Irregular uterine bleeding is a common symptom among women in the menopausal transition. Women commonly transition from having regular cycles to having irregular cycles before the final menstrual period. In late perimenopause, anovulation becomes more common, leading to skipped menstrual cycles. Low-dose oral contraceptive pills are effective in decreasing the amount of menstrual blood loss and improving menstrual cycle regularity. It is unclear whether menorrhagia is associated with normal perimenopausal hormonal changes. Studies to date have failed to correlate menorrhagia with hormonal levels and pathology within the uterus. Because of the common association between uterine pathology and menorrhagia, this is an important area for future studies. Vaginal dryness is a common symptom, particularly in late perimenopause. The association between vaginal dryness and low estrogen levels is clear. Estrogen-based hormone replacement therapy is effective in treating this symptom. Locally released estrogen therapy may be preferred over systemic therapy because of lower systemic estradiol levels, reduced side effects, and high efficacy. The long-term safety of these products, particularly in women with a history of breast cancer, requires more study. The prevalence of incontinence increases as women age, but it is unclear whether the menopausal transition is an independent risk factor. Incontinence is a frequent complaint among women in the menopausal transition. In postmenopausal women, hormone therapy (HT) appears to be ineffective in preventing or improving the symptoms of incontinence. Further study of HT, including locally applied estrogens for the common symptom of incontinence, are needed in women in the menopausal transition.