The Menopause Transition: Signs, Symptoms, and Management Options

Nanette Santoro; Cassandra Roeca; Brandilyn A. Peters; Genevieve Neal-Perry


J Clin Endocrinol Metab. 2021;106(1):1-15. 

In This Article


The menopause transition is an "irregularly irregular" process that can begin as early as in a woman's 30s and potentially last for over a decade. It is therefore important for clinicians to recognize the early signs and symptoms of the transition and be prepared to offer treatment that will help mitigate these symptoms. Fully 60% of women will present to a clinician for consultation regarding their menopausal transition and it therefore represents an ideal time to intervene in a health-affirming manner with patients who wish to optimize their lifestyle and position themselves to minimize their risks for diseases of aging.[116] New knowledge about risk factors for menopausal symptoms may help women alter their lifestyle to reduce their impact (e.g., modest weight loss to reduce VMS disruption). For other women, acute symptom control is the chief goal, as VMS, sleep disruption, or adverse mood changes may be severe. While HT remains a mainstay of treatment for most common menopausal symptoms, a substantial number of women have medical contraindications to its use and other simply wish to avoid it. Fortunately, new scientific breakthroughs in the fundamental mechanisms of hot flashes may lead to highly targeted treatment for this hallmark symptom of the menopausal transition. Other symptoms are also amenable to nonhormonal treatments, but many therapies remain unapproved by the FDA.