absent menses for 12 months, occurs at a median age of 51 when the loss of ovarian function leads to hypoestrogenemia

most commonly occurs at age ≥45 (average age 51)

| Clinical features | • Vasomotor symptoms (eg, hot flashes, night sweats, sleep disturbances) • Oligomenorrhea/amenorrhea • Sleep disturbances & worsening fatigue • Decreased libido • Depression • Cognitive decline • Vaginal atrophy→Painful intercourse due to vaginal dryness | | --- | --- | | Diagnosis | • Clinical manifestations • ↑ FSH | | Treatment | • Topical vaginal estrogen • Systemic hormone replacement therapy (The only current indication for HRT is vasomotor symptoms in women age <60 who have undergone menopause within the past 10 years) |

Genitourinary syndrome of menopause (atrophic vaginitis)

Osteoperosis

in women without previously normal menstrual cycles (eg, prior hysterectomy, endometrial ablation), the diagnosis of menopause cannot be made clinically because vasomotor symptoms and vulvovaginal atrophy can be due to other etiologies (eg, thyroid disorder, malignancy).  Therefore, these patients require an elevated serum FSH level for the diagnosis of menopause.

• Genitourinary syndrome of menopause
• Women begin the menopausal transition (ie, perimenopause) years before the final menstrual period and onset of menopause (average age 51).  Ovulation still occurs during this time, and women may become pregnant despite lower conception rates.  Symptoms of perimenopause include irregular menstrual periods, insomnia, fatigue, and weight gain, which often overlap with symptoms of early pregnancy.  All women of reproductive age with amenorrhea and signs of pregnancy should be evaluated with an hCG level.

Female hormones have cardioprotective associations, and the changes in sex hormones that occur with menopause reduce this protection. In the absence of other significant medical comorbidities or specific risk factors, this patient’s greatest risk of mortality is from cardiovascular disease.

• Management
• EUCATIONAL OBJECTIVES

Serum testosterone level does not affect menopausal status and does not correlate with sexual function in women; therefore, it is not measured in patients with menopausal symptoms or decreased libido.