Headaches and dizziness
Headaches not previously experienced occurred in nearly half the women in two of our surveys.4,5 Others who had been subject to migraines showed some increase. This is, after all, nothing new. Headaches experienced before a period are thought to be due in part to the fall in oestrogen at this time. Headaches experienced in the pill-free week when taking an oral contraceptive are also felt to be due to this factor. They can, of course, be due to many other causes. They may be a sign of disturbance in almost any system in the body. I am only mentioning them here as they are sometimes relieved when oestrogen replacement is administered, but I am certainly not suggesting that oestrogen is the first line of treatment for headaches at this time of life.
Vertigo, which is described as an odd sort of dizziness or motion sickness, may also occur at this period.
These are common at the menopause and are probably due to a relaxing muscle tone and osteoarthritis which often occurs first at the menopause. Osteoarthritis is also more common in women than in men. An everyday exercise programme (see chapter 
often helps, and many arthritis specialists agree that oestrogen replacement often helps to alleviate pains in the joints when they first appear at the menopause. This seems to be supported by recent reports that one of the advantages of the oral contraceptive pill is the reduction of arthritis in pill users. Some patients report relief of symptoms when on the oral contraceptive pill, and also during pregnancy, when circulating hormone levels are high.
Prolapse and laxness of the pelvic floor
There is a general reduction in muscle tone at the time of the menopause, and this of course is most noticeable in the pelvis. In addition, prolapse, which occurs after childbirth, becomes more evident. Prolapse – where the uterus descends into the vagina because its normal supports have weakened – may be helped by a regular exercise programme and by avoiding constipation.
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