Understanding and Managing Menopause

Dr. Klyde provides comprehensive evaluation and individualized care for women experiencing menopause and perimenopause. He works with patients throughout New York City and the Tri-State area to address hormonal changes, manage symptoms, and support long-term health and quality of life.

General

Perimenopause and menopause represent natural stages in a woman’s life that reflect changes in ovarian function and hormone production, particularly estrogen and progesterone. Perimenopause is the transitional period leading up to menopause and can begin several years before menstrual periods stop completely. During this time, hormone levels may fluctuate unpredictably, often leading to the early onset of symptoms even while menstruation continues. Menopause is officially diagnosed after twelve consecutive months without a menstrual period and marks the end of reproductive hormone cycling.

The hormonal changes of perimenopause and menopause can affect multiple systems throughout the body. Common symptoms include hot flashes, night sweats, sleep disturbances, fatigue, mood changes, difficulty concentrating, and changes in menstrual regularity. Some women also experience weight gain, decreased muscle mass, joint discomfort, headaches, or changes in skin and hair. Because these symptoms may develop gradually and vary widely in severity, they are sometimes dismissed or attributed to stress, aging, or other medical conditions.

Beyond short-term symptoms, declining estrogen levels can have important long-term health effects. Estrogen plays a key role in maintaining bone density, cardiovascular health, and metabolic balance. As levels decrease, women may face increased risks of osteoporosis, fractures, changes in cholesterol levels, and cardiovascular disease. Genitourinary changes, including vaginal dryness, discomfort, or urinary symptoms, may also occur and can persist if left unaddressed.

While menopause is a normal biological process, symptoms and health risks are not the same for every woman. Evaluation by an endocrinologist can help distinguish menopausal changes from other hormonal or medical conditions, assess individual risk factors, and guide personalized management strategies. With appropriate care, education, and treatment when needed, women can navigate perimenopause and menopause with improved comfort, confidence, and long-term health.

PRESENTATION

The symptoms of menopause and perimenopause arise from changing and declining estrogen and progesterone levels and can affect many systems throughout the body. Common symptoms include hot flashes, night sweats, sleep disturbances, fatigue, mood changes, and difficulty concentrating. Many women also experience changes in menstrual patterns during perimenopause, along with weight gain, decreased muscle mass, joint discomfort, headaches, and changes in skin or hair. The type, severity, and timing of symptoms vary widely, and symptoms may begin years before menopause is complete.

Because menopausal symptoms often develop gradually and can overlap with stress, aging, thyroid disorders, or mood conditions, they are sometimes misunderstood or overlooked. Women may feel that their symptoms are “something they should just tolerate” or may not recognize that hormonal changes are contributing to how they feel. Persistent sleep disruption, worsening anxiety or mood changes, unexplained fatigue, or symptoms that interfere with daily functioning are important signals that professional evaluation may be helpful.

Seeking medical care during perimenopause or menopause allows for a thorough assessment of symptoms, identification of contributing factors, and discussion of individualized treatment options. An endocrinologist can help determine whether symptoms are hormone-related, rule out other medical conditions, and guide appropriate management to improve comfort and protect long-term health. Early evaluation can be especially important for women at increased risk of osteoporosis, cardiovascular disease, or severe symptoms, and can provide reassurance and support during this transitional stage of life.

Diagnosis

Menopause is primarily a clinical diagnosis, based on a woman’s age, symptoms, and menstrual history. In most cases, menopause is diagnosed after 12 consecutive months without a menstrual period, provided there is no other medical cause for the absence of menstruation. For women over the age of 45 who develop typical symptoms such as hot flashes, night sweats, and menstrual irregularity, laboratory testing is often not required to confirm menopause.

During perimenopause, hormone levels, particularly estrogen and follicle-stimulating hormone (FSH), can fluctuate significantly from day to day. Because of this variability, blood tests may be misleading and are not always helpful in making the diagnosis. A single normal hormone level does not rule out perimenopause, and an elevated FSH level alone does not always confirm menopause. Clinical history and symptom patterns are often more reliable indicators than laboratory values during this transition.

Hormone testing may be appropriate in certain situations, such as in women with early or premature menopause, atypical symptoms, unclear menstrual history, or when other conditions such as thyroid disease, pituitary disorders, or pregnancy need to be ruled out. In these cases, an endocrinologist may order targeted blood tests to clarify the diagnosis and guide management.

A professional evaluation allows symptoms to be placed in the proper medical context, ensures that other conditions are not overlooked, and helps determine whether treatment is appropriate. An endocrinologist can provide reassurance, confirm the diagnosis when needed, and help women understand what to expect during this natural stage of life while addressing symptoms and long-term health considerations.

Treatment

Treatment during menopause is tailored to a woman’s symptoms, medical history, risk factors, and personal preferences. While menopause is a natural transition, treatment may be appropriate when symptoms affect quality of life or when long-term health risks such as bone loss are present. An endocrinologist can help determine which options are most appropriate and monitor therapy over time.

Hormone-based therapies are among the most effective treatments for menopausal symptoms. Menopausal hormone therapy (MHT), which may include estrogen alone or estrogen combined with progesterone, can help stabilize hormone levels and relieve symptoms such as hot flashes, night sweats, sleep disruption, and vaginal dryness. Progesterone is used in women with an intact uterus to protect the uterine lining. Hormone therapy is not appropriate for everyone, and careful evaluation is essential to balance benefits and risks based on age, time since menopause, cardiovascular health, and cancer risk.

For women who cannot use or prefer to avoid hormone therapy, non-hormonal treatments may also be helpful. Certain medications can reduce hot flashes and improve sleep or mood symptoms. Lifestyle measures—such as regular exercise, stress management, maintaining a healthy weight, limiting alcohol, and optimizing sleep habits—play an important supportive role and can improve overall well-being during the menopausal transition.

Bone health is a key focus of menopausal care, as declining estrogen levels accelerate bone loss and increase fracture risk. Strategies to preserve bone density include adequate calcium and vitamin D intake, weight-bearing and resistance exercise, and fall-prevention measures. In women at higher risk for osteoporosis or fractures, medications that slow bone loss or increase bone density may be recommended. These treatments can significantly reduce fracture risk when used appropriately and monitored over time.

An individualized treatment plan allows symptoms to be addressed while also protecting long-term health. Regular follow-up with an endocrinologist ensures that therapies remain effective, safe, and aligned with a woman’s evolving needs throughout and beyond the menopausal transition.