Which symptom is least likely to occur in a woman starting menopause?

Severe vaginal atrophic changes are least likely to occur at the onset of menopause. While hormonal fluctuations during the perimenopausal phase can indeed lead to some vaginal dryness or mild atrophic changes, significant and severe atrophic changes typically develop later in the menopausal process as estrogen levels decline more significantly.

In the early stages of menopause, women often experience symptoms such as hot flashes and irregular menstrual periods due to the body's adjustment to decreasing estrogen levels. Cyclic mood swings can also be common during this transitional phase because of hormonal fluctuations. However, severe atrophic changes usually take longer to develop, making them less likely to be among the first symptoms experienced as menopause begins.