Menopause

Natural end of menstrual cycles and reproductive hormone cycling, usually occurring in midlife

Menopause
Synonyms	Climacteric, change of life, menopausal transition
Pronounce	N/A
Specialty	Gynecology, Endocrinology, Primary care, Women's health
Symptoms	Hot flashes, night sweats, vaginal dryness, sleep disturbance, mood changes, irregular periods during perimenopause
Complications	Genitourinary syndrome of menopause, osteoporosis, fracture, cardiovascular disease, sexual pain, urinary symptoms
Onset	Usually between ages 45 and 55
Duration	Menopause is permanent; symptoms vary in duration
Types	N/A
Causes	Natural decline in ovarian follicle number and reproductive hormone cycling
Risks	Smoking, family history, chemotherapy, pelvic radiation, ovarian surgery, autoimmune disease, genetic factors
Diagnosis	Usually clinical after 12 months without menstrual periods; selected hormone testing when indicated
Differential diagnosis	Pregnancy, thyroid disease, hyperprolactinemia, polycystic ovary syndrome, depression, medication effects, abnormal uterine bleeding
Prevention	Not preventable when natural; complications can be reduced by healthy lifestyle, bone protection, and appropriate medical care
Treatment	Lifestyle measures, menopausal hormone therapy, vaginal estrogen, nonhormonal medications, behavioral therapies, bone health treatment
Medication	Estrogen therapy, estrogen-progestogen therapy, vaginal estrogen, fezolinetant, elinzanetant, SSRIs, SNRIs, gabapentin, oxybutynin, bisphosphonates when indicated
Prognosis	Normal life stage; symptoms and health risks are manageable
Frequency	Universal in people with ovaries who live to midlife, unless ovaries are removed earlier
Deaths	N/A

Menopause is the permanent end of menstrual cycles caused by loss of ovarian follicular activity and sustained decline in cyclic estrogen and progesterone production. It is usually diagnosed retrospectively after 12 consecutive months without a menstrual period, when no other pathologic or physiologic cause is present. Menopause is a normal stage of aging, but the hormonal transition can cause symptoms and long-term health changes that may require medical care.Menopause: identification and management(link). National Institute for Health and Care Excellence.The Menopause Years(link). American College of Obstetricians and Gynecologists.

The years around menopause are often called the menopausal transition or perimenopause. During this time, menstrual cycles become irregular and symptoms such as hot flashes, night sweats, sleep disturbance, mood changes, vaginal dryness, and changes in sexual function may occur. After menopause, lower estrogen levels can contribute to genitourinary syndrome of menopause, bone loss, and changes in cardiometabolic risk.What Is Menopause?(link). National Institute on Aging.

Overview

Menopause is not a disease, but it is an important health transition. Some people have few symptoms, while others experience symptoms that interfere with sleep, work, mood, relationships, sexual health, and quality of life. Management should be individualized according to symptoms, age, time since menopause, medical history, uterus status, personal preferences, and risk factors.

The average age of natural menopause is around 51 years in many populations, although normal timing varies. Menopause before age 40 is called premature ovarian insufficiency or premature menopause, while menopause between ages 40 and 45 is often called early menopause. Surgical removal of both ovaries causes immediate surgical menopause.

Terminology

• Menopause - Permanent end of menstrual periods due to loss of ovarian follicular activity.
• Perimenopause - Time before menopause when cycles become irregular and symptoms may begin.
• Menopausal transition - Physiologic transition from reproductive cycling to menopause.
• Postmenopause - Life stage after menopause has occurred.
• Climacteric - Older term for the transition around menopause.
• Natural menopause - Menopause that occurs without surgery, chemotherapy, or other medical cause.
• Surgical menopause - Menopause caused by removal of both ovaries.
• Induced menopause - Menopause caused by medical treatment such as chemotherapy, pelvic radiation, or ovarian suppression.
• Early menopause - Menopause occurring before age 45.
• Premature ovarian insufficiency - Loss of ovarian function before age 40.
• Vasomotor symptoms - Hot flashes and night sweats related to thermoregulatory changes.
• Genitourinary syndrome of menopause - Vaginal, vulvar, urinary, and sexual symptoms related to low estrogen.

