The majority of women do not experience a voice change during menopause. Rarely, some women may lose the upper register of voice.

Although many women do not experience any additional facial hair growth, it can be a problem for some. There are a number of hair removal options available to you, including waxing, depilatories (liquids or creams that remove body hair) and laser hair removal. Check with your doctor or a medical aesthetician to determine the right hair removal method for you and to ensure that it will not harm your skin.

You will know for sure that you have experienced menopause when you have not had your period for an entire year. Until you have gone one year without a period, you should still use birth control if you do not want to become pregnant. You should continue to practice safe sex techniques with use of latex condoms to reduce risk of sexually transmitted infection.

While hot flashes (or flushes) are very common in perimenopause, not all women experience them, and not all flashes are of the same intensity. Hot flashes can be as mild as a light blush or severe enough to wake you from a sound sleep (called night sweats). Most hot flashes last 30 seconds to 5 minutes. They usually disappear within a few years after menopause. However, up to 10-15% of women experience hot flashes for years.

Compared to regular birth control pills, the lower dose of estrogen in very-low-dose pills may be safer for perimenopausal women. (Perimenopause begins about 3 to 5 years before your final period.) While regular birth control pills contain 30 to 50 micrograms of estrogen, these low dose pills contain only 20 micrograms of ethinyl estradiol.

In addition to preventing pregnancy, the pills can regulate heavy or irregular menstrual periods and may provide protection from ovarian and uterine cancer. The pills may also prevent bone loss, which can lead to osteoporosis . However, women with a history of breast cancer, blood clots, or heart disease, or women who smoke, should not take these pills.

While menopausal hormone therapy (HRT) relieves hot flashes for many women, there are other drug treatments that may offer relief. These include both over-the-counter and prescription therapies. Over-the-counter therapies you may want to try include Vitamin B complex, Vitamin E, Ibuprofen and soy protein found in foods.

Prescription treatments include:

• Bellergal-S, a combination medicine used to treat some symptoms of menopause. However, based on side effects and the butalbital-an additive substance in Belergal-S-it is not recommended by the North American Menopause Society (NAMS) www.menopause.org .
• Catapres, Catapres-TTS and Aldomet blood pressure medications. However, based on the side effects, these drugs are not recommended unless a woman has hypertension.
• Antidepressants Zoloft, Paxil, Effexor (Note: Paxil has been shown to reduce tamoxifen levels)
• Other hormones, such as Provera and Megace

As with all medicines, there are risks and benefits. Scientists continue to study the long-term effects of HT. The most recent study found that Prempro, a type of menopausal HT, increased a woman's risk of blood clot and stroke, and slightly increased the risk of being diagnosed with breast cancer. Estrogen alone has not been shown to increase the risk of breast cancer. If you are concerned about taking menopausal HT, talk to your doctor; there are other options.

Botanical products containing or acting like estrogens may provide some of the benefits of estrogen in relieving menopausal symptoms, but are not as well studied. Other botanicals, including black cohosh, have also shown promise for reducing menopausal symptoms. However, more research is needed to define the benefits and risks of these alternative treatments, and you should always check with your doctor before using them.

The pain you are experiencing during sex is likely due to vaginal dryness associated with declining estrogen levels. There are a number of lubricants you can try. Ask your doctor or pharmacist for a suggestion. There are local estrogen treatments-cream, tablets, and an estrogen ring-for women desiring treatment of vaginal atrophy.