A good spa experience can be one of the best ways to decrease hormonal symptoms," says Christiane Northrup, M.D., the author of The Wisdom of Menopause and a frequent speaker at the Sanoviv Medical Institute in Mexico, one of North America's leading establishments in combining high-tech diagnosis with complementary medicine. Northrup's assertion reflects the growing appreciation of the role day-to-day stress plays in aggravating the symptoms of menopause. That's a major reason spas are creating a role for themselves in helping women negotiate this stage of life.

The main cause of menopause is the decline in estrogen that besets women at an average age of 51. The symptoms are well-known: hot flashes, night sweats, insomnia, vanishing libido, weight gain, and loss of energy. The treatments at spas reflect the three main schools of thought about ameliorating these symptoms. On one end of the spectrum are advocates of natural or bio-identical hormones, popularized by actress Suzanne Somers's book, The Sexy Years: Discover the Hormone Connection. Although bio-identical hormones haven't been approved by the U.S. Food and Drug Administration, the treatment is legal and many doctors and medical spas administer it. At the opposite end are Ayurvedic practitioners, who believe hormonal changes should be balanced, not suppressed, and without drugs. In the middle are spas that combine spa treatments with Western medicine, which considers the severity of symptoms and personal health history against the risks and benefits of FDA-approved drugs.

However, there's no one-size-fits all solution, say experts. "The biggest myth about menopause is that we can make any kind of generalization about it," says Marcie Richardson, M.D., a gynecologist who is an instructor at Harvard Medical School and codirector of the menopause consultation service at Harvard Vanguard Medical Associates. "There's no silver bullet."

While there may not be a universal solution, Northrup thinks there is a universal villain: stress. "Not only are most of the symptoms of perimenopause and menopause stress-related, but about 90 percent of them can be helped by making lifestyle changes," she says. "Because of the debates about the safety of hormones, it's easy to get all caught up in thinking you need an arsenal of pharmaceuticals to get through these changes—and you don't." In fact, the North American Menopause Society (NAMS) says that when it comes to riding out hormonal shifts, the right mentality may be your most important asset. "Negative beliefs held prior to menopause can be predictive of a more difficult time," reports NAMS, meaning they can worsen symptoms like hot flashes. And "changing those negative thoughts and attitudes can result in a reduction of symptoms."

To find out about the variety and validity of spa menopause programs, I get on the phone and get on a plane. I'm 47, which means I'm perimenopausal, the medical term used to describe the five or so years of hormonal change preceding menopause. So far, my symptoms are minor and textbook—creeping weight gain, the odd bout of insomnia, and one very intense hot flash.

I start by calling Daniel Cosgrove, M.D., the medical director of the WellMax Center for Preventive Medicine at La Quinta Resort and Club near Palm Springs, California. Cosgrove is an exponent of the bio-identical path but says it has to be woven into the entire medical-evaluation process. "We approach menopause in several ways all at once," he says. "We want to know what symptoms are present, from hot flashes and night sweats to vaginal dryness, and how severe they are. And we measure bone density, as well as key hormones" and, if necessary, prescribe what Cosgrove calls natural hormones, bio-identical hormones derived from plant or synthetic sources. These have grown in popularity since conventional hormones—some of which are also called equine hormones because they're created from the urine of pregnant mares—have come under fire.

Cosgrove finds that these hormones, when used properly, can make an enormous difference in a woman's life. "If my patient's body's own receptors (and those of her grandmother's grandmother) know human estrogen and I can duplicate the hormone and its delivery, this seems intuitively more prudent than providing orally delivered equine estrogens and totally synthetic Provera," he says.

But just focusing on drugs is a big mistake, says Cosgrove. He also talks to patients about symptoms such as mood swings in order to distinguish biological problems from the psychological issues that typically crowd midlife. "It's too easy for some doctors to solve a woman's stress at the time of menopause with a quick prescription," he says. "It's important to look at all kinds of stress—including the challenge of confronting a milestone as major as menopause. Our doctors have found that there's an overall midlife stress independent of job, husbands, empty-nest syndrome, and hormones. There are fears of getting older and for many women a sense of being lost, of needing to reinvent their lives."

Richard M. Foxx, M.D., who oversees the Medical and Skin Spa at the Agua Serena Spa at the Hyatt Grand Champions Resort in Indian Wells, California, is also a big believer in stress management, as well as bio-identical hormones. His prescriptions are precisely tailored to each individual and prepared by a specially trained compounding pharmacist. In fact, Foxx, who completed a residency in ob-gyn, believes that most women, and many men, can benefit from these drugs. "Even if you're not having hot flashes, these hormones prevent heart disease and bone-density loss, help the skin, and help with cognition," he says.

Popular as these bio-identical hormones have become, many doctors caution against using them. "Custom-compounded hormones may provide certain benefits. However, there may be risks," warns NAMS. The Endocrine Society is also wary: "Formulations are not subject to FDA monitoring for dose, purity, safety, or efficacy, and there may be additional and unknown risks associated with them. Postmarket surveys of such hormone preparations have uncovered inconsistencies in dose and quality." Foxx counters that using well-established compounding pharmacists minimizes those risks.

Ayurveda, on the other hand, deems hormonal shifts totally natural. It's just that menopausal symptoms are worse than ever, says Pratima Raichur, a chemist who runs Pratima Ayurvedic Skin Care, a day spa in New York City. "Because women are under so much more stress than they used to be, symptoms have gotten more and more extreme. We can manage the symptoms by managing the stress."

Nancy Lonsdorf, M.D., the author of The Ageless Woman: Natural Health and Beauty After Forty with Maharishi Ayurveda and the former medical director at the Raj spa in rural Iowa, says menopause should be a kinder, gentler stage of life. "If a woman's well rested, eating right, and taking good care of herself, it should be a smooth and easy time," she explains. "And for about 25 percent of women, it is. But so many people are out of balance. Ayurvedic treatments focus on gentle rebalancing: getting lots of rest, eating cleansing foods, meditating, practicing yoga, and using a series of oil-based massage treatments—the most powerful being shirodhara," in which a stream of warm oil is poured on the forehead. The Raj sees women start to get relief from serious symptoms after a stay of five or six days.

Part of Ayurveda's appeal to me is its rock-solid science in this area: NAMS reports that one of the most proved methods of controlling hot flashes is paced respiration, like the rhythmic breathing practiced in many yoga classes. And a recent study from the University of Massachusetts found that by using mindfulness-meditation techniques, women could reduce the severity of hot flashes by 40 percent.