Climacteric refers to the decline in fertility which usually occurs in a person's 30s and 40s. During climacteric women have shorter, irregular periods. Hot flashes may begin. Menopause refers to the end of menstruation and childbearing years, which occurs an a woman's early 50s. During menopause, a further decrease in estrogen occurs. It causes a decrease in vaginal lubrication, skin elasticity, and can accompany bone loss. Individual differences about reacting to menopause include the importance of childbearing capacity and other interests. Cultural differences about reacting to menopause include medicalization in industrialized west linked to complaints; ethnic differences in North America; and social status of aging women linked to reactions.