Menopausal Symptom

Menopausal symptom management is a risk-stratified treatment decision, not simply a decision to replace a laboratory value. First identify whether the pattern fits the menopausal transition, determine whether symptoms are vasomotor, genitourinary, or both, and look for bleeding or systemic findings that require a different workup. For bothersome vasomotor symptoms, systemic hormone therapy is the most effective option when the patient is an appropriate candidate. Age, time since menopause, uterine status, thrombotic and cancer history, hepatic function, and patient preference determine whether it is appropriate. Local vaginal treatment follows a different safety and prescribing logic because its goal is tissue-level genitourinary treatment rather than systemic symptom control. A useful clinical sequence is: recognize the menopausal pattern; exclude pregnancy, thyroid disease, malignancy, and other mimics when indicated; investigate every episode of postmenopausal bleeding; then choose therapy with its monitoring plan already attached.