Menopause is that period of life when estrogen and progesterone production, ovulation, and menstruation stop; it is a natural part of a woman's life. The average age that women reach menopause is 51. The years leading up to menopause, called perimenopause, usually occur between ages 45 and 55. Perimenopause differs from woman to woman. During this time, estrogen production declines. Some women menstruate regularly until their periods suddenly stop. Others may see changes in the amount of menstrual flow or the length of time between periods. Still others have missed periods or bleeding between periods. Up to 75 percent of women have hot flashes as they approach menopause. The flashes—a sudden flushed feeling that usually begins near the chest and spreads to the neck, face, and arms—usually last three to four minutes. They can occur as often as once per hour or as infrequently as a few times a month. Hot flashes can happen any time of the day or night. They may wake you from sleep (called night sweats). They may continue to occur for as long as five years, as your body adjusts to the lower production of estrogen and progesterone. Perimenopausal women may have sleep problems because of night sweats or insomnia. Lack of sleep can affect moods, health, and ability to function. Vaginal and urinary tract changes can occur as estrogen levels fall. The vaginal lining gets thinner and drier. The lining of the urinary tract also becomes thinner, and tissue supporting the bladder may weaken. These changes can cause urine to leak with sneezing, lifting, or other exertion. This is called stress incontinence and can be helped by doing Kegel exercises or corrected with surgery. A woman's risk for heart disease and stroke increases after menopause. A woman's own natural estrogen may help to protect the heart and blood vessels by decreasing the LDL ("bad") cholesterol and increasing the HDL ("good") cholesterol in the blood and by having positive effects on blood vessels. Although hormonal therapy (HT) may help relieve menopausal symptoms, it does not appear to prevent heart disease and increases the risk for breast cancer. Take steps to reduce your risk for heart disease by eating a healthy diet, exercising regularly, maintaining a healthy weight, avoiding smoking, and following your treatment plan if you have diabetes or high blood pressure. Until a woman turns 30, her body builds bone. After age 30, bone is broken down faster than it is replaced. Mild bone loss will not cause problems. But when the loss becomes excessive, bones weaken and fractures occur. Talk with your doctor about ways to help prevent excessive bone loss and fractures. Oral HT can relieve vaginal dryness, reduce or end hot flashes, and help bladder symptoms. HT, however, increases other health risks. For vaginal dryness and urinary incontinence, a prescribed vaginal cream that contains estrogen may be helpful. Water-based lubricants can make sexual intercourse less painful. Talk with your doctor to find out what is best for you. Nonhormonal measures also are available to help relieve menopausal symptoms. Herbal products containing estrogen-like substances are not recommended for control of symptoms because their quality cannot be assured and many of their effects have not been studied. Below are some other self-care steps for menopause: Dress in layers and wear loose clothing. Drink plenty of water. Do weight-bearing exercise for 30 to 60 minutes a day most days of the week. Avoid caffeine and alcohol, which can intensify hot flashes and cause insomnia. Eat a balanced diet that includes fruits and vegetables, 1,000 to 1,200 milligrams of calcium, and 400 to 800 IU of vitamin D. Achieve and maintain a healthy weight.