Stages of menopause

Premenopause

Premenopause refers to the reproductive years before menopausal transition begins. Menstrual cycles are usually regular, though symptoms can still occur for other reasons.

Perimenopause

Perimenopause is the transitional phase leading to menopause.

• Irregular menstruation - Periods may become closer together, farther apart, heavier, lighter, or skipped.
• Anovulation - Cycles without ovulation become more common.
• Hot flashes - Sudden heat sensations may begin before the final menstrual period.
• Night sweats - Hot flashes during sleep can cause awakenings.
• Sleep disturbance - Insomnia or fragmented sleep may occur.
• Mood changes - Irritability, anxiety, or low mood can occur.
• Breast tenderness - May occur with fluctuating hormones.
• Migraine - Hormone-related migraine may worsen in some people.
• Fertility decline - Pregnancy becomes less likely but is still possible until menopause is confirmed.

Menopause

Menopause is confirmed after 12 consecutive months without menstrual bleeding when no other cause is present. It is a point in time, not a long phase.

Postmenopause

Postmenopause refers to the years after menopause.

• Vaginal atrophy - Thinning and dryness of vaginal tissues may occur.
• Urinary urgency - Urinary symptoms may become more common.
• Bone loss - Bone mineral density may decline more rapidly after menopause.
• Cardiovascular risk - Risk increases with age and may be affected by metabolic changes.
• Sexual dysfunction - Pain, dryness, low desire, or arousal changes may occur.
• Skin changes - Skin dryness and reduced elasticity may be noticed.

Causes

Natural menopause occurs because ovarian follicles are gradually depleted over time. As follicles decline, the ovaries produce less estrogen and progesterone, ovulation becomes irregular, and menstrual cycles eventually stop.

• Ovary - Organ that produces eggs and reproductive hormones.
• Ovarian follicle - Structure containing an immature egg cell.
• Estrogen - Hormone that affects the reproductive tract, bone, brain, blood vessels, skin, and other tissues.
• Progesterone - Hormone produced after ovulation that prepares the endometrium.
• Follicle-stimulating hormone - Pituitary hormone that rises as ovarian function declines.
• Luteinizing hormone - Pituitary hormone involved in ovulation and ovarian hormone production.
• Anti-Müllerian hormone - Marker of ovarian reserve, not routinely needed to diagnose typical menopause.
• Ovarian aging - Gradual decline in follicle number and function.
• Hypothalamic thermoregulation - Brain temperature regulation affected by estrogen withdrawal.

Types of menopause

Natural menopause

Natural menopause occurs spontaneously, usually in midlife, without surgery or medical treatment.

Surgical menopause

Surgical menopause occurs after removal of both ovaries.

• Bilateral oophorectomy - Surgical removal of both ovaries.
• Hysterectomy - Removal of the uterus; does not always cause menopause unless ovaries are removed.
• Abrupt estrogen decline - Symptoms may be sudden and severe after bilateral oophorectomy.
• Bone health - Early surgical menopause increases bone loss risk.
• Cardiovascular health - Early loss of ovarian hormones can influence long-term risk.

Chemotherapy- or radiation-induced menopause

Cancer treatment can impair ovarian function.

• Chemotherapy - Can damage ovarian follicles.
• Pelvic radiation - Can cause ovarian failure depending on dose and field.
• Ovarian suppression - Medical treatment that temporarily or permanently suppresses ovarian function.
• Fertility preservation - Should be discussed before gonadotoxic therapy when possible.
• Cancer survivorship - Menopause management must consider cancer type and recurrence risk.

Premature ovarian insufficiency

Premature ovarian insufficiency is loss of ovarian function before age 40.

• Amenorrhea - Absent menstrual periods.
• Infertility - Reduced fertility, though intermittent ovarian activity can occur.
• Autoimmune disease - Possible cause in some cases.
• Fragile X premutation - Genetic risk factor.
• Turner syndrome - Chromosomal condition associated with ovarian insufficiency.
• Iatrogenic condition - Medical treatment can cause ovarian insufficiency.
• Hormone therapy - Often recommended until the average age of natural menopause unless contraindicated.

