A 53-year-old woman presents with symptoms of menopause including hot flashes, vaginal dryness, and irritability that started one year ago. Menopause is defined as the permanent cessation of menstruation that occurs naturally in women between ages 40-60, with a mean age of 51. It results from depletion of ovarian follicles leading to elevated FSH levels. Symptoms include amenorrhea, hot flashes, and effects of declining estrogen like risks to the reproductive, urinary, psychological, cardiovascular, and bone health such as osteoporosis. Hormone replacement therapy was previously advocated to prevent these effects but large prospective studies found increased health risks.