It is the beginning of hormonal and menstrual changes or when other symptoms of approaching menopause begin until at least one year after the final menstrual period.

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Ovulation becomes irregular after a woman has reached her forties. Before ovulation stops altogether, the menstrual cycle often lengthens. This can start anything from two to eight years before menopause. The fact that ovulations occur less frequently is one of the reasons why older women find it more difficult to fall pregnant.

Other common symptoms include:

• Hot flushes (also called hot flashes)
• Night sweats
• Decreased libido
• Insomnia (sleeplessness)
• Body fat redistribution (the so-called "middle age spread")
• Psychological changes (including moodiness, depression and tearfulness)

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