Physiology of menopause and the role of hormone therapy

Natural menopause, a biological transition in women, is often underrepresented in medical education, leading to knowledge gaps among health care professionals. This Staying Current article aims to provide physiology educators with an updated, comprehensive overview of menopause, including its physiological basis, symptomatic manifestations, and systemic effects and the current controversies and benefits surrounding menopausal hormone therapy (MHT). This article details the hormonal regulation of reproductive aging, the STRAW and STRAW + 10 criteria for characterization of menopausal staging, and the pathophysiology of common menopausal symptoms such as vasomotor disturbances, genitourinary syndrome, mood and sleep disturbances. It critically examines the history, risks, and benefits of MHT, referencing pivotal studies like the Women's Health Initiative, and outlines nonhormonal management strategies. Addressing educational gaps in menopause physiology is essential for improving women's health outcomes. This article equips physiology educators with current evidence and recommendations to enhance curricula and patient-centered care.NEW & NOTEWORTHY Natural menopause remains underrepresented in medical curricula, leaving clinicians with gaps in reproductive-aging knowledge. This Staying Current article gives physiology educators an updated, evidence-based overview-covering hormonal regulation, STRAW/STRAW + 10 staging criteria, and the pathophysiology of vasomotor, genitourinary, mood, and sleep symptoms. It critically revisits menopausal hormone therapy, including lessons from the Women's Health Initiative, alongside nonhormonal alternatives, equipping instructors to strengthen curricula and advance patient-centered women's health care.