But why choose a predominantly medical approach or a mainly holistic one when you can have both? I sign up for Journey: A Woman's Retreat at Canyon Ranch in Tucson, a seven-day program for "women in transition." On previous trips here, I've enjoyed the anonymity imparted by the size of the property—three pools, hundreds of staffers, and dozens of exercise classes and fitness activities. This program takes me to a different side of the resort, the Life Enhancement Center, a spa within the spa. It has its own dining room, gym, treatment area, and lecture rooms, which give it a medical-school-campus vibe. We spend the first evening sitting in a large circle, explaining why we're here. I have a creeping self-help campfire feeling, but it fades. Many of the other 25 participants are just like me: gradually waking up to the realization that we're stranded in middle age, with stressful lives and tuckered-out ovaries. "I'm here," one tells the group, "because I am struggling to deal with a body that's just ravaged by all these hormonal changes."

Our days are filled with lectures on topics such as the effect of hormone fluctuations on heart health, metabolism, cancer risks, and mood. In between, there are medical tests and treatments. I opt for basic blood work and urinalysis, but bone scans, hormone-level measurement, and fitness diagnostics are also available.

In a private session of nutritional counseling for the perimenopausal, I'm deluged with the most specific—and helpful—eating advice I've ever received. (And for a health writer, that's saying something.) Most of it comes from nutritionist Jenny Flora. She's not sold on soy as an extinguisher of hot flashes. "Many women say it does help, and others find it of no use. So try eating a serving a day for a few weeks, and if it's not working, then stop."

Flora recommends that I add a daily serving of organic yogurt to my diet, for the calcium and the probiotics. Also known as "good bacteria," these improve digestion and the immune function of the GI tract, the location of many receptors for serotonin, a mood elevator. "A healthier gut could mean more serotonin uptake," explains Flora, "which really helps women with the mood swings and sleep issues that sometimes come with hormonal shifts."

I also get a reality check: The 5 pounds I say I need to lose, Flora ups to 15. And she doesn't sugarcoat it: I'm heading for a big fat weight snowball. "Because metabolism slows and muscle mass can start to shrink at menopause, most women gain weight," she says. "Since you're already overweight, you need to work on that now. It'll only be harder later." Flora suggests I strive to lose weight slowly, perhaps a pound every ten days. "The point is to make changes you can stick with."

Because I'm already practicing yoga, taking a few steps deeper into Ayurveda feels right. I sign up for bindi-shirodhara, which may be the most blissful 100 minutes of my life. After my body has been exfoliated and massaged with rose-scented oil, a thin, gentle stream of warm oil is poured onto my forehead and allowed to run back into my hair. I lose all track of time, and when the treatment is over, I stumble back to my room, so intensely relaxed that I don't care that my hair looks like a circus clown's.

That induces me to request Jyotsna Sahni, M.D., who specializes in hormonal issues and has an interest in Ayurvedic medicine, to go over my test results. Hoping for a warm chat about the Eastern approach to perimenopause, I get another rude awakening: It turns out I'm a Western-health cliché, with a serious cholesterol problem. "If I were most doctors," she says, "I wouldn't let you leave here without a Lipitor prescription." Instead of a recommendation for weekly shirodhara, I walk out with orders to banish bacon, ice cream, butter, and cheese from my diet for six months and then get retested. "Losing weight will help," she says.

This is the first time a doctor has ever told me to lose weight, and it smarts. But the program's pace doesn't allow much time to pout. There are acupuncture and private yoga sessions and group hikes and exercise classes, including Fit Strip, in which our fishnet- and stiletto-clad instructor treats us as if we were lap dancers instead of refugees from middle age. It has us all in stitches. And while it's tempting to dismiss such fun as fluff, the reality is that laughs are essential. A recent study from Harvard Medical School found that depression risk doubles for women during perimenopause. Throughout the week, I hear echoes of that from participants. "Do you think it's hormones?" a woman asks me by the pool one morning. "Or is this just life?"

Surprisingly, despite the luscious treatments, the binders full of medical information, and the solid coaching from Canyon Ranch's experts, these intimate conversations are the best part of the week. One night toward the program's end, we share our experiences—believe it or not—around a campfire. "I came here because I misplaced my pizzazz," one woman says. "And I'm so happy that I found it again."

Hormone Replacement: Tough Decision
Since the 1940s, doctors have freely prescribed hormone-replacement drugs to women struggling with menopausal symptoms. Some of these drugs, long approved by the FDA, are made from mares' urine and synthetic chemicals and go by the names Premarin and Prempro. Provera, a synthetic progesterone, was FDA-approved in the '60s.

In 2002 the Women's Health Initiative issued a chilling report, saying that such drugs led to an increased risk for breast cancer, heart disease, and other problems. That sent women scurrying for alternatives, with many turning to bio-identical hormones. But there's a great deal of confusion about what this term means. Some people use it to refer to plant-based drugs, usually derived from yams. (These are often called natural hormones.) Others use the phrase for pharmaceutical drugs, which are also often plant-derived and mimic human hormones.

Both are usually prepared by specially trained compounding pharmacists, who tailor each prescription to the individual. Both commonly come in the form of patches, creams, and gels, which doctors are finding to be more effective than oral medication. Neither plant- nor pharmaceutical-based hormones are FDA-approved, and mainstream medical groups, including the Endocrine Society and the North American Menopause Society (NAMS), warn against taking them. Some doctors advocate taking hormones for as short a period as possible, to get through the worst of the symptoms and minimize any risk from the medication.

But bio-identical substances are also found in a handful of drugs that are FDA-approved. These include estradiol patches such as Estraderm, Climara Pro, and Vivelle-Dot, as well as natural progesterone, Prometrium.

There may be a swing back to FDA-approved drugs. After five years of debate and fine-combing the Women's Health Initiative results, NAMS recently "identified flaws in the study" and asserted that the benefits of hormone replacement therapy for women ages 50 to 60 outweigh the risks.

Spas for Menopause Management
1. The seven-day Journey: A Woman's Retreat at Canyon Ranch in Tucson combines Eastern and Western approaches. US$5,750–$8,210, 800-742-9000, www.canyonranch.com
2. The Medical and Skin Spa at the Agua Serena Spa at the Hyatt Grand Champions Resort in California is run by Richard M. Foxx, M.D., a member of the North American Menopause Society, who favors bio-identical hormone therapy. One-hour consultations for patients only, US$400, not including tests. 760-674-4106, www.medicalandskinspa.com
3. Pratima Ayurvedic Skin Care, a New York City day spa, offers menopause consultations and treatment. Initial consultation: US$125. Follow-up visit: US$75, 212-581-8136, www.pratimaskincare.com
4. The Raj in Iowa offers tailored Ayurvedic programs of five days or more. From US$3,422, 800-248-9050, www.theraj.com
5. The WellMax Center for Preventive Medicine at La Quinta Resort and Club in California offers personalized two- and three-day complete physicals that include consultations with Daniel Cosgrove, M.D., and bio-identical hormone treatments. Membership is required (US$3,000 per year). US$7,250–$11,250, 800-621-5263, www.wellmax.com