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Menopause, like puberty, is a time of exquisite change--a time of fluctuating hormones, of shifting biological and menopause priorities. But unlike puberty, we don't celebrate menopause. We dread it. We ignore it. We treat it as an illness.

"Some people have this idea that menopause means that you're old; that we're somehow outliving what's natural for us," says Neal Barnard, M.D., author of Eat Right, Live Longer (Harmony Books, 1995) and Foods That Fight Pain (Harmony Books, 1998). "To which I say, `That's a lot of hooey.' There's just as much life after menopause as there was before it."

That's likely to be good news to the 4,000 U.S. and Canadian women who reach menopause each day. According to the North American Menopause Society, women go through menopause at an average age of 51--and by the year 2030, 1.2 billion women worldwide will be 50 or older.

Menopause, technically, takes place on the first anniversary of the day you had your last menstrual period (assuming there are no other medical reasons to explain the absence of menses). The stuff we spend so much time obsessing over--mood swings, hot flashes and erratic periods, which on average last for three and a half years--actually occur during what's called peri-menopause. Once the big anniversary has come and gone, you're postmenopausal and, according to health statistics, at increased risk for heart disease and bone fractures due to osteoporosis.

But there are many things you can do to make the passage from peri- to post-menopause a peaceful one and to make yourself comfortable once you've gotten there. Many of them can be done easily and naturally, without overmedicalizing a very normal and indeed exhilarating part of your life.

HRT OR NOT?

The decision whether to take hormone replacement therapy (HRT) is one that every perimenopausal woman faces. In addition to its recognized benefits in protecting against osteoporosis, HRT can also decrease hot flashes and vaginal dryness, keep skin supple and may ward off Alzheimer's disease.

Yet women are increasingly opting against HRT. An estimated 20 million prescriptions are handed out for HRT drugs each year, making Wyeth-Ayerst Laboratories' Premarin, the basic estrogen formulation, the most prescribed drug in this country for the past seven years. But 30 percent of women given HRT prescriptions never take them to their pharmacies, according to a 1997 report in the American Family Physician. Of the women who do choose HRT, 60 percent discontinue it within a year. And 80 percent of postmenopausal women in the United States do not use any form of HRT at all.

Why? Part of it is, of course, the serious inherent risks--with breast cancer topping the list. Then, too, the fact that Premarin is extracted from the urine of pregnant mares--not to mention the purportedly inhumane conditions under which these horses are kept and the slaughter of most of their foals for meat--makes it a non-option for many women.

The argument against HRT grew even stronger last year, when a major multi-center study of more than 2,700 postmenopausal women with heart disease found that taking HRT initially raises their risk of heart attack and over a four-year period gives them no heart-health advantage over women who don't take hormones. And yet, HRT's protection against coronary disease has been among the most touted and was the primary reason many women considered hormone therapy in the first place.

But even without that particular benefit, taking hormones of one sort or another may make sense for some women. There are HRT options that are less ethically questionable than Premarin. One is a prescription-only mixture of three estrogens (estrone, estradiol and estriol) derived from soybeans. This phytoestrogen mix, known as tri-est, is available from compounding pharmacies (specialty retail outlets such as the Women's International Pharmacy in Madison, Wis.) that blend their own pharmaceuticals.

SOY FAR, SO GOOD

In Japan, women so rarely experience hot flashes that their language doesn't even have a word for that symptom. On the other hand, eight out of 10 menopausal American women reportedly experience these "power surges." The explanation for the discrepancy, experts say, can be found in our diets.

"There's nothing like getting on a healthy diet way in advance," says Barnard. "If you go on a very low fat, plant-based diet in the years before menopause, the amount of estrogen in your blood decreases [because fat cells release estrogen] and so your body adapts to having less estrogen. In America, women are typically on high-fat diets. When you add menopause, when the ovaries stop making estrogen, it all comes crashing down. The symptoms you have are primarily [estrogen] withdrawal symptoms."

Barnard says that by cutting dietary fat to 20 percent of total caloric intake, premenopausal women can reduce their estrogen levels by a third, making menopause a much less dramatic transition. Barnard himself recommends an even more fat-restricted diet--10 percent of total calories and no dairy products. This eating plan will bring down estrogen levels by 50 percent, he says.

Other experts believe that the way to stave off menopause's "hormonal hangover" is with a hair of the dog that bit you. That means eating foods that are rich in plant-based estrogens, or phytoestrogens, which affect the body in some of the same ways that the human version of estrogen does. But because they're a bit weaker than estrogen, phytoestrogens don't come with many of estrogen's downsides--including the risk of breast cancer. At least one type of phytoestrogen--genistein--has been reported to actually stop estrogen from getting to estrogen-dependent breast cancer cells by filling up the estrogen receptor sites on those cells itself, thus blocking the tumor's growth.

Soy products offer one of the best ways to get phytoestrogens into your diet. Clinical studies have shown that in addition to cutting cancer risk, soy can lower cholesterol, and it may reduce the risk of heart attack and shore up weakening bones. However, cautions Sadja Greenwood, M.D., M.P.H., assistant clinical professor of obstetrics and gynecology at the University of California at San Francisco and author of Menopause, Naturally: Preparing for the Second Half of Life (Volcano Press, 1996), "We shouldn't rely on using the isolated soy protein in protein powders that are now sold for shakes and found in things like candy bars. You do better eating the whole food rather than taking an isolated part. It's not only the soy protein that's effective in working against heart disease and certain cancers."

Of course, tofu, tempeh and the like do not have a monopoly on the phytoestrogen market. Other foods bursting with plant-based estrogens include alfalfa, flaxseed, seaweed, wheat, corn, oats, almonds, cashews, peanuts, peas, lentils, corn, papaya and apples.

According to Woodstock, N.Y., herbalist Susun Weed, author of Menopausal Years: The Wise Woman Way (Ash Tree Publishing, 1992), what a menopausal woman needs to know can be summed up in a single word. "Minerals," she asserts. "Minerals from natural sources. No pills."

When Weed talks about minerals, she's talking about a lot more than calcium, the best-known supplement for menopausal women. "Focusing on any one mineral will not be very helpful," she says. "For instance, taking only calcium leads to brittle tissues. Chalk is made of calcium--taking calcium supplements will make your bones as strong as chalk. What you need is the entire spectrum of minerals--not just calcium but magnesium, manganese, potassium, sodium, selenium and zinc."

In fact, scientists looking into dietary requirements for the new government guidelines--the DRIs, or dietary reference intakes that replace the older recommended daily allowances (RDAs)--say that menopausal women don't need much more calcium than their premenopausal sisters (the DRI is 1,200 milligrams [mg.] for women over 50) and that HRT status doesn't play a role as previously believed. In addition, they say, vegetarians and people who are lactose-intolerant don't need to up their calcium intake beyond the recommended levels, either.

One of the best ways to get a variety of minerals in useful amounts is through eating seaweed and cooked greens like kale, spinach, collards and chard. And you want to eliminate certain foods from your meal plans, notes Barnard. "Keep the calcium in your bones by adjusting your diet. Sodium costs you calcium--it encourages the loss of calcium through the kidneys. Cutting sodium intake down to a gram or two a day is as good as taking a calcium supplement of hundreds of milligrams. Animal protein, too, encourages the loss of calcium through the urine."