These are generally divided into three groups namely: Vasomotor symptoms, Metabolic/genital symptoms and Phychological symptoms.

Vasomotor Symptoms:

Vasomotor refers to the effects of certain nerves influencing the contraction and dilation of the blood vessels.

Hot flushes:
These are probably the most common of symptoms in menopausal women, in which the woman experiences a sudden surge of heat around the face, neck and chest area. It is most often accompanied by reddening of the skin and sweating, which only adds to the discomfiture of the sufferer. The intensity and frequency of hot flushes, vary from one woman to the other - occurring several times during the day and night, or several times during an hour, and lasting for a couple of minutes or seconds.
The cause for hot flushes has not yet been fully established, however it is thought to be due to oestrogen deficiency causing a hormonal imbalance which, in turn, causes an imbalance in the brain's temperature-regulating center. Flushing may occur a few years prior to the cessation of menstrual periods, thus suggesting that the woman is in the pre-menopausal stage, and often indicating that menopause is not far off. If left untreated, they are experienced by 75% to 80% of all menopausal women. Approximately 20% to 50% of women suffer hot flushes for 5 years or longer.

Palpitations:
This refers to the unpleasant awareness of exceptionally rapid or irregular beating of the heart, which may also be accompanied by a tingling sensation of the skin and faintness. Palpitations often occur together with the hot flush, and in this case their exact cause remains unknown.

Metabolic/Genital Symptoms:

This generally refers to the manner in which cells, organs and structures maintain their function.

Irregular heavy bleeding:
The decrease in hormones and ovulation may cause irregular heavy bleeding in many women - a seven to ten day bleeding period is not unusual, nor is bleeding throughout the entire month. This is a particularly dangerous condition, as it can result in anaemia, or alternatively be early signs of a more severe condition, e.g. fibroid tumours, uterine or cervical cancer. This phase leading up to menopause can be treated through a simple surgical procedure, known as a dilation and curettage (D&C). The cells that are removed during this procedure will then be analysed for any abnormal patterns.

Loss of periods:
Failure to menstruate for at least 6-12 months in the older woman, would usually indicate menopause. This may occur quite abruptly, with there having been little or no irregularity to the periods beforehand or more commonly, where menstruation occurs less frequently and the duration of each period being shorter.

Loss of elasticity to external genitals:
Approximately 1 in 10 women develop genital problems, which is often reported to be even more distressing than the discomfort and embarrassment of hot flushes. In this case the skin of the vulva (external genitals surrounding the opening of the vagina) may become thin, and shrinkage of the vaginal opening may occur. However this is much more a feature of the elderly women, those well past the menopausal stage.

Painful intercourse:
Vaginal dryness may be the most troublesome symptom for a sexually active woman. This together with possible thinning of the vaginal skin, often results in painful sex, which may in turn lead to the development of a host of psychosomatic symptoms. 30% of women experience vaginal dryness or itching and thinning of vaginal tissue after menopause has occurred. This can lead to increased chances of infection (such as 'thrush').

Weakening of the ligaments and tissues that support the uterus:
The ligaments and tissues that surround and support the uterus may become weakened, thus resulting in prolapse of the uterus. 'Prolapse', literally means the displacement of an organ from it's usual place, and in this case would refer to the condition whereby the uterus has slipped downwards in the vagina. This could probably be due to weaknesses in the pelvic floor following the delivery of a number of babies, or from the weakening effects of low oestrogen levels on the ligaments.

Symptoms of prolapse:

• A 'descending' sensation in the vagina
• Feeling a lump at the opening of the vagina, especially when coughing or sneezing
• Difficulty in urinating and emptying the bowels
• A 'full' sensation, even after emptying the bladder and bowels
• Urinary incontinence during times of particular strain
• Feelings of 'obstruction' during intercourse

Reduction in breast firmness and size:
Seeing that oestrogen is responsible for the development of the breasts at puberty, and also maintaining the firmness and glandular functions thereafter, it is no wonder that a woman's breasts lose their shape, and the nipples become smaller and less erectile during menopause. These changes do not tend to cause direct symptoms, although many women have difficulty in coming to terms with the effect it has on their bodily appearance.

