The climacteric begins

• Decline in the body's estrogen and progesterone levels, which begins in the mid-thirties, accelerates.
• Your testosterone levels may also decline slightly.
• Monthly cycles may become markedly irregular (can begin anytime between the ages of 35 and 50).

Possible symptoms (from estrogen deficiency)

Early:

• Hot flashes (with possible associated dizziness, shortness of breath, palpitations)
• Night sweats
• Sleep disorders, insomnia

• Vaginal dryness, painful intercourse
• Reduced libido (sex drive)
• Dry hair, hair loss
• Anxiety, mood swings, headaches, depression
• Short-term memory loss
• Stress incontinence
• Heavy menstrual flow

• Dry skin, itching, crawly skin
• Increased cholesterol levels
• Atherosclerosis (hardening of the arteries)
• Osteoporosis (thinning, weakening of bones)

Menopause: Your last period

• Your ovaries have run out of eggs and are no longer producing estrogen and progesterone. Small amounts of estrogen still present in your body come from adrenal glands and fat tissues. Your ovaries do continue to produce testosterone, although in slightly lower amounts.
• You miss several consecutive periods (pregnancy and other causes ruled out). Climacteric symptoms may increase and be more intense.

After your menopause

• Your menstrual periods stop, and you can no longer become pregnant. Reproductive organs become smaller and change position; vagina and urethra tissues get thinner; skin loses fat layer and moisture. Bone density decreases. Muscles may lose tone. Fat content of breasts increases as milk glands shrink. Cholesterol levels rise.
• Your body shape may change-you might notice that you have less of a waist than before.
• For most women, if they're not on HRT, climacteric symptoms will gradually cease as their bodies adjust to lower hormone levels.
• An FSH test may be helpful in confirming menopause, particularly in women who have not menstruated for 12 months. An FSH level of over 40 ng/dl indicates that a woman is menopausal.