Symptoms

Symptoms vary widely. Some people have no significant symptoms, while others have severe symptoms for years.

Vasomotor symptoms

• Hot flash - Sudden feeling of heat, often involving the face, neck, or chest.
• Night sweats - Sweating episodes during sleep.
• Flushing - Redness and warmth of the skin.
• Palpitations - Awareness of heartbeat during hot flashes.
• Chills - May follow a hot flash.
• Thermoregulation - Body temperature regulation becomes more sensitive during menopause.
• Sleep disruption - Night sweats can lead to fatigue and poor concentration.

Menstrual symptoms

• Irregular menstruation - Common during perimenopause.
• Heavy menstrual bleeding - Can occur during perimenopause but should be evaluated when excessive.
• Intermenstrual bleeding - Bleeding between periods requires evaluation.
• Postmenopausal bleeding - Any bleeding after menopause requires medical assessment.
• Anovulatory cycle - Cycle without ovulation, often causing irregular bleeding.

Genitourinary symptoms

The term genitourinary syndrome of menopause describes chronic vulvovaginal, sexual, and urinary symptoms related to low estrogen.

• Vaginal dryness - Common symptom after menopause.
• Dyspareunia - Painful sexual intercourse.
• Vulvar irritation - Burning, itching, or discomfort.
• Vaginal atrophy - Thinning and fragility of vaginal tissue.
• Urinary urgency - Sudden need to urinate.
• Urinary frequency - More frequent urination.
• Urinary tract infection - Recurrent infections may increase after menopause.
• Stress urinary incontinence - Urine leakage with coughing, sneezing, or exercise.
• Overactive bladder - Urgency and frequency syndrome.
• Sexual dysfunction - Pain, low desire, arousal difficulty, or orgasm changes.

Mood and cognitive symptoms

• Mood swings - Emotional changes may occur during the transition.
• Anxiety - Can occur or worsen during perimenopause.
• Depression - Risk may increase in susceptible individuals.
• Irritability - Common complaint during sleep disruption and hormone fluctuation.
• Brain fog - Subjective memory or concentration difficulty.
• Fatigue - Often related to poor sleep or mood symptoms.
• Decreased libido - May be related to hormones, pain, relationship factors, mood, sleep, or medications.

Musculoskeletal and skin symptoms

• Arthralgia - Joint pain may occur during menopause transition.
• Myalgia - Muscle aches may occur.
• Sarcopenia - Age-related muscle loss can accelerate with inactivity.
• Osteopenia - Low bone mass.
• Osteoporosis - Fragile bone condition with increased fracture risk.
• Skin aging - Skin dryness, thinning, and reduced elasticity may be noticed.
• Hair thinning - Some people notice scalp hair thinning.
• Weight gain - Midlife weight gain is influenced by aging, activity, sleep, and metabolic factors, not menopause alone.
• Central adiposity - Body fat distribution may shift toward the abdomen.

Long-term health considerations

Bone health

Estrogen decline contributes to increased bone turnover and bone loss after menopause.

• Osteoporosis - Common postmenopausal bone disease.
• Fragility fracture - Fracture from low-level trauma.
• Hip fracture - Serious complication of osteoporosis.
• Vertebral compression fracture - Spine fracture that may cause pain or height loss.
• Dual-energy X-ray absorptiometry - Bone density test used to diagnose osteoporosis.
• Calcium - Important nutrient for bone health.
• Vitamin D - Supports calcium absorption and bone health.
• Weight-bearing exercise - Helps maintain bone strength.
• Bisphosphonate - Medication class used to treat osteoporosis.
• Denosumab - Medication used for osteoporosis in selected patients.
• Selective estrogen receptor modulator - Medication class with estrogen-like effects in bone.

Cardiovascular health

Cardiovascular risk increases with age and may be influenced by menopausal changes.

