Abstract
The menopause experience is unique to people with ovaries who attain an age at which functioning follicles are depleted. Unlike male reproductive aging, menopause is accompanied by a definable reproductive milestone in that menstrual periods cease and the failure of follicle growth results in a large drop in circulating estrogen and no further ovarian production of progesterone. While the focus on menopause has largely been centered on this absence of hormone production, the most dynamic changes in symptoms and health markers begin before the final menstrual period, and merit attention. Vasomotor symptoms, the most common symptom of menopause and the primary symptom that drives women to seek treatment, peak in frequency and prevalence in the late menopause transition, when women are still having menstrual periods. Body composition and adverse lipoprotein and lipid changes also worsen most acutely in the late transition, and then assume a slower, age-related trajectory of change. Multiple processes that worsen across the transition restabilize after it is over. The notion that the menopause transition is an adaptive process for women has scientific merit and suggests that facilitating this adaptation and recognizing its implications may represent the next phase of progress in the field.