Resistance training, weight training, exercise, meditation, yoga, things like Pilates are absolutely essential for any woman over the age of, I'd say, 45. Because by then the effects of gravity and the effects of the aging process have to be consciously attended to on a daily basis. And then you can create the best health of your life, because you’ve got the wisdom of your age but with the consciousness of knowing what to do. So I think it's just so crucial for women to understand that the little old lady thing that we see all around us, as bent-over women, with hip problems and so on, is largely a choice. It is not inevitable.

REDWOOD: In The Wisdom of Menopause, you wrote that "the brain catches fire at menopause." What are the most important ways that women can harness this fire rather than being consumed by it?

NORTHRUP: Well, that is one great question. The thing is to realize that it is all about you, not about the people you have surrounded yourself with. This is the number one key thing. If you start using that fire to lash out at others in your life, to become a flame thrower, you’re not harnessing the power of it. You must realize that whether it is a marriage that is no longer working, a relationship with a child that's no longer working, or with a parent, it is not particularly because of anything they’re doing, but because you have spent years teaching them how to act around you. So the person who needs to change now is you and the most important way to make this change is taking time for introspection and making yourself healthy. During perimenopause - which is a 7- to 13- year process during which we start skipping ovulations and the brain changes - many women talk about the fact that their lives would be fine if they could just go into a cave and not have to fold the towels for a while. So you have to make time for yourself in a way that, perhaps, you never did before. It has to be a priority. You can no longer put everyone’s needs ahead of your own and silently resent it, and silently wait for someone to give you permission to rest. If you continue that pattern, you will set the stage for the rest of your life being one of disease and decrepitude. So I see it as a crossroads in your life. One road says ‘grow’ and the other says ‘die.’ And this 'brain catching fire' is designed to get you to pay attention because it becomes too uncomfortable to continue ignoring yourself.

REDWOOD: In the past few years there has been a dramatic about-face on the part of the medical profession following the release of large-scale research demonstrating larger than expected problems with hormone replacement therapy for women in menopause. What is your current understanding of where we are on this issue?

NORTHRUP: The very good thing about the Women's Health Initiative and the study on Prempro is that we realize that one dose of one type of hormone, in other words [practicing medicine with] a herd mentality, does not work. So that's very good news. I don't think that that approach ever worked. The bad news is that the results of just that one study, with one type of hormone, scared women about all kinds of hormone replacement, and scared them in a way that I think is undue and unjust.

The best approach to that whole issue is to individualize treatments using bioidentical hormones at the lowest possible dose for the least amount of time necessary. But some women do well with some hormones for many years, up to 10 to 15, particularly women who have had hysterectomies, either with their ovaries removed or even with their ovaries left in, because when you do a hysterectomy you change the blood supply to the ovaries. For women who have gone through a hysterectomy or a premature menopause, the right kind of hormone replacement for as long as necessary can be very helpful for their sense of well-being. We also know that if you are going to replace hormones, you should replace them at a physiological level, perhaps at the age of a 35-year-old woman, using the three different hormones, in combination or singly. Those are, of course, androgen, estrogen and progesterone. For a long time we’ve made hormone replacement just be about estrogen and have ignored the role of bioidentical progesterone, which can be so helpful for many women during perimenopause, when so many suffer the effects of estrogen-dominance, too much estrogen relative to progesterone. And they get through perimenopause, many of them, much easier with a little progesterone, which helps with anxiety, headaches, PMS symptoms and so on. So we don’t want to throw the baby out with the bath water at this point.