My first foray into the subject of menopause and hormone replacement therapy began back in 1991 as part of my research for my first book, Making the Estrogen Decision. Although the major landmarks of the menopausal transition remain the same, an incredible explosion of information has changed all the road maps. Typing in the word menopause on Medline, the premier database of published medical studies maintained by the National Library of Medicine, recently yielded over 20,000 matches! Ten years ago, there might have been at most 25 book titles about menopause and midlife health issues for women. Now, logging on to Amazon and typing in the word menopause can yield up to 500 matches. Reflecting the groundswell for alternatives, the words holistic, homeopathic, natural, healing, and gentle are more likely to be included in book titles on managing the menopausal transition.

In the ensuing years since I first began this research, one other change has occurred on a personal level. The signs and symptoms that I reported on ten years ago are now happening to me. The transition has begun, and there are days when I'm not so sure I'm happy about this!

Women who are facing menopause often have a feeling of uncertainty. They may fear loss of control or feeling "out of sorts." Having no set expectations makes the anticipation worse. While a minority of women report no symptoms of menopause, the usual course is that a woman will begin feeling changes during the perimenopause (peri, meaning "around"), which can last from two to five years leading up to menopause. One perimenopausal woman complained to me, "I just want to feel like I did before. I don't feel like my old self. I don't want things to change!"

But change they most probably will. There is no predicting your own passage through menopause -- it may be long or short, bumpy or smooth. Nor can you foresee the time when you will begin it. Some women may be able to rely on their mother's history as foreshadowing, but it does not always follow that a daughter's menopause mimics her mother's pattern. Your mother may have had a hysterectomy, in which case you have no precedent for the timing of a natural menopause, which usually happens around age 50. Many women have had a surgical menopause, in which the ovaries as well as the uterus are removed, and for them menopause is immediate. Carol, now 55, recalls waking up with intense hot flashes the day after her hysterectomy. An early menopause (younger than age 45) is also not uncommon and may take a woman who's been trying to conceive by surprise. Women who have been amenorrheic (without menstrual periods) because of overexercising or anorexia nervosa may be dealing with the same issue of estrogen depletion that a 50-year-old menopausal woman is. In these latter cases, replacing estrogen becomes more important because of the extended number of years without it. So the issues of women who are going through a natural menopause often align with concerns of those younger women who are already dealing with the consequences of estrogen loss.

Dealing with menopause will be both more hopeful and more frustrating for the current generation of midlife women -- the "boomers" --than it was for their mothers. "Hopeful" because we're better equipped to ferret out our own health and medical information and able to speak up and act as our own advocates in health care decision-making. "Frustrating" because definitive answers about the best and most effective therapies for bone, heart, breast, and brain health are still unknown. As Carolyn Kaplan, M.D., a reproductive endocrinologist and associate professor at the Emory University School of Medicine in Atlanta points out, the "information is not there." By this, she means the long-term studies that would show whether estrogen replacement is beneficial to heart and bones, and whether it can cause cancer. These are the big questions that have yet to be answered.

In addition, Dr. Kaplan notes, "Women have conquered contraception and child spacing and most feel that there is greater equality in the workforce. But there is still not enough interest in terms of research dollars being directed toward menopause." Women at this stage in their lives tend to be take-charge people, juggling jobs, families, and social and volunteer activities. Menopause is something we don't control, and that can be annoying. Who can predict when a hot flash is going to happen? Or when you'll have a bad night plagued by insomnia and feel sub-functional the next day? Or how you'll really feel the first time lovemaking becomes unpleasant because you have no vaginal lubrication? These changes can all be manageable, but that doesn't mean you won't have strong emotions about them.

Whenever and however menopausal changes appear, it can be valuable to have information beforehand, and while you're experiencing menopause. Studies have shown that women who are prepared to take charge of their own health care tend to do best through the menopausal passage. Information can function as your survival kit as you negotiate your way through this very important change in your life.

Becoming well informed is not easy. To whom can we turn for reliable, safe, and personalized health care information? For whatever reason, most women are not getting all the information they need about menopause from their doctors. Research has revealed that only about 'of women in menopause receive education about the process from their doctors. Incursions of managed care, with its emphasis on cost-containment, almost guarantee that the physician's time is at a premium. Nonetheless, the information that needs to be imparted about menopause is often complex and takes some careful discussion. One of the solutions to the scarcity of a doctor's time versus the patient's need for information has been to provide classes, often conducted by nurse practitioners. As Judith H. LaRosa, Ph.D., former deputy director of the Office of Research on Women's Health at the National Institutes of Health, comments, "The nurse is the one who does the counseling. It's absolutely crucial that you get a nursing perspective, too."

In her practice at the University of California at San Francisco, Mt. Zion Faculty Practice gynecology office, Janis Luft, N.P., M.S., believes all perimenopausal women who come into the office should have the information about the health concerns of menopause and what lifestyle changes they need to confront in order to address those health issues.

