Answer from Dr. Prior: First of all it sounds like you are very close to 'graduation!' That's what I consider menopause--you will reach that when you have been a year without flow. Menopause is a normal part of every woman's life and doesn't need any treatment. However, if it came before the age of 40, or if you know you have osteoporosis (especially if you also have hot flushes) or if you have persistent, disturbing hot flushes then and only then does menopause need treatment. We have learned from the Women's Health Initiative Estrogen plus Progestin trial results that hormone therapy is not healthy for menopausal women who don't have one of those three situations mentioned above. We now know the same about estrogen therapy.

This is the time of perimenopause when you are more likely to experience hot flushes and night sweats. But often if they only start now they are mild and go away quickly. You may also notice some vaginal dryness. That usually only needs some water soluble (over the counter) lubricant.

I trust you have looked at the BCERF website (www.bcendocrineresearch.com) which has the article 'Perimenopause The Ovary's Frustrating Grand Finale'. That will help you understand perimenopause which it sounds like you have almost completed. There is also information on our Centre for Menstrual Cycle and Ovulation Research website (www.cemcor.ubc.ca).

Now's a good time to think positive and look ahead to many healthy years. You don't need a specialist. You can deal with your family doctor for any problems. If you live in BC and have a perimenopause problem you and your family doctor can't solve, you can ask your family doctor to phone me.

Perimenopause can be quite rough, and it sounds like you've had a difficult time of it. You can rejoice when it is over!

Question: I need your help. I had a total hysterectomy five weeks ago. Since then, I am literally falling apart, and cannot get the doctors here to either listen to me, or else I cannot get an appointment at all. I guess they don't consider endocrinology an emergency. I am basically treating myself because the doctors aren't listening to me.

I switched from Premarin to Menest because I thought the Premarin made me feel mentally foggy. I discovered that Premarin does contain androgens (they don't tell you that) because it was making my skin break out. I am now taking a .625 Menest and a .3 Menest every day because on the .625 alone I was still having night sweats. It seems, however, that I am still not getting as much estrogen as on the Premarin because my skin is still dry, and I don't know if Menest has as much or any androgens in it as Premarin.

Now for the worst part, the part I need immediate help with. Since the hysterectomy, I have arthritis symptoms almost overnight. I can't get an appointment with an endocrinologist here. I've been trying to get an appointment with an endocrinologist who can write prescriptions for compounds because I think my DHEA, which used to be high, and other hormones are all messed up.

The doctors, my OB/GYN group, pooh-poohs me when I try to talk to them about it. They won't order blood work yet, but I am extremely chemically sensitive, and drugs affect me immediately.

I don't know what to do. I am at my wit's end about all of this. I need to get the right treatment so I can go on with my life.

Thank you very much.

Answer from Dr. Prior: It sounds like life is pretty rough right now. I will do my best to provide you with some ideas and support. However, I can't really know what is going on without having seen you and taken a history as well as done a physical exam.

It is not uncommon to feel badly after having a sudden removal of your ovaries. The natural menopause or perimenopause transition is a more gradual process with spikes and dips over about 10 years.

The first and most important thing is that you get a prescription for oral micronized progesterone (Prometrium) 100 mg and take 3 capsules at bedtime (as long as you aren't allergic to peanuts--the medicine is in peanut oil). This will help your sleep (improves deep sleep by 15%), help the estrogen to control night sweats and may also help your joint symptoms.

I strongly suggest that you use a kind of estrogen that is a patch or a gel rather than a pill. We now know that important risks for blood clots (increased by 211% over placebo) occur in menopausal women on estrogen pills. Estrogen delivered through the skin is less likely to cause clots.

Other things that will help with the hot flushes/night sweats are some regular exercise and some relaxation (such as yoga). I'd also recommend 400 IU of vitamin E, 1200 mg of calcium/day (with 500 mg at bedtime) and at least one multiple vitamin to provide 400 IU of vitamin D. Calcium has been shown to decrease PMS-like symptoms in a randomized double blind trial.

I don't know anything about you and what you do and what supports you have. But I would urge you to be with people you trust, to talk with close friends or family and to start thinking about what you are good at and that you want to do with the rest of your life. It is really easy, when life/hormones/health are disrupted as yours have been, to focus on illness and lose perspective.

Please also go to the Centre for Menstrual Cycle and Ovulation Research website at: www.cemcor.ubc.ca. You will also find the Daily Menopause Diary that you can use to track changes you are experiencing. Knowing changes helps you to better understand and deal with them.

I know that you will soon start to feel better.

Jerilynn Prior is a Professor of Endocrinology at the University of British Columbia and an internationally know expert on women's health.