For many women, the first sign of oncoming menopause is a fluctuation in menstrual cycles. This period of transition is known as perimenopause. Menopause occurs when a woman has not had a menstrual period for 12 consecutive months and no other biological or physiological cause for this phenomenon can be identified.

As women enter menopause, they may begin to experience several symptoms typically associated with the changes that are taking place in their bodies. These symptoms include:

• Hot flashes. This is a feeling of warmth in the face, neck or chest that ranges from mild to severe. According to the Food and Drug Administration (FDA), about 85 percent of women approaching or going through menopause have hot flashes.
  
  
• Night sweats (evening versions of “hot flashes”) and difficulty sleeping. Lack of sleep can contribute to women feeling tired, stressed or tense.
  
  
• Changes in vaginal tissue, including thinning, dryness, itchiness or burning. In some cases, sex may become painful (dyspareunia) due to decreased vaginal secretions.
  
  
• Thinning of bones. Known as osteoporosis, this condition can lead to a reduction of bone mass that reaches 20 percent in some women. As a result, menopausal and postmenopausal women are susceptible to fractures of the hip, spine, wrist and other bones. In some cases, osteoporosis can lead to loss of height.
  
  
• Abnormal vaginal bleeding or “spotting.” This is a common sign of menopause. However, women who have not had a period for 12 consecutive months should see a physician if they experience spotting, as this can sometimes be a sign of other conditions, such as:
  
• • Cancer
    
  • Side effects of using birth control pills or hormone replacement therapy
    
  • Hormonal imbalance
    
  • Noncancerous growths in the lining of the uterus, such as fibroids
    
    
• Mood changes. These changes can include mood swings, depression and irritability. Some researchers believe these emotions are a result of changes in the brain caused by a decrease in estrogen. Others think menopausal symptoms such as sleep problems, hot flashes and fatigue cause the feelings. Still others maintain that a combination of these factors is probably responsible.
  
  
• Urinary problems. These may include leaking, burning or pain when urinating (dysuria) or urgency. Leakages may also occur during sneezing, coughing or laughing. An increase in urinary tract infections (UTIs) is also associated with menopause as a result of a thinning of the urethra that happens at this time.
  
  
• Increased risk of heart problems. Estrogen helps raise HDL cholesterol (“good cholesterol”). This in turn helps remove LDL-cholesterol (“bad cholesterol”), which can contribute to plaque buildup in the arteries. As estrogen levels drop, there is increased risk of this buildup, which can lead to coronary artery disease, in which the veins and arteries to the heart become narrowed or blocked.
  
  
• Heart palpitations. A sudden pounding in the chest sometimes occurs in women during menopause. While heart palpitations can be harmless, they can also be a sign of a major health disorder. For this reason, women who experience palpitations should seek medical care.
  
  
• Memory or concentration problems. The source of these symptoms is not clearly understood, though they may be related to factors such as stress or lack of sleep.
  
  
• Lack of interest in sex or changes in sexual response due to decreased hormone production.
  
  
• Changes in physical appearance. After menopause, weight that previously was settled in the hips and thighs may shift to the waist. The breasts may lose their fullness, wrinkles may form and hair may thin on the woman’s head. As estrogen levels drop, the small amount of testosterone that women produce may have more pronounced effects on the body. This may include development of coarse hair on the chin, upper lip, chest and abdomen.

The severity of these symptoms varies from woman to woman, with some experiencing few or no symptoms. In many women, the symptoms may fade over time, with or without treatment.