• Cardiovascular disease - Leading cause of death in postmenopausal women.
• Hypertension - Blood pressure often increases with age.
• Dyslipidemia - Cholesterol patterns may worsen after menopause.
• Insulin resistance - May increase with weight gain and aging.
• Metabolic syndrome - Cluster of cardiometabolic risk factors.
• Atherosclerosis - Artery disease that increases with age.
• Smoking cessation - Essential for cardiovascular and bone health.
• Physical activity - Reduces cardiometabolic risk.

Hormone therapy is not recommended solely for the primary prevention of chronic conditions such as cardiovascular disease in postmenopausal people.Hormone Therapy in Postmenopausal Persons: Primary Prevention of Chronic Conditions(link). U.S. Preventive Services Task Force.

Metabolic health

• Weight management - Healthy eating, activity, sleep, and resistance training support metabolic health.
• Prediabetes - Midlife screening may be appropriate based on risk.
• Type 2 diabetes - Risk increases with age and weight gain.
• Nonalcoholic fatty liver disease - May become more common with metabolic syndrome.
• Sleep apnea - Risk increases with age and weight changes.

Sexual health

• Sexual pain - Often related to genitourinary syndrome of menopause.
• Low libido - Multifactorial and may involve hormones, mood, relationship, pain, sleep, or medications.
• Vaginal estrogen - Effective local treatment for vaginal dryness and pain with sex.
• Lubricant - Reduces friction during sexual activity.
• Vaginal moisturizer - Helps chronic dryness.
• Pelvic floor physical therapy - Helps selected people with pelvic pain or urinary symptoms.
• Sex therapy - May help when relationship, desire, or arousal issues are prominent.

Diagnosis

Menopause is usually diagnosed clinically. Routine hormone testing is not needed for most healthy people older than 45 with typical symptoms and menstrual changes.Menopause: identification and management(link). National Institute for Health and Care Excellence.

Clinical diagnosis

• Age - Typical onset is between ages 45 and 55.
• Amenorrhea - Twelve months without menstrual bleeding confirms menopause in many cases.
• Menstrual history - Pattern of irregularity helps identify perimenopause.
• Symptom history - Hot flashes, night sweats, sleep change, vaginal dryness, and mood symptoms support diagnosis.
• Medication review - Hormonal contraception, chemotherapy, endocrine therapy, and other medications can affect bleeding.
• Pregnancy test - Important when pregnancy is possible.
• Gynecologic examination - Used when symptoms, bleeding, pain, or pelvic concerns are present.

Laboratory testing

Testing is selective, not universal.

• Follicle-stimulating hormone - May be elevated in menopause, but fluctuates during perimenopause.
• Estradiol - May be low after menopause, but varies during transition.
• Thyroid-stimulating hormone - Used when thyroid disease is suspected.
• Prolactin - Used when hyperprolactinemia is suspected.
• Pregnancy test - Used when pregnancy is possible.
• Complete blood count - May be useful in heavy bleeding.
• Ferritin - Evaluates iron deficiency from heavy bleeding.
• Anti-Müllerian hormone - Not routinely used for diagnosing natural menopause.
• Lipid panel - Assesses cardiovascular risk.
• Hemoglobin A1c - Screens for diabetes risk when indicated.

When to evaluate bleeding

Some bleeding patterns require assessment.

• Postmenopausal bleeding - Any bleeding after menopause requires evaluation.
• Heavy menstrual bleeding - Excessive bleeding during perimenopause may require evaluation.
• Intermenstrual bleeding - Bleeding between periods should be assessed.
• Bleeding after sex - Requires evaluation.
• Endometrial hyperplasia - Overgrowth of uterine lining that may cause bleeding.
• Endometrial cancer - Important cause of postmenopausal bleeding.
• Uterine fibroid - Benign tumor that can cause bleeding.
• Endometrial polyp - Benign growth that can cause bleeding.

