Menopause Symptoms
Menopause -- the permanent cessation of menstruation for 12 consecutive months -- is a normal life transition driven by declining ovarian estrogen and progesterone production. While not a disease, the estrogen decline produces symptoms that range from mildly inconvenient to significantly quality-of-life limiting, and carries long-term implications for bone density and cardiovascular health.
Symptoms
Hot flashes and night sweats (vasomotor symptoms), sleep disturbance, vaginal dryness and dyspareunia, urinary urgency and recurrent UTIs, mood changes including irritability and low mood, cognitive changes (brain fog), joint aches, and decreased libido.
Causes and risk
Natural menopause occurs at an average age of 51. Premature menopause before age 40 (primary ovarian insufficiency) requires urgent evaluation. Surgical menopause following bilateral oophorectomy causes abrupt symptom onset. Smoking, low BMI, and a family history of early menopause are risk factors for earlier onset.
How it is evaluated
Menopause is a clinical diagnosis -- FSH above 30 -- 40 IU/L and estradiol below 30 pg/mL confirm it if there is diagnostic uncertainty. We assess cardiovascular risk, bone density (DEXA scan), and discuss contraindications to hormone therapy.
Treatment
Hormone therapy remains the most effective treatment for vasomotor symptoms and is appropriate for healthy women under 60 or within 10 years of menopause onset. Non-hormonal options (SSNRIs, gabapentin, fezolinetant) are used when hormone therapy is contraindicated. Vaginal estrogen effectively treats genitourinary symptoms with minimal systemic absorption.