Skin changes:
As women age (particularly after menopause), the elastic fibres in their skin decrease, resulting in wrinkles and sagging around the chin and neck area. Unlike skin changes to the vulva and vagina, lack of oestrogen would not be the sole cause of these problems, but more a combination between the effects of ageing and oestrogen deficiency.

Effects on bones and joints:
Loss of bone substance - or osteoporosis as it is more commonly known, increases with age, causing the bones to become porous and brittle and so more liable to break. This is mainly due to the lack of oestrogen, reducing calcium availability, and is one of the most severe health problems that can occur during menopause. Other factors that could increase your risk of osteoporosis, would include - a diet high in salt, protein, alcohol and caffeine, inadequate vitamin D intake, lack of exercise and smoking.
Approximately 1% of calcium is lost from the bones each year, after the age of 50, and 15% by the time the woman reaches 70. Although this may vary drastically, as it often depends on the age of the woman at onset. One out of four women will suffer an osteoporotic fracture by age 60. By age 75, this fracture rate will increase to one out of two women.

Psychological Symptoms:

These would include a whole host of symptoms that are very real to menopausal women, and not 'just in the mind' - as the name may suggest. The severity of these symptoms would depend entirely on the woman's social circumstances and to what extent she 'allows' the symptoms of menopause to affect her well-being.

Headaches:
There is no evidence to suggest that headaches as such, are a true symptom of menopause, and are often the result of a response to stress, anxiety or when in need to evade an unpleasant situation - such as avoiding painful intercourse.

Insomnia:
The inability to sleep is certainly a common complaint among menopausal women, and could possibly be due to two main factors. Firstly, it is necessary to bear in mind that as one ages, so the need for sleep diminishes. Secondly, it may well be that the discomfort of sweating and hot flushes is responsible for your disturbed sleeping pattern.

Alteration in libido:
The decrease in the desire to have sexual intercourse during a woman's middle years is likely to be due to external factors rather than to a hormonal imbalance. Pain during intercourse, resulting from the reduction in Ooestrogen levels, often leaves the woman with little or no desire to make-love to her partner. If left untreated, the situation worsens and will inevitably result in some form of depression.

Stress and Depression:
Many women find the menopause to be psychologically upsetting, and there probably are a multitude of reasons for her feeling somewhat inadequate and unable to cope with the day-to-day problems that arise. This state of despair may be due to a number of factors namely:

Marriage:
By the time a woman has reached her middle forties, her partner may have reached a peak in his profession, that requires longer working hours, and less quality time spent with her. He is apt to be tired on returning from work, and may not even notice the changes taking place in her body - seeming more preoccupied with matters other than their sex life, or appears to show no interest whatsoever in his wife. This whole scenario places immense stress on the woman, who may now suspect that her husband is having an extra-marital affair, which only adds to her poor self image.

Children:
Menopause often coincides with the children leaving home resulting in somewhat of an 'empty-nest-syndrome'. There may also be more serious worries to deal with, such as drug addiction, teenage pregnancy or just general family feuds. As children demonstrate their independence they begin to provoke their parents in ways unimaginable, and this results in the women feeling that she must have failed in some area of child-raising.

Parents:
By the time the woman reaches the menopause, her own parents or those of her partner are likely to be elderly and increasingly dependent on her. Their need for constant support complicates the woman's life even further, as her partner now feels he can distance himself even more as his wife now has the company and preoccupation of another.

Work:
More is likely to be demanded of the woman as she reaches a senior position in the workplace, and fatigue, irritability and depression result in her feeling inadequate and fearful of the future. Alternatively, the woman whose children are becoming more independent may feel the need to return to the workplace. This is seldom as easy as it may appear to be at first sight. Firstly because of the fact that she may have been unemployed for quite some time, and battle to gain a suitable position, and secondly because she may feel less effective than that of the new generation of younger women. She may battle to cope with her new role of 'house-keeper' and 'working woman', especially if she insists on keeping her house and home functioning as impeccably as before.

Health and Appearance:
Weight gain is a major downfall in middle age, and one just cannot ignore the fact that a slim, youthful figure is more attractive than an overly-sized one. Clothes are less easy to find and often more expensive, adding to the battle of self-acceptance and being presentable to others, especially seeing that most designs and creations are aimed at the younger generation. Her skin and hair may also deteriorate, thus needing far more attention, and often resulting in great expense and a sense of youth having slipped by.
 

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