Menopause
ICD-10 N95.1
- ~0
- average age at natural menopause (US)
- 0%
- experience vasomotor symptoms (hot flashes)
- 0-7 years
- median symptom duration
- <0 or <10y
- post-menopause window where MHT benefit outweighs risk
What is menopause?
Menopause is the permanent cessation of menses, defined retrospectively after 12 consecutive months without menstruation. Average US age 51. Symptoms (vasomotor flushes, sleep disruption, mood changes, vaginal dryness) result from estrogen decline. Perimenopausal transition typically begins 4-8 years before final menses.
What are the symptoms of menopause?
- Hot flashes (vasomotor symptoms) and night sweats
- Sleep disturbance — distinct from but worsened by night sweats
- Mood changes, irritability, anxiety; new or worsened depression
- Vaginal dryness, painful intercourse, urinary urgency (genitourinary syndrome of menopause)
- Cognitive symptoms — brain fog, word-finding difficulty
- Joint aches, bone density decline (post-menopausal osteoporosis risk)
Who is at risk for menopause?
- Smoking — earlier menopause by ~1-2 years
- Family history of early menopause
- Surgical or chemotherapy-induced menopause — typically more severe symptoms
- Primary ovarian insufficiency (menopause before 40) — distinct entity, evaluate
- Eating disorders or very low body weight in earlier life
How is menopause diagnosed?
Clinical, in women age 45+ with 12 months amenorrhea. Lab testing (FSH, estradiol) is not routinely needed but useful in atypical cases or before age 45 (to rule out primary ovarian insufficiency).
How is menopause treated?
Menopausal hormone therapy (MHT) is most effective for vasomotor symptoms; benefits outweigh risks for symptomatic women under 60 or within 10 years of menopause. Non-hormonal options: SSRIs/SNRIs (paroxetine FDA-approved), gabapentin, fezolinetant (Veozah, 2023 NK3 antagonist). Vaginal estrogen for genitourinary symptoms; safe even in those who avoid systemic MHT.
Authority reference: www.menopause.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society · Menopause, 2023 · PMID 37252752
- Fezolinetant for Moderate-to-Severe Vasomotor Symptoms (SKYLIGHT 2) · The Lancet, 2023 · PMID 36963419
- Estrogen Therapy and Coronary-Artery Calcification (KEEPS substudy) · New England Journal of Medicine, 2007 · PMID 17554118
People also ask
Is menopausal hormone therapy safe?
The Women's Health Initiative findings have been re-analyzed: for symptomatic women under 60 or within 10 years of menopause, MHT benefits (symptom relief, bone density, cardiovascular when started early) typically outweigh risks. The 'timing hypothesis' is now standard care. Outside that window risk-benefit shifts unfavorably. Individualized assessment essential.
What's the new non-hormonal hot flash treatment?
Fezolinetant (Veozah, FDA-approved 2023) is the first NK3 (neurokinin-3) receptor antagonist for moderate-to-severe vasomotor symptoms. Reduces hot flash frequency and severity without hormone exposure. Monitoring for liver function abnormalities required. Alternative for women who decline or have contraindications to MHT.
Will hormone therapy give me cancer?
Combined estrogen-progestin MHT increases breast cancer risk modestly after ~5 years of use; estrogen-alone (in women with hysterectomy) does not show the same signal in long-term data. Vaginal estrogen at low doses for genitourinary symptoms is locally absorbed and considered safe even in breast cancer survivors per current oncology consensus.
Can I take a GLP-1 during perimenopause for weight management?
Yes — there's no specific menopausal contraindication. Perimenopausal weight gain is partly driven by metabolic and lifestyle changes that GLP-1s address. Discuss with prescriber if pregnancy is still possible (effective contraception required during titration; semaglutide impairs oral contraceptive absorption).