I'm not there yet, but fast approaching — menopause. With the concern over the safety of Estrogen Replacement Therapy, many women are looking for natural alternatives to deal with the most uncomfortable symptoms. Several studies have found diet and exercise to play an important role in easing hot flashes.

The most recent news, published in the Archives of Internal Medicine, found that overweight menopausal women can ease hot flashes by losing weight through diet and exercise. Previous studies have shown that women with higher body mass indexes (BMI) do experience worse symptoms, but the recent study is the first to follow women through weight loss and document their response.

The study included 150 overweight and obese women, two-thirds of which were assigned to an intensive program to help them lose up to 9% of their body weight. This included 40 minutes of moderate exercise each day, a reduced calorie diet of no more than 1500 calories a day, and weekly one-hour long counseling sessions.

Six months later, the women who participated in the weight-loss program were more than twice as likely to experience an improvement in hot flash symptoms. In fact, for each 11 pounds that a woman lost, she was roughly one-third more likely to experience a decline in severity or frequency of hot flashes.

Other dietary measures may also help women decrease the severity of menopausal hot flashes. Most women find that caffeine-containing foods, such as tea, coffee, or soft drinks, make symptoms worse. Also avoid alcohol and spicy foods. Refined sugar also tend to increase the number of hot flashes that a woman suffers, so avoid sweets or anything made with high fructose corn syrup.

Foods containing phytoestrogens may help, such as soy. In Japan, where women eat more soy than American women, menopausal symptoms appear to be about one-third as likely. Try incorporating soy products into the diet, such as switching from regular milk to soy milk, or adding tofu to soups. Another great soy snack is edamame — low fat, low-calorie, and full of fiber and protein.

It's also important to remember to stay hydrated. Keep a bottle of water with you to ensure you drink at least 64 ounces of fluid each day.

Remember that as you go through menopause, certain health risks increase. For example, heart disease in women increases sharply after menopause. (Estrogen is thought to be protective to some extent in younger women). Eating a balanced diet full of whole grains, fruits, vegetables, and lean protein sources — and avoiding fatty and highly processed foods — may help both reduce the menopausal symptoms you feel and decrease the risk of developing high cholesterol, high blood pressure, or diabetes that can lead to heart disease.

Osteoporosis is another risk that increases after menopause. Both diet and exercise can play a role. Ensure that you are getting enough calcium in the diet for bone maintenance (1200-1500 mg/day) and participate in weight-bearing exercise to maintain bone mass. Rich sources of calcium include milk, fortified soy milk, cheese, sardines, salmon, prunes, and leafy green vegetables. Don't forget about Vitamin D, which helps the body absorb calcium. The National Osteoporosis Foundation recommends 800 to 1000 IU a day for adults 50 and over.

Supplements such as black cohosh and vitamin E may help, but good clinical studies are lacking, so check with your doctor before trying an herbal or vitamin regimen. This is also important if you are taking medications for another condition — supplement/drug interactions can be deadly.