Menopause is the permanent end of menstrual periods, diagnosed after 12 months without a period, at an average age of 51 in the US. Falling estrogen causes hot flashes, vaginal dryness and bone loss, and treatment is tailored to symptoms and risks.
Key symptoms
- Hot flashes and night sweats
- Irregular periods that finally stop
- Vaginal dryness, pain with sex and urinary symptoms
- Sleep problems, mood changes and trouble concentrating
What you find on exam
- Blood pressure and BMI
- Pelvic exam: thin, pale vaginal tissue
- Breast exam
- Height loss or kyphosis suggesting osteoporosis
Tests
- Clinical diagnosis after age 45; labs usually not needed
- FSH and pregnancy test if under 45 or unclear
- TSH if symptoms suggest thyroid disease
- Bone density scan (DEXA) at 65, earlier with risk factors
Treatment basics
- Hormone therapy (estradiol) for bothersome hot flashes, with a progestin if the uterus is present
- Best started before 60 or within 10 years of menopause
- Nonhormonal options: paroxetine, venlafaxine, gabapentin or fezolinetant
- Vaginal estrogen or moisturizers for genitourinary symptoms
- Calcium, vitamin D, exercise and no smoking for bone health
Red flags
- Any vaginal bleeding after menopause (rule out endometrial cancer)
- Menopause before age 40 (primary ovarian insufficiency)
- Leg swelling, chest pain or stroke signs on hormone therapy
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.