Menopause is a time at which a woman's reproductive capacity ends. It is defined as the absence of menstrual periods for a period of 12 consecutive months. Prior to the actual menopause, a woman may experience irregular periods and irregular episodes of vaginal bleeding. After menopause, symptoms can occur due to lowering of estrogen levels in the body. Not every woman will experience all the symptoms of menopause, and symptoms vary among women. It is also possible for symptoms of lowered estrogen to begin years before the actual menopause. Some of the most commonly reported symptoms include hot flashes and night sweats. These can be associated with flushing and may be followed by intense sweating. Other symptoms that are related to lowering of estrogen levels include vaginal dryness, painful sexual intercourse (dyspareunia), and vaginal irritation or itching. Changes in the urinary system may cause leakage of urine or the need to urinate frequently. Some women report changes in skin texture, worsening of acne, or weight gain. Cognitive and mood symptoms as well as generalized physical symptoms can accompany menopause in some women. These vary among women and can include mood changes, stress, tiredness, fatigue, irritability, and difficulties with memory. Hot flashes and night sweats can contribute to sleep disturbances.