Menopause

Diagnosis

Most people can recognize menopause based on symptoms such as irregular periods or hot flashes. If you are concerned, talk with your healthcare professional.

Tests are usually not needed to diagnose menopause, but in some cases, blood tests may be suggested to check:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol). FSH typically rises and estrogen falls during menopause. Hormone fluctuations during perimenopause can make these tests less conclusive.

• Thyroid-stimulating hormone (TSH). Overactive thyroid, or hyperthyroidism, can cause symptoms similar to menopause.

Home FSH tests are available without a prescription and can indicate higher FSH levels, which may suggest perimenopause or menopause. However, FSH levels vary throughout the menstrual cycle, so these tests cannot definitively diagnose menopause.

Treatment

Menopause itself does not require treatment. Management focuses on easing symptoms and preventing or treating age-related conditions. Treatments may include:

• Hormone therapy. Estrogen therapy can reduce hot flashes, ease other menopause symptoms, and slow bone loss. For those with a uterus, progestin is combined with estrogen. Hormone therapy is most effective when started before age 60 and within 10 years of menopause onset. Long-term use may carry risks for heart disease and breast cancer, so individual assessment is important.

• Vaginal estrogen. Creams, tablets, or rings applied to the vagina can relieve dryness, discomfort with intercourse, and some urinary symptoms.

• Prasterone (Intrarosa). Vaginal DHEA can ease dryness and pain with intercourse.

• Low-dose antidepressants (SSRIs or SNRIs). May help manage hot flashes, especially in people who cannot take estrogen.

• Gabapentin. Reduces hot flashes, particularly nighttime symptoms, for those unable to use estrogen.

• Clonidine. Sometimes relieves hot flashes but may cause low blood pressure, sleepiness, headache, or constipation.

• Fezolinetant (Veozah). A non-hormonal option that blocks brain pathways controlling body temperature, though it may cause abdominal pain, liver issues, or sleep problems.

• Oxybutynin. Treats overactive bladder and may relieve menopause symptoms, but may contribute to cognitive decline in older adults.

• Medicines for osteoporosis. Various treatments and vitamin D supplements help reduce bone loss and fracture risk.

• Ospemifene (Osphena). Taken orally, this SERM treats painful intercourse due to thinning vaginal tissue. Not recommended for people with breast cancer or high risk for it.

Before starting any treatment, consult your healthcare professional to discuss the benefits, risks, and suitability of each option. Review treatment choices annually, as your needs may change over time.