Differential diagnosis

• Pregnancy - Can cause missed periods and symptoms.
• Thyroid disease - Can cause menstrual changes, sweating, palpitations, mood symptoms, and weight change.
• Hyperprolactinemia - Can cause irregular or absent periods.
• Polycystic ovary syndrome - Can cause irregular menstruation.
• Primary ovarian insufficiency - Menopause-like ovarian failure before age 40.
• Depression - Can cause sleep, mood, libido, and concentration symptoms.
• Anxiety disorder - Can cause palpitations, sweating, and sleep disturbance.
• Medication adverse effect - Antidepressants, opioids, endocrine therapies, and other medicines can cause symptoms.
• Carcinoid syndrome - Can cause flushing.
• Pheochromocytoma - Rare cause of sweating, palpitations, and hypertension.
• Infection - Fever and night sweats can mimic menopausal symptoms.
• Lymphoma - Can cause night sweats and systemic symptoms.
• Abnormal uterine bleeding - Requires gynecologic evaluation.

Treatment

Treatment depends on symptoms, personal goals, health risks, contraindications, and preferences. Not everyone needs medical treatment.

Lifestyle and self-care

• Layered clothing - Helps manage hot flashes.
• Cooling strategy - Fans, cool rooms, and breathable fabrics may help.
• Trigger avoidance - Alcohol, spicy foods, heat, and stress can worsen hot flashes in some people.
• Regular exercise - Supports bone, cardiovascular, mood, sleep, and weight health.
• Resistance training - Preserves muscle and bone strength.
• Weight management - May reduce hot flashes and improve metabolic health in some people.
• Smoking cessation - Reduces hot flashes, cardiovascular risk, cancer risk, and bone loss.
• Sleep hygiene - Regular sleep schedule and cool bedroom may reduce sleep disruption.
• Mindfulness - May help stress and coping.
• Cognitive behavioral therapy - Can improve coping with vasomotor symptoms and sleep disturbance in some patients.
• Pelvic floor exercise - May help urinary symptoms.
• Vaginal lubricant - Helps sexual discomfort from dryness.
• Vaginal moisturizer - Helps ongoing vaginal dryness.

Menopausal hormone therapy

Menopausal hormone therapy is the most effective treatment for vasomotor symptoms and can also help prevent bone loss while used. It should be individualized and periodically reassessed.The 2022 hormone therapy position statement of The North American Menopause Society(link). Menopause.Hormone Therapy for Menopause(link). American College of Obstetricians and Gynecologists.

• Estrogen therapy - Used for people without a uterus or with special indications.
• Estrogen-progestogen therapy - Used when the uterus is present to reduce endometrial cancer risk.
• Progestogen - Protects the endometrium from unopposed estrogen.
• Transdermal estrogen - Patch, gel, or spray route that may reduce some clot-related risks compared with oral therapy in selected patients.
• Oral estrogen - Systemic estrogen taken by mouth.
• Vaginal estrogen - Low-dose local treatment for genitourinary symptoms.
• Micronized progesterone - Bioidentical prescription progesterone used in some regimens.
• Levonorgestrel intrauterine device - May provide endometrial protection in selected regimens and contraception during perimenopause.
• Tibolone - Synthetic steroid used in some countries but not available everywhere.
• Bioidentical hormone therapy - Should distinguish regulated prescription products from unregulated compounded products.
• Compounded hormone therapy - Not routinely recommended when approved products are available because of concerns about dose consistency, safety, and lack of regulatory oversight.

For many healthy symptomatic people younger than 60 or within 10 years of menopause onset, benefits of hormone therapy may outweigh risks when therapy is individualized. For people who start hormone therapy after age 60 or more than 10 years after menopause, the benefit-risk profile is generally less favorable.2022 Hormone Therapy Position Statement(link). The Menopause Society.

Contraindications and cautions

Hormone therapy may not be appropriate for everyone.

• Breast cancer - History of estrogen-sensitive breast cancer is a common contraindication to systemic hormone therapy.
• Endometrial cancer - Requires specialist evaluation.
• Venous thromboembolism - Prior blood clot may affect therapy choice.
• Stroke - History of stroke is a major caution or contraindication.
• Coronary artery disease - Requires individualized risk assessment.
• Liver disease - Active liver disease can affect hormone use.
• Unexplained vaginal bleeding - Must be evaluated before systemic hormone therapy.
• Migraine with aura - Requires individualized assessment, especially with systemic estrogen.
• High cardiovascular risk - May favor nonhormonal options.
• Shared decision-making - Essential for weighing risks and benefits.

