these conditions.

Q. Are there any rituals that women can do to acknowledge this important time in one's life?

Rituals can build identity and help shape emotions when we face major events in our life. Some women describe menopause as a new stage, the beginning of a time for me, or an ending such as the end of fertility; remember each woman will see it differently. Think about what menopause means for you and then think how you would like to acknowledge it, if at all.

Maybe call a gathering of friends. If you are in a trusted environment then ask some questions of each other:

• What does menopause mean to you?
• Is this a beginning or an ending?
• What would you like to do for you at this time of life?
• What have you always dreamed of doing?

Really any ritual is up to you, your friends and family and what feels important and right for you.

Content Updated April 30, 2008