What are the possible symptoms and problems of the menopause?

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The menopause is a natural event. You may have no problems. However, it is common to develop one or more symptoms which are due to the low levels of oestrogen.

Short term symptoms

Hot flushes occur in about 3 in 4 women. A typical hot flush lasts a few minutes and causes flushing of your face, neck, and chest. You may also perspire (sweat) during a flush. Some women become weak, faint, or feel sick during a hot flush. The number of hot flushes can vary from the occasional flush, to fifteen or more times a day. Hot flushes tend to start just before the menopause, and typically persist for 2-3 years.
Sweats commonly occur when you are in bed at night. In some cases they are so severe that sleep is disturbed and you need to change bedding and night clothes.
Other symptoms may develop such as headaches, tiredness, palpitations, being irritable, difficulty sleeping, depression, anxiety, aches and pains, loss of libido (sex drive), and feelings of not coping as well as before. It can be difficult to say whether these symptoms are due to the hormone changes of the menopause. For example, you may not sleep well or become irritable because you have frequent hot flushes, and not directly because of a low oestrogen level. Also, there may be other reasons why these other symptoms develop. For example, depression is common in women in their 'middle years' for various reasons.

Long term changes and problems

Skin and hair. You tend to lose some skin protein (collagen) after the menopause. This makes the skin drier, thinner, and more likely to itch. You may have less underarm and pubic hair. Some women have an increase in facial hair.
Genital area. Lack of oestrogen tends to cause the tissues in and around the vagina to become thinner and drier. These changes can take months or years to develop.
Osteoporosis ('brittle bones') may develop after the menopause. As you become older, you gradually lose bone tissue. Oestrogen helps to protect against bone loss. When the oestrogen level falls, the rate of bone loss increases. If you lose a lot of bone tissue, then this is called osteoporosis. It may cause no symptoms. However, if you have osteoporosis the bones are 'thinner' and are more likely to break. You may break a hip or wrist quite easily after a fall or minor injury. Not all women develop osteoporosis after the menopause. See separate article called 'Osteoporosis' for more detail.

What is HRT (hormone replacement therapy)?

All types of HRT contain an oestrogen hormone. If you take HRT it replaces the oestrogen that your ovaries no longer make after the menopause. HRT is good at preventing hot flushes, vaginal dryness and related vaginal symptoms, and may help to improve sleep if your sleeping pattern is affected by the menopause. Long-term use of HRT also has a small benefit in helping to prevent osteoporosis and bowel cancer. However, there are risks in taking HRT. See separate the leaflet called 'Menopause and HRT' for more detail. The rest of this leaflet discusses some other treatment options for menopause symptoms.