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This phase in the life of a woman is characterized by the cessation of menstruation and is complete when the woman has experienced no menstrual periods for a year. The average age of menopause is 50 in the US. In some women, menopause occurs abruptly, while in others there is a gradual cessation of normal periods. Decreased estrogen levels and a shift from ovarian production of estrogen to other sources, i.e. adrenal, is seen.

Symptoms that may occur during menopause are hot flashes, changes in reproductive organs, cardiovascular disease, osteoporosis, nervousness, and depression. Hot flashes are the most common symptom and are associated with estrogen withdrawal. Reproductive organ changes include vaginal dryness, thinning of the vaginal lining, and a decrease in size of the uterus and cervix. These changes are also a result of estrogen withdrawal and account for complaints such as vaginal itching and stress incontinence. There is an increased incidence of high blood pressure, stroke, and heart disease following menopause probably due to the removal of the protection estrogen affords. Osteoporosis is also a risk when estrogen decreases making postmenopausal women more at risk for fractures. The breasts become less glandular and are composed of more fat tissue than in reproductive years.

Treatment includes low-dose estrogen administration with some progesterone therapy and calcium supplementation. This therapy is protective of the breasts and uterus against cancer, deters the loss of bone, and increases HDL (high density lipoproteins, the good ones) and lowers LDL (low density lipoproteins, the bad ones) in the blood. Sometimes a topical vaginal estrogen cream is used to restore the vagina and external genitalia to a premenopausal state.

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