A natural decline in reproductive hormones when a woman reaches her 40s or 50s. Menopause is signalled by 12 months since last menstruation. Common symptoms include hot flashes and vaginal dryness. There may also be sleep disturbances. The combination of these symptoms can cause anxiety or depression. Menopause is a natural process with treatments that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or oestrogen. Medications can reduce the severity and frequency of hot flushes. In special circumstances, oral hormone therapy may be used.