After the Women's Health Initiative's disturbing findings, the latest of which were released last week, millions of menopausal women were taken off hormone replacement therapy. Thus, women who are more fit and active than any generation before them are left with sleeplessness, hot flashes, moodiness, headaches, vaginal dryness, difficulty reaching orgasm and-or low libido.

The groundswell that is building among this population of women is undeniable. This is the generation that spearheaded the women's rights movement and the sexual revolution. And they most certainly do not intend to struggle through menopause silently. These women have challenged every taboo, been active participants in their health care decisions and informed themselves every step of the way.

Today, a woman can expect to live one-third of her life after menopause, and baby boomers are clear that struggling with its symptoms is no way to live. The average age of menopause is 51, and right now there are more than 40 million American women over 50.

It should also be mentioned that it's not just menopausal women who experience these hormonal changes and the accompanying symptoms, but perimenopausal women are at risk as well. Perimenopause is defined as the period of time before menopause when a woman's menstrual cycles may become irregular and her hormone levels begin to decline. Symptoms may include hot flashes, disturbed sleeping patterns, bone loss and high cholesterol. Some women experience perimenopause as early as age 35.

So what's a girl to do?

We tell our patients that hormone therapy alone, should they even choose to take it, may not be enough. For it to be most effective, it should be accompanied by good nutrition, regular exercise and a detailed stress reduction plan.

It is extremely common for menopausal and perimenopausal women to struggle with metabolic changes resulting in weight gain. The body has a much harder time holding onto and benefitting from nutrients as menopause approaches. Therefore, nutritional goals should be to increase the intake of omega-3 fatty acids, for metabolism and cancer-fighting effects; Vitamin D to prevent osteoporosis; selenium to help prevent colon and breast cancer; antioxidants, and folic acid. We also recommend a balanced, low-carbohydrate diet that consists of several smaller meals a day.

Fitness is a central part of any woman's healthy lifestyle, but there are specific challenges that menopausal women face that can be effectively addressed with a good exercise program. First of all, regular exercise helps raise metabolism and reduce body fat. Weight-bearing exercises help prevent of osteoporosis, as does yoga. Certain yoga poses can even be helpful in relieving hot flashes and sleeplessness. Yoga is also thought to be excellent in combating depressive symptoms, anxiety and flexibility challenges so common during menopause.

Women going through menopause also need support with their sexual symptoms. Often they just need information and education to prepare them for the changes in their body, how to optimize their sexual response, and how to best communicate their sexual needs to their partners. Many women entering menopause are often also simultaneously faced with the empty-nest syndrome as their grown children move out. It is crucial that these women get the information and support they need for reconnecting with their partners and rebuilding an intimate life that will carry them through their golden years.

I'd bet most of today's menopausal woman would agree with me that the end of our reproductive viability does not mean the end of our vitality, our health or sex lives. It can mean a whole new beginning; free of worries about pregnancy, child rearing and the distractions of balancing work and family. Every woman deserves to experience this time in her life with health, vitality and in comfort.

Laura Berman, Ph.D., co-host of "Berman & Berman" on Discovery Health, has been a sex educator and therapist for more than a decade and is director of Chicago's Berman Center (www.bermancenter.com; 800-709-4709). Questions about your sexual health? E-mail drberman@suntimes.com.