When women are asked what they know about menopause, hot flashes are often the first, and sometimes the only, symptoms that come to their mind. But hot flashes are not the only symptom of menopause and the menopausal transition may begin in various, and far less obvious, ways.

As the menopausal transition begins, ovarian function becomes increasingly variable, leading to lower levels of progesterone and fluctuations in oestrogen. These hormonal changes can affect multiple systems in the body-from head to toe, causing varied symptoms affecting multiple bodily systems.