All perimenopausal and postmenopausal women should see their health care provider annually for a full physical exam. This exam should include a breast exam, pelvic exam, and mammogram.

Women should learn about the risk factors for heart disease  and colon cancer from their health care professional and consider being screened for these diseases.

Women who are still menstruating and are sexually active are at risk of becoming pregnant (even if their periods are irregular). Birth control pills containing low doses of estrogen can be useful for perimenopausal women to prevent pregnancy  and to relieve perimenopausal symptoms, such as hot flashes. Doctors may check the FSH level of women aged 50 years to determine if they have reached menopause.

Over-the-counter medications, prescription medications, and lifestyle changes, such as diet and exercise, help control hot flashes and other menopausal symptoms, including high cholesterol and bone loss.

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Hot flashes: Several nonprescription treatments are available, and lifestyle choices can help.

• Soy protein is a popular remedy for hot flashes, although data on its effectiveness are limited. Some doctors recommend 60 grams of soy protein, or about 2 cups of soy milk, daily. Soy contains phytoestrogens, or natural plant estrogens (isoflavones), which are thought to have effects similar to estrogen therapy. The safety of soy in women who have a history of breast cancer has not been established, although clinical studies indicate soy is no more effective for treating symptoms than a placebo. Soy comes from soybeans and is also called miso or tempeh. The best food sources are raw or roasted soybeans, soy flour, soy milk, and tofu. Soy sauce and soy oil do not contain isoflavones.
• Regular aerobic exercise was found to reduce hot flashes.
• Foods that may trigger hot flashes, such as spicy foods, caffeine, and alcohol, should be avoided.

Heart disease: A low-fat, low-cholesterol diet helps to reduce the risk of heart disease.

Weight gain: Regular exercise is helpful in controlling weight.

Osteoporosis: Adequate calcium intake and weight-bearing exercise are important. Strength training (lifting weights or using exercise bands in resistance training) can strengthen bones.

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Black cohosh (Remifemin) is a commonly used herbal supplement that is believed to reduce hot flashes. However, small German studies that tested black cohosh only followed women over a short time period. The German agency that regulates herbs does not recommend using black cohosh for longer than 6 months. Side effects can include nausea, vomiting, dizziness, visual problems, slow heartbeat, and excessive sweating. Black cohosh is not regulated by the U.S. Food and Drug Administration, so women must be careful about the safety and purity of this supplement.

Inconclusive and conflicting studies indicate that other herbals, such as dong quai, red clover (Promensil), chasteberry (Vitex), yam cream, Chinese  medicinal herbs, and evening primrose oil, should be avoided or taken with care under the supervision of a health care provider to avoid unwanted and dangerous side effects and interactions.

According to the National Center for Complementary and Alternative Medicine, other nonprescription techniques may relieve the symptoms of menopause. These techniques include meditation, acupuncture, hypnosis, biofeedback, deep breathing exercises, and paced respiration (a technique of slow breathing using the stomach muscles)

Menopause cannot be prevented; however, steps can be taken to help reduce the risk factors for other problems associated with menopause. At a 1994 National Institutes of Health Consensus Conference, the recommendation was made that postmenopausal women not on estrogen therapy consume 1,500 mg of calcium daily to prevent loss of bone mineral density. Women on estrogen therapy should consume at least 1,000 mg of calcium daily.

The least expensive way to obtain calcium is through diet. Diet can easily provide 1,000-1,500 mg of calcium daily. The following foods contain calcium:

• One cup of milk (regular or fat-free/skim) - 300 mg
• One cup of calcium-fortified orange juice - 300 mg
• One cup of yogurt (regular or fat-free) - about 400 mg on average
• One ounce of cheddar cheese - about 200 mg
• Three ounces of salmon (including the bones) - 205 mg

Dietary calcium supplements are a good option for women who cannot consume adequate calcium through diet. Calcium carbonate is the least expensive, although some women complain of bloating. Calcium citrate may be better absorbed by women who take acid-blocking medications, such as ranitidine (Zantac) or cimetidine (Tagamet).

Calcium products made from bone meal, dolomite, or unrefined oyster shells may contain lead and should be avoided. Products with "USP" on the label meet the voluntary quality standards set by the United States Pharmacopeia and are more likely not to contain harmful contaminants.

Women should carefully read the label of calcium supplements to check the exact number of milligrams of elemental calcium in each supplement. The intestinal tract generally does not absorb more than 500 mg of elemental calcium at a time, so calcium intake should be spread out during the day.

Women should not take excessive doses of calcium due to the risk of kidney stones. Women with certain medical conditions, such as sarcoidosis or kidney stones, should consult their health care providers prior to taking calcium supplements.

Vitamin D plays an important role in calcium absorption, but megadoses should be avoided. The National Osteoporosis Foundation recommends 400 International Units (IU) for women and men aged 51-70 years and 600 IU for people aged 71 years and older. Most multivitamins contain 400 IU of vitamin D.

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