Nonhormonal treatment for hot flashes

Nonhormonal options are useful for people who cannot use hormones, prefer not to use hormones, or need additional treatment.

• Fezolinetant - Oral neurokinin 3 receptor antagonist approved by the FDA in 2023 for moderate to severe vasomotor symptoms due to menopause.FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause(link). U.S. Food and Drug Administration.
• Elinzanetant - Oral nonhormonal neurokinin receptor antagonist approved in 2025 for moderate to severe hot flashes due to menopause.Lynkuet prescribing information(link). U.S. Food and Drug Administration.
• Selective serotonin reuptake inhibitor - Some SSRIs can reduce hot flashes.
• Serotonin-norepinephrine reuptake inhibitor - Some SNRIs can reduce hot flashes.
• Paroxetine - Low-dose paroxetine is FDA-approved for vasomotor symptoms.
• Venlafaxine - Common nonhormonal option for hot flashes.
• Desvenlafaxine - May reduce vasomotor symptoms.
• Escitalopram - May help hot flashes in some patients.
• Gabapentin - May help night sweats and sleep-related symptoms.
• Oxybutynin - Anticholinergic medication that can reduce hot flashes but may cause dry mouth, constipation, or cognitive concerns in older adults.
• Clonidine - Older option with limited use because of side effects.
• Cognitive behavioral therapy - May reduce bother and improve sleep.
• Clinical hypnosis - Supported by some evidence for vasomotor symptom reduction.

The Menopause Society's 2023 nonhormone therapy position statement lists several evidence-based nonhormonal options and emphasizes that treatment should be individualized.The 2023 nonhormone therapy position statement of The North American Menopause Society(link). Menopause.

Treatment of genitourinary syndrome of menopause

Genitourinary symptoms often persist or worsen without treatment.

• Vaginal moisturizer - Used regularly for dryness.
• Vaginal lubricant - Used during sexual activity.
• Low-dose vaginal estrogen - Effective for vaginal dryness, painful sex, and recurrent urinary symptoms in many patients.
• Vaginal estradiol tablet - Local estrogen option.
• Vaginal estrogen cream - Local estrogen option.
• Vaginal ring - Local estrogen option.
• Prasterone - Vaginal DHEA used for dyspareunia in selected patients.
• Ospemifene - Oral selective estrogen receptor modulator used for dyspareunia in selected patients.
• Pelvic floor physical therapy - Helps pelvic pain, pelvic floor dysfunction, and urinary symptoms.
• Recurrent urinary tract infection - Vaginal estrogen may reduce recurrence in postmenopausal patients.
• Sexual counseling - Helpful when pain, desire, relationship, or anxiety issues are present.

Bone health management

• Dual-energy X-ray absorptiometry - Used for osteoporosis screening based on age and risk.
• Calcium intake - Should be adequate through diet or supplements when needed.
• Vitamin D - Correct deficiency when present.
• Weight-bearing exercise - Walking, stair climbing, and resistance training support bone.
• Fall prevention - Vision care, strength training, balance training, and home safety reduce fracture risk.
• Smoking cessation - Protects bone health.
• Alcohol moderation - Reduces fall and fracture risk.
• Bisphosphonate - First-line osteoporosis medication for many patients at high fracture risk.
• Denosumab - Alternative osteoporosis therapy in selected patients.
• Anabolic osteoporosis therapy - Teriparatide, abaloparatide, or romosozumab may be used for very high fracture risk.
• Menopausal hormone therapy - Can prevent bone loss while used but is not first-line solely for chronic disease prevention in all postmenopausal patients.

