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Once a month, when you’re suffering from cramping, bloating, moodiness and fatigue, do you imagine menopause as a dream where your menstrual cycle ends? That, like a butterfly, you’re freed from monthly changes forever?

Think again, my friend. Estrogen, the hormone that makes a woman a “woman,” controls not only female menstrual cycles and fertility but also sleep patterns, bladder control, bone density, muscle mass, mood, mental clarity and even the tightness of your grip. And rarely does anyone warn you what those changes can feel like—or even that they’re coming.

Why is talking about menopause shied away from like a shameful secret? Younger women don’t ask what’s happening when they see older women sweating like the Fourth of July in the middle of December, and older women going through it oftentimes don’t tell. Changes in how we perceive our sexuality are so deeply tied to our self-esteem—both culturally and personally—that any diminishment of those powers can feel like a total loss of self. The mental changes are as real as the physical ones, yet there is very little open conversation in our culture, or among women.

Every woman has soldiered through rough menstrual cycles, knowing the end was in sight in a few days. Menopause is not your period. Studies show that menopausal symptoms can occur anytime of the day or night, and endure for up to as long as 14 years in African-American women (versus the average of 11.5 years in white and Asian women). Black women are also more likely to suffer the effects of estrogen-related symptoms like night sweats and loss of bladder control than other ethnic groups. Eating a meal, exercising, falling asleep, drinking caffeine, consuming sugar or alcohol can all be triggers for hot flashes in menopausal women. So, basically—living.

Overwhelming, right? Exercise and hormone replacement therapy can help to control those symptoms. Hormone therapy is either ingested as a pill or compounded in cream form to be rubbed on the fattiest part of your inner thigh, or as a patch worn continuously on the body between the heart and the waist. Each of these treatments is associated with less hot flashes and increasing libido, but their popularity with both physicians has been on the decline since studies linked them to an increased risk of breast cancer.

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Alternatively, low-dose vaginal suppositories pose less of a risk and can be helpful in reducing the vaginal dryness in menopausal women associated with painful sex.

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Your OB/GYN is your first line of defense, but not your only or last resource for coping with menopause. There are gynecologists who specialize in treating menopausal women and are deeply attuned to prescribing hormonal cocktails to alleviate not only physical symptoms but also the anxiety and depression that often accompany “the change.” For instance, Menopause Confidential by Dr. Tara Allmen is one of the most comprehensive—and funniest—guides around.

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Postmenopause, there are also noninvasive laser procedures that can help restore vaginal elasticity and function. The aptly named V-Spot clinic in New York City offers the “Femilift,” an outpatient procedure that requires three visits over a period of as many months. It helps correct excessive tightening of the vaginal canal associated with menopause, which is especially common in women who have not experienced vaginal birth and/or have only had cesarean sections.

Conversely, Femilift can also help to correct bladder incontinence caused by vaginal childbirh and/or hormonal changes. The treatment, which takes about 20 minutes per visit, is widely hailed to be virtually painless. Unfortunately, like most treatments involving women’s reproductive health, Femilift is not covered by insurance.

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As women, the most important thing we can do for one another is talk often and openly, and support each other around issues concerning our health and well-being—sexual and otherwise. Although fully 50 percent of women say they don’t experience any symptoms of menopause, it’s still important to be informed and know how the other half lives. You never know when you might join the tribe.