Final Menstrual Period
- Estrogen declining toward postmenopausal baseline
- FSH rises markedly
- LH rises markedly
- Progesterone near zero
Menstrual Changes
No periods — but defined retrospectively after 12 months
Primary Symptoms
- • Continued vasomotor symptoms (often peaking near FMP)
- • Sleep disruption
- • Genitourinary symptoms beginning
Clinical Protocol
- Confirm menopause diagnosis after 12 months amenorrhea (under 50: 24 months)
- Do not stop HRT at FMP — most women need it for several more years
- Reassess cardiovascular risk factors
- Begin bone density screening if not already initiated
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