Cardiometabolic health management

• Blood pressure - Should be monitored regularly.
• Lipid panel - Helps estimate cardiovascular risk.
• Diabetes screening - Based on age, weight, risk factors, and guidelines.
• Mediterranean diet - Supports cardiometabolic health.
• Physical activity - Aerobic and resistance exercise improve cardiovascular risk.
• Smoking cessation - One of the most important interventions.
• Sleep apnea - Should be considered with snoring, daytime sleepiness, or resistant hypertension.
• Weight management - Supports cardiometabolic and joint health.
• Statin - Used based on cardiovascular risk, not menopause alone.
• Aspirin - Not used routinely for primary prevention without individualized risk assessment.

Complementary and alternative approaches

Many complementary products are marketed for menopause symptoms, but evidence and safety vary.

• Phytoestrogen - Plant-derived estrogen-like compounds such as soy isoflavones; evidence is mixed.
• Black cohosh - Common supplement with inconsistent evidence and possible liver safety concerns.
• Evening primrose oil - Not consistently effective for hot flashes.
• Acupuncture - May help some symptoms, but evidence varies.
• Yoga - May improve sleep, mood, and general well-being.
• Mind-body intervention - May support coping and stress reduction.
• Dietary supplement - Should be reviewed for interactions and safety.
• Compounded hormone therapy - Should be approached cautiously when regulated alternatives are available.

Patients should tell clinicians about supplements because some can interact with medications or have safety concerns.

Menopause and cancer survivorship

Menopause symptoms are common after cancer treatment.

• Breast cancer - Hormone therapy is often avoided or requires specialist input.
• Endometrial cancer - Hormone therapy requires individualized specialist review.
• Ovarian cancer - Menopause may be surgical or treatment-induced.
• Chemotherapy-induced ovarian failure - Can cause abrupt symptoms.
• Aromatase inhibitor - Can worsen hot flashes and vaginal dryness.
• Tamoxifen - Can cause hot flashes and menstrual changes.
• Nonhormonal therapy - Often preferred in hormone-sensitive cancer survivors.
• Oncology - Cancer team should be involved in treatment decisions.

Menopause in transgender and gender-diverse people

People with ovaries may experience menopause regardless of gender identity.

• Transgender man - May experience menopause naturally or after stopping ovarian function.
• Nonbinary person - May need individualized language and care.
• Gender-affirming hormone therapy - Testosterone use may suppress menses but does not necessarily equal menopause.
• Oophorectomy - Removal of ovaries causes surgical menopause.
• Inclusive care - Uses respectful language and addresses anatomy-based health needs.
• Bone health - Important when gonadal hormones are low.
• Fertility counseling - Should be offered when relevant.

Menopause in animals

Menopause is unusual in the animal kingdom but has been observed in humans and a few other long-lived species.

• Human - Menopause is a normal life stage.
• Orca - One of the species known to have prolonged post-reproductive lifespan.
• Short-finned pilot whale - Species with evidence of menopause.
• Chimpanzee - Evidence of post-reproductive lifespan has been reported in some populations.
• Evolution of menopause - Theories include kin selection, grandmother hypothesis, and reproductive conflict.

History and culture

Menopause has been described in medical and cultural texts for centuries. Attitudes vary widely: some cultures view it as a time of loss, while others view it as a transition to authority, freedom, or elder status.

• Climacteric - Historical term for the menopause transition.
• Women's health movement - Increased attention to informed consent and individualized hormone therapy.
• Women's Health Initiative - Large trial that changed hormone therapy prescribing patterns.
• Medicalization - Concern that a normal life stage may be framed as disease.
• Stigma - Menopause symptoms may be minimized or hidden because of social stigma.
• Workplace health - Hot flashes, poor sleep, and mood symptoms can affect work life.
• Menopause education - Improves self-advocacy and timely care.

Patient education

Patients should be reassured that menopause is a normal transition and that effective treatments are available.

