The changes before ‘the change’

As women enter their fifth decade, the gradual depletion of their ovarian follicles as they make the transition to the menopause can have medically important adverse consequences. Their physicians need to review with them the changes that can occur during this period (including irregular bleeding, sexual dysfunction, and other perimenopausal symptoms) and inform them about available treatments. Patients considering pregnancy should be offered fertility testing, and those who wish to avoid pregnancy should be made aware of the benefits and risks of oral contraceptive therapy. Preventive health measures should be discussed.