"Probably the majority of us will live through our 70s into our 80s," Luft points out. "How well we live into our 70s and 80s is the issue.... All women need to have a health program as they enter menopause."

To have a health program, you'll probably need to put together a health care team of specialists as well as general practitioners on whom you can rely for guidance and counseling. As you seek such resources, you may find yourself confronting a variety of philosophic and economic issues.

For instance, in addition to getting the most out of our health care dollar, many of us have begun to voice concerns about the remedy most recommended by Western medicine for menopause and the years after: hormone replacement therapy (HRT). Many women view HRT, given most commonly in pill form, as drug treatment. They favor looking to alternative solutions, for the following reasons:

* They're uncomfortable about taking a medication for the rest of their lives.

* They're worried about the possible (though still not conclusively proven) link between HRT and cancer.

* They're unwilling to continue with a medication that's adding side effects and discomfort when it should be relieving their symptoms.

Even mainstream Western medicine, which has scoffed at alternative healing methods, has begun to reconsider its stance. Several large medical institutions, such as Memorial Sloan-Kettering Cancer Center in New York City, now have departments of integrative medicine, in which allopathic physicians, those trained in traditional methods of Western medicine, work to integrate their practices with homeopathic and complementary healing techniques. Some physicians now work in affiliation with acupuncturists; some herbalists have clients who also take hormone therapy. Perhaps most important, growing numbers of physicians recognize that a sound health plan requires participation and cooperation between patient and physician. These are the physicians who trust in their patients' intelligence, good sense, and ability to make the right choices when given full information.

This shift in attitude, I'm convinced, has much to do with pressure from consumers. We as women want to know what will work best for us, and we're seeking information in a variety of places. As I researched and gave presentations for my book Making the Estrogen Decision one theme kept recurring: Women are unsure about taking hormones for the rest of their lives. They want to know: Is it possible to do this the "natural" way? Can hormonal and herbal therapies be combined?

In answer to such questions, I formulated the central mission of The Menopause Sourcebook: to provide a compendium of resources, both traditional and alternative, to help you cope with the physical and emotional challenges that often accompany menopause. The Menopause Sourcebook puts at your fingertips the information you'll need to handle this life-altering event.

If you've had an early or surgical menopause, and can't or won't take estrogen, this sourcebook belongs to you, too. You may not find all your particulars addressed, but you'll learn how to find the most reliable and recent information, what science does and does not know about this aspect of a woman's physiology, and what sort of issues to take into account in formulating your own health plan. The "Best Resources" section at the end of each chapter offers print and organizational sources of information that can become the core of your health plan. Web site addresses and other Internet resources have also been included.

It is my hope that The Menopause Sourcebook will be the beginning of your own personal survival kit for menopause -- a place to go for referrals, to learn how to assess and evaluate treatments and remedies, practitioners, and attitudes toward aging. This book will provide you with sources of support and suggestions on how to formulate your own health plan with your physician. Remember that not every bit of information is going to apply to you. You should take from this sourcebook what makes sense and is relevant to you. My purpose is also to stimulate you to ask more of the questions necessary so that the decades following your menopausal transition will be ones of health and renewed purposefulness and activity.

I have observed, as have others working in health education and preventive medicine, that women often benefit from sharing experiences and emotions in a supportive and mutually beneficial way. A "menopause management" class I attended at Kaiser Permanente's Sunset Boulevard facility in Los Angeles is an example of how a group can provide a forum for both emotional support and reliable information. Following a two-hour lecture, each woman in the group was asked to share some personal details about why she had come to the class. Most were hesitant at first. Then, as first one and then another of the women began speaking, the others smiled, laughed, or nodded in agreement and recognition:

I was taking estrogen for menopause, and seven months later I had to have a breast biopsy for a suspicious lump. I went off the hormones. Now my hot flashes have started again, but I'm still scared to death to take the hormones. I want to know what I can do.

I don't think I'm in menopause yet, but I notice that I've just been so nervous lately, and fearful. Something is changing, but I'm not sure what.

When I was a girl, my mother really helped me with my first period. She talked to me and prepared me for what was going to happen with my body. But now I find I don't have any preparation for menopause. This is just one more stress in my life!

My doctor suggested that I come to this class. I'm starting to get hot flashes and he is in favor of hormones, but I'm not so sure.

At the end of the discussion period, most of the women reported that they still had questions and would return for the next class meeting for more information. But they could see that they weren't alone -- everyone in the room had unresolved issues. They had arrived as strangers, feeling isolated with their symptoms. Now they could see that other women were going through a similar quest. Not all their resolutions would be the same. But it was clear that they had taken the first step in managing their menopause: seeking out information and support.

Let The Menopause Sourcebook provide you with a support group in writing, guiding you to the information you need and want.