Hormone Replacement Therapy. Natural progesterone creams made from the Mexican wild yam plant. Herbal mixtures of black cohosh, red clover and Dandelion root. Homeopathic remedies such as sepia and belladonna. Plant nutrients called phytoestrogens. The list goes on and on.
If you're heading for the menopause and worried about being a little more confused at this life stage, you will be - if only from the choice of treatments on offer to help you cope.
In the United States, you will find up to 50 books on the menopause in the self-help _section of many bookshops. And, we are quickly following the trend of reading all about the possible symptoms of and treatments for the menopause - sometimes years before experiencing the onset of a hot flush or night sweat. Thoughts of the peri-menopause (or pre-menopause) are even striking fear into the hearts of women still in their thirties.
Are we in danger of over-medicalising what is essentially an inevitable life stage for all women? Are women at risk of being taken for a ride by pharmaceutical companies keen to sell them hormones for another five to 10 years after their female contraceptive needs have been met?
And can women reliably and safely choose from the increasing array of over -the -counter alternative products said to alleviate everything from hot flushes to vaginal dryness?
"Women are more independent nowadays and they want to know what's in front of them," says GP Dr Mary Shortt. "They want to know will they be able to manage the menopause themselves, what treatments are available and what are the consequences of these treatments," says Dr Mary Short, general practitioner and Dr Short is a member of the Saffron Initiative Steering Committee. In the late 1990s, the Saffron Initiative carried out a survey of women's knowledge, understanding and awareness of their lifetime health needs and the menopause.
Dr Shortt continues:, "Women will try alternative therapies and I don't find anything inappropriate about that as long as they know what they are trying. For example, phytoestrogens (plant hormones) will protect against flushes and sweats as a natural ingredient but not in powdered form because the process of making the tablet destroys the active ingredient. I'd have more of a problem with progesterone creams, because analysis by the British Menopause Society found that you would need about a tub-full a day to get a significant amount through absorption."
In Ireland, about one in 10 menopausal women take HRT (compared to one in four in the US). Eighty per cent of these women pay for their own treatments - that's at between a cost of £8 to £20 per month for up to 10 years.
Dr Shortt says points out that HRT won't solve all the potential problems associated with the menopause, but she believes it suits most women.
"No amount of HRT will give you the elixir of youth - that's down to your genes and the amount of prematurely ageing sunshine you've been exposed to. But, it will treat symptoms such as hot flushes and vaginal dryness (which makes intercourse painful and causes recurrent urinary tract infections) and protect against the more morbid consequences of the menopause, such as heart disease, osteoporosis and perhaps Alzheimer's disease," she says.
The downside: HRT is associated with an increased risk of endometrial cancer and breast cancer. Dr Brendan Fitzpatrick, Dublin, is a medical doctor in Dublin who includes acupuncture, homoeopathy and nutritional advice in his treatments. approaches. He believes the ever-widening choice of over-the-counter remedies for menopausal symptoms can be confusing.
"There is more and more evidence that there are viable alternatives to HRT, but people can select remedies that are unsuitable or take them in the incorrect dosages or for the wrong length of time," he says.
"A lot of women aren't sure why they are going on HRT. In some ways, the menopause has become tied up with the decision of whether to take HRT or not and it is about much more than that," he advises. "HRT is only one option and women have to be sure why they are taking it. Is it for short-term relief of symptoms such as hot flushes, or is it for long-term protection against heart disease and osteoporosis? If you have no family history of either of these conditions and you are relatively healthy in other ways, you should think long and hard before taking HRT," continues Dr Fitzpatrick.
"I think in the future HRT will be reserved for particular cases. rather than the generally advised treatment. Menopausal symptoms such as sleeplessness, low energy levels and bladder problems can all be treated with natural approaches." This will cost you money too - perhaps as much as HRT.
Ruth Appleby, homeopath and author of Menopause - The Common Sense Approach (Newleaf £5.20), says that most of the menopausal women who come to her are already on HRT as it has been the only treatment offered to them. She believes that women who have general good health should experience fewer problems in the menopause.
"The menopause is a natural stage in every woman's life. Every woman can go through this process naturally and gracefully, and come to the realisation of the wisdom we have gained in our lifetime so far. The menopause should not be the end of the road but the beginning of a new adventure," she writes.
Aideen Hurley, owner of the Evergreen health stores in Galway, city, believes the medical profession is are pushing women into taking HRT. Experiencing the menopause herself for the past two years, she refused HRT and opted instead for herbal preparations to help her cope with hot flushes and night-time sweats.
"I have found the hot flushes more severe and intense than I had expected. When I have one, I feel dreadful. I feel like my body is going to explode. I've found wild yam cream (£15 for a month's supply) quite effective and I've also taken another herbal preparation called Menoherbs (£11.99 for 90 tablets). I think women are better able to tell what their own bodies need rather than someone telling them what to take," she believes.
"In our health stores, we have a lot of women coming in who have been on HRT for 10 to 15 years and they want to come off it now but are afraid they will have all the symptoms again," says Hurley.
Dr Shortt says that by gently phasing out HRT, women will not experience a resurgence of symptoms. She and advises women to explore all their treatment options. She says women heading into the menopause should have a health check which includes a smear test, a breast examination (and a mammogram if over 50), a fasting blood sugar test, and checks a check on thyroid function, cholesterol levels and haemoglobin levels if she has they have been having heavy periods.
"Inform yourselves about the symptoms of the menopause, be pragmatic about your family history of osteoporosis, heart disease and Alzheimer's disease and listen to what your family are saying about how you are coping," she advises. "Sometimes, you might think you are dealing with symptoms while your family may not."
In the US, there is a new network of "menopause mentors". Maybe this is what women need most - wise women who will share their experiences with younger women, passing on practical advice and knowledge about how to best to pass through these sometimes turbulent years, reflecting on milestone events, celebrating achievements and mourning losses whilst looking ahead to life after the menopause.
Information taken from the Saffron Report on Women's Lifetime Health Needs. Nationwide Country-wide information meetings on the menopause held in conjunction with the Irish Countrywomen's Association will begin again in September. Tel:01 4734305 for details.