The most common symtoms of menopause should be divided in accordance to the time of their occurrence, thus early symptoms usually include hot flashes, dizziness, increased perspiration, palpitations, BP elevation, sleep disorders. After 2-3 years from the last period, atrophic changes in the urinary tract take place resulting in urine incontinence, dryness of the vaginal mucosa, dyspareunia (discomfort during coitus), atrophic cystourethritis. Late symptoms usually develop approximately in 5 years after the onset of menopause and are represented by metabolic disorders l such as osteoporosis and atherosclerosis.

To the question of possible factors which might impact the clinical course of the postmenopausal period. Some of the factors are well established, like smoking which leads to early menopause, surgical or so called artificial menopause, radiation therapy and chemotherapy, Stein-Levental syndrome, endometriosis. There are as well factors which are believed to have some impact, like the respected author of the question have mentioned, e.g. living in the areas >3500 meters over the sea level, chronic inflammatory pelvic diseases, intake of oral contraceptive pills, stress, etc.

Concerning ethnicity, it was noted that in Asian countries with high intake of food containing soybean early symptoms of menopause are postponed and frequently less extensive compared to the Western female population.

Thank you Iryna for the nice elaboration on the symptoms of menopause and their causes. How does living in high altitudes influence that? And do girls who take the contraceptive pill early in their lives become susceptible to these symptoms?

As I have mentioned these are unconfirmed, namely possible risk factors for the development of premature menopause as well as more severe manifestations of the climacteric symtoms. Here I can only provide my suggestions in relation to high altitudes: it is well-known that the level of solar as well as cosmic radiation increases with increase of the altitude, (as we know radiation therapy is an established risk factor), besides highlanders experience constant hypoxia, so far these are mine hypothesis.

That is interesting, thanks Iryna. Do you recommend HRT for all cases?

HRT prescription should be strongly individaual, taking into account a range of factors, I would list some of them: trombophilia, venous trombosis, familial hystory of cancers, especially breast cancer. additionally, I will quote my own answer concerning CVD and HRT here:

This is quite true that endogenous estrogens protect female hearts and vessels prior to onset of menopause, they act as vasodilators, similarly to calcium channel blockers, have favorable effect on lipid metabolism and coagulation. But as for the application of HRT for primary or secondary prevention of CVD, it remains questioable due to the results of recent studies like HERS, WHI, PEPI, NHS, etc. which had demonstrated that selective beneficial effects of HRT on CVS doesnt overweight the possible risk of certain types of cancer, like invasive breast cancer, though decreasing the risk of colon cancer. Besides, HRT increses the overall risk of arterial and venous thrombosis in patients with trombophillia, EVTET trial.