Rugation diminishes, and the vaginal wall becomes smooth
Atrophic cystitis, when present, can mimic a urinary tract infection
The uterus becomes smaller
Symptoms may begin up to 6 years before the final menstrual period and continue for a variable number of years after the final menstrual period
Hot flashes or flushes (most common)
Headache
Fibroids, if present, become less symptomatic, sometimes shrinking to the point where they can no longer be palpated on manual pelvic examination
Mood changes
The menopausal ovary diminishes in size and is no longer palpable during gynecologic examination
Mastodynia
As the postmenopause years progress, with an accompanying loss of ovarian response to gonadotropins, associated affective symptoms of menopause also decline
Vaginal changes often result in insertional dyspareunia
Insomnia
With loss of estrogen, the vaginal epithelium becomes redder as the epithelial layer thins and the small capillaries below the surface become more visible
Irregular menses
A decrease in urine pH leading to a change in bacterial flora may result in pruritus and a malodorous discharge
Weight gain and bloating
Later, as the vaginal epithelium further atrophies, the surface becomes pale because of a reduced number of capillaries
Depression
Endometriosis and adenomyosis are alleviated
In older women, a general loss of pelvic muscle tone occurs, sometimes manifested as prolapse of reproductive or urinary tract organs
