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Q: I am now 54 and going through menopause. I notice about three days before and three days after my period that I have itching and a runny nose, like my seasonal allergies. My psychiatrist said that I might be allergic to one of my hormones. I am also taking Xanax and Effexor. Could either of them be causing this problem?

-- C.H., Buffalo

A: The formal medical definition of menopause is the cessation of all menstrual flow for 12 months. The time leading up to this point is called pre- or peri-menopause. However, most women and many doctors use the term menopause, as you do, to include all of the time prior to stopping menstruation.

The average age of onset of menopause is 51 years. Premature menopause, defined as onset before the age of 41, occurs in approximately 5 percent of women.

The symptoms of menopause result from a decrease in estrogen and other closely related hormones. This decrease is associated with normal aging, but it will occur after surgical removal of the ovaries, regardless of age. The effects caused by changing estrogen levels vary for each woman.

Unless the change results from surgery, the onset is gradual and can occur up to five years before menstruation stops. It can be an uncomfortable nuisance but can also lead to some serious problems.

The most common symptoms during peri-menopause are hot flashes and night sweats. Hot flashes are a sensation of warmth spreading across the skin. Hot flashes usually occur across the face, neck and upper chest, but they can occur in other places as well. They often go away without treatment within a few years, but this can be an insufferably long time.

Some women have emotional problems during this time. While there's no evidence that the menopausal process causes severe mental health problems, mood swings and episodes of anxiety can occur. It's hard to separate out the cause of these emotional problems because menopause often coincides with other major life changes, such as departure of children from the home, midlife crises, divorce and a feeling of loss of youth.

Vaginal dryness, thinning of the vaginal wall and pain during vaginal intercourse are also quite common. And these problems tend to get worse over time.

An itchy and runny nose, as experienced in seasonal allergies, is not a symptom I've heard of in women going through peri-menopause. It might be a reasonable guess that any symptom was related to changes the hormone levels. But these levels are not the same three days before and three days after your period.

Many medications cause an allergic response in some patients, and that is true for Xanax and Effexor. But, even if you were allergic, it would not explain only having symptoms when you do. If this continues to be a problem, I suggest you consult with a gynecologist.

Many women experience only mild peri-menopausal symptoms and choose not to have treatment. For others, estrogen replacement has been the treatment of choice while their bodies adjust to lower estrogen levels.

Estrogen replacement therapy (called ERT or HRT) reduces many of the symptoms. For years doctors commonly recommended it because they thought it protected against heart disease and stroke, as well as not having any major risks.

I do recommend exercise (it's good for everything else anyway), as well as black cohosh and increasing soy products in the diet.

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