Hot flushes are the classic sign of the menopause and perimenopause transition. No two women describe the exact same symptoms when talking about a hot flush. They are generally a sudden, intense sensation of heat that spreads over the chest and travels to the neck, face and head. Following this feeling of intense heat, a woman commonly notices reddening of the head and neck area. This then leads to perspiration and a cooling or chilling phase. Some women may also experience an intense episode of sweating. The typical hot flush lasts approximately 2-3 minutes. They are most common during perimenopause and the first one to two years after menopause. Although variable, hot flushes generally occur every 2-4 hours. Despite the increase in skin temperature, there is no change in core body temperature.

Mood Changes

Many women describe mood changes during the menopause and perimenopause transition. Poor sleep quality and quantity from hot flushes may lead to chronic fatigue and depressed mood. Hot flushes can cause a sense of anxiety, especially if associated with palpitations and rapid heart beat. Many women overwhelmed with the responsibilities involved in juggling their careers, marriage, children and elderly parents can experience more frequent episodes of mood changes and irritability. Lastly, other medical conditions may contribute to mood changes in the menopause

At some time, many women will experience vaginal dryness. Beginning in the perimenopause, the vagina may weaken or shrink and produce fewer secretions. Due to a relative lack of estrogen, the vaginal tissue can be more easily injured. Also, decreased acidity of the vagina can lead to infections. A thinning of the tissue lining the vagina may lead to pain during intercourse. Vaginal dryness can also occur, as may itching or irritation. Although few women experience serious problems with vaginal dryness and thinning right after menopause, both dryness and thinning continue to occur over time.

The medical term for sleep disturbance is insomnia. Insomnia can means:
1. Trouble falling asleep in less than 30-45 minutes
2. Frequently awaking with trouble falling back to sleep
3. Not feeling rested after a night of sleep. The average total sleep time nightly is 7.5 to 8 hours. Healthy adults can require
   anywhere from 4 to 10 hours of sleep.

This can be caused by a variety of factors, such as stress and anxiety, noise, temperature change, change in sleep environment. Commonly, people will describe sleep disturbances with shift changes at work or with jet lag. The changing hormonal patterns associated with the perimenopause and menopause transition can lead to insomnia. Many women also notice night sweats that occur as the result of a hot flush while sleeping. This sweating can cause an altered sleep pattern and frequent awakenings.