• Track symptoms - Record hot flashes, sleep, bleeding, mood, and triggers.
• Discuss treatment goals - Decide whether the priority is hot flash relief, sleep, sexual comfort, mood, bone health, or overall quality of life.
• Report bleeding - Bleeding after menopause should always be evaluated.
• Ask about hormone therapy - Benefits and risks depend on age, time since menopause, uterus status, and medical history.
• Ask about nonhormonal options - Many effective nonhormonal treatments exist.
• Use vaginal moisturizers - Helpful for chronic dryness.
• Use lubricants - Helpful for painful sex due to dryness.
• Protect bones - Exercise, calcium, vitamin D, and screening when appropriate.
• Protect the heart - Monitor blood pressure, cholesterol, glucose, smoking, diet, and activity.
• Sleep care - Treat night sweats, insomnia, sleep apnea, and mood issues.
• Mental health - Depression and anxiety are treatable.
• Avoid unregulated hormones - Use regulated therapies when possible.

When to seek medical care

• Postmenopausal bleeding - Any bleeding after menopause requires evaluation.
• Heavy menstrual bleeding - Heavy or prolonged bleeding during perimenopause should be assessed.
• Bleeding after sex - Requires evaluation.
• Severe hot flashes - Treatment can improve quality of life.
• Night sweats with fever - May signal infection, malignancy, or other illness.
• New depression - Mood symptoms should be treated.
• Suicidal ideation - Requires urgent care.
• Severe pelvic pain - Needs evaluation.
• Painful intercourse - Effective treatments are available.
• Recurrent urinary tract infection - Postmenopausal urinary symptoms can be treated.
• Early menopause - Menopause before age 45 should be medically evaluated.
• Premature ovarian insufficiency - Symptoms or amenorrhea before age 40 require evaluation.
• Fracture - Low-trauma fracture may indicate osteoporosis.
• Chest pain - Requires urgent medical evaluation.
• Stroke symptoms - Sudden weakness, speech difficulty, facial droop, or vision loss requires emergency care.

Prognosis

Menopause is permanent and normal. Most symptoms improve over time, but some, especially genitourinary symptoms, may persist or worsen without treatment. Long-term health after menopause is influenced by genetics, lifestyle, medical conditions, socioeconomic factors, and access to preventive care.

• Vasomotor symptoms - Often last several years but duration varies.
• Genitourinary syndrome of menopause - Often chronic and treatable.
• Bone loss - Can be prevented or treated.
• Cardiovascular risk - Can be reduced by risk-factor management.
• Quality of life - Often improves with individualized symptom management.
• Healthy aging - Menopause care is part of midlife preventive health.

See also

• Perimenopause
• Postmenopause
• Premature ovarian insufficiency
• Early menopause
• Menstrual cycle
• Hot flash
• Night sweats
• Genitourinary syndrome of menopause
• Vaginal atrophy
• Hormone replacement therapy
• Menopausal hormone therapy
• Estrogen therapy
• Progesterone
• Osteoporosis
• Cardiovascular disease
• Women's Health Initiative
• Gynecology
• Endocrinology
• Women's health
• Aging
• Fertility
• Oophorectomy
• Hysterectomy

Further reading

• Menopause: identification and management(link). National Institute for Health and Care Excellence.
• The Menopause Years(link). American College of Obstetricians and Gynecologists.
• Hormone Therapy for Menopause(link). American College of Obstetricians and Gynecologists.
• The 2022 hormone therapy position statement of The North American Menopause Society(link). Menopause.
• The 2023 nonhormone therapy position statement of The North American Menopause Society(link). Menopause.
• Hormone Therapy in Postmenopausal Persons: Primary Prevention of Chronic Conditions(link). U.S. Preventive Services Task Force.
• FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause(link). U.S. Food and Drug Administration.
• Lynkuet prescribing information(link). U.S. Food and Drug Administration.
• What Is Menopause?(link). National Institute on Aging.

External links

• NICE - Menopause: identification and management
• ACOG - The Menopause Years
• ACOG - Hormone Therapy for Menopause
• The Menopause Society
• National Institute on Aging - What Is Menopause?
• FDA - Fezolinetant approval for hot flashes
• FDA - Elinzanetant prescribing information
• USPSTF - Hormone therapy for primary prevention of chronic conditions
• NHLBI - Women's Health Initiative