The actual menopause is defined as your last period and happens at an average age of 52. However, from the early- to mid- forties, changing and fluctuating hormone production causes subtle physical changes. These may go unrecognized and not everyone has a problem, but for others they gradually worsen until realization finally hits home and help is sought. Some of symptoms are due to the fall in estrogen but many factors such as diet, exercise and lifestyle, medications and attitudes can influence the incidence, severity and impact of symptoms.

Symptoms:

Hot flashes - Classic menopause symptom. For many women, they don't cause much distress, but one in five suffers so badly that flushes interfere with work, sleep and quality of life. Sufferers can experience total body heat, may drip in sweat and wake up several times a night drenched in sweat.

Falling estrogen levels are thought to affect the body's temperature control centre but the exact underlying mechanism is unclear.
Headaches - Palpitations and dizziness are also common.

How long the symptoms last?
Sleeplessness - Insomnia has also been shown to be menopausal symptom, regardless of temperature changes, and may begin a few years before the menopause.

Joint aches - They may affect neck, wrists and shoulders

Weight gain - Another by-product of the menopause as it's thought that the rate at which you burn off calories (your metabolic rate ) reduces.
Breast tenderness - Although estrogen levels overall are falling, a rollercoaster of hormonal ups and downs means estrogen levels can also peak, casing breast tenderness, as well as dip.

Period problems - Most women experience changes with heaviness, irregular, less frequent or more frequent periods. This changing pattern can fluctuate over years before they stop altogether.

Heavy bleeding with flooding - It is one possible result of hormonal upheavals an can be alarming as well as inconvenient. Symptoms need to be investigated to rule out other causes but there are a variety of effective treatments available.

Psychological symptoms - Mood swings, irritability, anxiety, forgetfulness and foggy brain. However, other pressures such as elderly relatives, teenage children, an empty nest and work may also contribute to such "symptoms".

The mood changes in particular are often distressing, with many women being concerned about the effect on their nearest and dearest. Some of them agree on a code for their husbands, "Don't worry, it's just a hormone dip." It works wonders!

How long the symptoms last? - The average time that the early symptoms of estrogen deficiency lasts is about two years, but some women have none at all and others continue having symptoms for 20 years or more.

What tests should I have? - The best diagnosis is from the history of your period pattern and symptoms. If you have a Mirena coil fitted, you might not know if you're becoming menopausal as you'll have no period pattern to follow. Go by symptoms such as flushes and perhaps by assessing response to a trial of treatment such as HRT. Have general health tests such as blood pressure and cholesterol level.

Natural ways to beat hot flushes - Eat healthily, don't smoke, reduce alcohol and caffeine intake, and exercise. Wear loose, thin layers of cotton clothing that are easy to peel off, and keep your bedroom cool at night by leaving a window open or investing in a fan.

Will alternative therapies help? - Red clover, black cohosh, the pollen extract Female and even acupuncture have been found to be useful, and evening primrose oil and sunflower oil may help reduce breast tenderness.

How will the menopause affect my sex life?

- Some women feel sexier once they're freed from having periods, or are at a stage in life when they have more confidence and more time to spend with their partner.

- After the menopause, estrogen deficienty causing dryness of the vaginal tissues can cause sexual discomfort. This can be effectively treated with vaginal estrogen in the form of small vaginal tablets, creams or vaginal ring. All are available on prescription. this can be used even if you can't - or don't wish to - take HRT, since the estrogen is very low dose and concentrated in the vagina. There are non-hormonal lubricants too available over the counter.

- Women who have had their ovaries removed will experience "surgical menopause" and may have low levels of testosterone as well as low estrogen, since ovaries produce half of our testosterone. They may benefit from a testosterone as well as estrogene replacement.

- Other issues affect libido too, such as relationship problems, stress, worry and tiredness.