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What is it? When does it occur? Physical symptoms

Emotional symptoms Hormone replacement therapy Nutrition

Self-help Advice and support

The decline in the release of oestrogen and progesterone can begin a few years before menstruation stops, leading to some uncomfortable physical symptoms including:

• Hot flushes - most women experience these in varying degrees of severity. There can be an all-over hot feeling one minute - enough to make you feel like opening all the windows in the house - and a shivering sensation the next. On average, flushes occur four or five times a day and usually last from a few seconds to a few minutes. Some women also experience 'crawling' sensations on the skin.

• Night sweats - these are hot flushes that occur at night. If severe, they can drench your bedding, disturbing your sleep pattern and that of your partner.

• Irregular, scant or heavy periods - this is a common sign of the approaching menopause, but it's worth remembering that irregular or heavy bleeding can be caused by conditions other than the menopause (for example, polyps or fibroids), so it's a good idea to get it checked out.

• Dry or itchy skin - as we age, our skin becomes thinner and without oestrogen our skin finds it difficult to retain moisture.

• Aches and pains - low levels of oestrogen can lead to an increase in aches and pains. These can range from joint and muscular pains to backaches or headaches.

• Insomnia - this is caused by low levels of oestrogen, but can be exacerbated by night sweats as these disturb your sleep pattern. It can also be brought on by anxiety or depression.

• Tiredness and lethargy - lack of sleep owing to night sweats can cause you to feel exhausted during the day.

• Bladder problems - these include an increased susceptibility to cystitis or other bladder infections and stress incontinence. Stress incontinence is caused by loss of muscle and tissue elasticity in the pelvic cavity, which leads to a tendency to leak urine on coughing or laughing. Some women also experience reduced bladder capacity.

• Loss of vaginal elasticity - intercourse can become uncomfortable or painful owing to the thinning of the vaginal walls, causing dryness and loss of elasticity. A water-based lubricant can help, although if the pain is severe and persistent it's advisable to seek medical help.

Other symptoms such as dizziness, swollen ankles and palpitations have been reported but are less common.

Some women sail through the menopause

Some women sail through the menopause with no emotional changes whatsoever, but for others there may be psychological issues to contend with - on top of all the strange physical effects.

Mood swings can range from tearfulness and irritability to depression. Depression may be more likely in the years immediately before the menopause, especially if you've experienced PMS (premenstrual syndrome) in the past.

Your hormones can make life miserable, but oestrogen deficiency alone may not be causing you to feel emotionally 'out of kilter'. It's not always clear whether depression is linked to low oestrogen levels or to the fact that many women face changes during their 40s and 50s, such as pressures of work or marriage, caring for unwell or elderly parents, problems with children and struggling to cope with the altered self-image that can come with ageing.

Emotional symptoms can include:

• Panic attacks - getting older in a society where youth is everything can be stressful and cause increased levels of anxiety. Frequently feeling anxious can lead to panic attack symptoms including palpitations, shortness of breath or dizziness.

• Poor memory and concentration - since oestrogen plays a part in the healthy functioning of nerve cells in the brain, there could be some slight drop-off in concentration when there's less of it.

• Decrease in sexual desire - this may be caused by the decrease in female hormones, tiredness or vaginal dryness, which can cause pain or discomfort. But the reasons aren't always physical. If there are misunderstandings in a long-term relationship that have never been addressed, they may come to the fore now. It could be the menopause is the trigger but not the cause of your loss of libido. Try talking things through with your partner.

On the other hand, some women find they enjoy sex more after the menopause. Freedom from worry about unwanted pregnancy can release your inhibitions, bringing with it spontaneity and an increase in sexual confidence. For some couples, it can be a new beginning.

The extent of menopause symptoms varies from person to person, but with a bit of help you can minimise the effects.