Menopause Symptoms
Menopause is a normal life transition, confirmed after 12 consecutive months without a period, with most symptoms stemming from declining ovarian estrogen, per the 2022 North American Menopause Society (NAMS) Hormone Therapy Position Statement.
Symptoms
Hot flashes and night sweats affect more than half of women and can last 7+ years; vaginal dryness and urinary symptoms (genitourinary syndrome of menopause) tend to worsen over time rather than resolve; sleep disturbance, mood changes, and "brain fog" are also common.
Causes and risk
The natural, age-related depletion of ovarian follicles; smoking and a family history of early menopause can bring on menopause earlier, and surgical removal of both ovaries causes immediate surgical menopause.
How it is evaluated
For women 45 and older with typical symptoms, menopause is diagnosed clinically based on age and menstrual pattern -- blood hormone testing is not needed or recommended in this group, since levels fluctuate too much to be reliable.
Treatment
Per the 2022 NAMS position statement, hormone therapy is the most effective treatment for hot flashes and genitourinary symptoms, with the best benefit-to-risk profile in women under 60 or within 10 years of menopause onset. Non-hormonal options -- low-dose paroxetine, gabapentin, and the newer agent fezolinetant (which requires liver monitoring) -- are effective alternatives for women who cannot or prefer not to use hormones. Black cohosh, soy isoflavones, and other herbal remedies were rated not recommended by NAMS due to lack of proven benefit.
When to seek care
Any vaginal bleeding occurring 12 or more months after your last period needs prompt evaluation to rule out endometrial cancer. Sudden leg swelling or pain, chest pain, shortness of breath, or sudden severe headache while on hormone therapy could signal a blood clot or stroke and needs emergency care.