Menopause Symptoms
Menopause is defined as 12 consecutive months without a period, typically around age 51. In women 45 and older it's a clinical diagnosis -- FSH and estradiol testing usually isn't needed -- per the 2024 Menopause Practice Standards and a 2023 JAMA review.
Symptoms
Hot flashes and night sweats are the hallmark, affecting most women to some degree; vaginal dryness, sleep disruption, mood changes, and brain fog are also common.
Causes and risk
The natural, gradual decline in ovarian estrogen production; surgical removal of the ovaries causes an abrupt version with typically more severe symptoms.
How it is evaluated
Diagnosis is clinical based on age and symptom pattern. Vasomotor symptoms occasionally mimic thyroid disease or, rarely, other hormonal conditions, which is why atypical presentations get a broader workup.
Treatment
Hormone therapy is the most effective treatment for vasomotor symptoms, with the 2022 Menopause Society Hormone Therapy Position Statement framing the favorable benefit-risk window as starting before age 60 or within 10 years of menopause onset. For those who can't or prefer not to use hormones, 2023 non-hormone options (including newer non-hormonal medications) are effective alternatives.
When to seek care
Any postmenopausal bleeding requires prompt evaluation -- it is never considered a normal menopause symptom and needs to be worked up.