Climacteric symptoms are so closely associated with the menopause to be practically considered its hallmark. However, symptoms can already appear before the onset of menopause. The frequency, extent and intensity of symptoms are dependent on social factors, body composition, race and geographical region. In about 20-25% of menopausal women they do not occur at all. These symptoms are most prominent in women who are suddenly deprived of their endogenous estrogen secretion, for instance by bilateral ovariectomy, particularly in younger women. Climacteric symptoms can to be subdivided into five categories: menstrual bleeding disorders; vegetative symptoms; psychosomatic symptoms; somatotrophic changes; and metabolic changes. For prevention and treatment of the various symptoms, estrogen/progestogen replacement therapy (HRT) or estrogen replacement therapy (ERT) in individualized dosages and various forms of applications are the most cost-effective modalities in order to control menopausal symptoms and restore organic function, or prevent all of this and improve women's quality of life. Recent publications indicate that gene polymorphisms may be associated with severe and persistent climacteric symptoms. This is also true for current and ever cigarette smokers.