The most prominent symptoms of the transition to menopause include:
- Irregular menstrual periods. In the years preceding menopause, women experience changes in their menstrual cycle. The time between periods can become shorter or longer and periods may last a longer or shorter number of days. Bleeding can be heavier or lighter, and change in flow from month to month. It is also normal for periods to skip a cycle.
- Hot flashes and night sweats. Women often feel hot flashes as an intense build-up in body heat, followed by sweating and chills. Some women report accompanying anxiety as the sensation builds. In most cases, hot flashes last for 3 - 5 years, although they may linger in some women for years after menopause. Women who have surgical removal of both ovaries, and who do not receive hormone replacement therapy, may have more severe hot flashes than women who enter menopause naturally.
- Difficulty sleeping. Insomnia is common during perimenopause. It may be caused by the hot flashes, or it may be an independent symptom of hormonal changes.
- Vaginal dryness. Decrease in estrogen can cause thinning and drying of the vaginal membrane (vaginal atrophy also called atrophic vaginitis), which can cause itching and pain during sex (dyspareunia).
- Mood changes. Mood changes and irritability are most likely to be a combination of sleeplessness and hormonal swings. Some women find the menopausal transition to be psychologically stressful. Once a woman has reached a menopausal state, however, depression is no more common than before, and women with a history of premenstrual depression often have significant mood improvement.
Although forgetfulness is often mentioned as a symptom, evidence indicates that menopause does not affect memory or other cognitive functions. It is normal for both men and women to experience some memory lapses as part of the natural aging process.