In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes
Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.

If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.