Dear Readers, I am struck with what little information women are given about menopause. When patients come in they are uncertain what to expect and whether or not to treat it. It makes me think about puberty. This unusual time in a girl’s and boy’s life when their body starts to change. It is unspoken but understood, in a way. Not talked about much and somewhat weathered alone. It is, however finite, and well defined. Most everyone goes through the same symptoms, with some variety, and then at some point it is over- complete. One would think that menopause, the turning off of ovaries, would also be well defined, and finite. That there may be a predictable turns of events and then a point is reached when it is, over…. or beginning depending on your perspective. In my clinical practice, this is not the case. I have listened to thousands and thousands of versions of menopause. There are approximately 34 symptoms that can manifest, or not. In my experience there are about 4 different large classifications of this process. Some women don’t even notice. Some enter the menopausal state, average age 48-51 and with their symptoms, without treatment, keep these symptoms for the REST OF THEIR LIFE. Some women enter a window of symptoms for 3-5 years and then return to a manageable baseline and some, after 3-5 years return to a plateau that is different and tolerable, or not. It is complicated and confusing, even for physicians. The information out there is contradictory at times, even in the ‘evidence based literature’. Women are wandering in the dark and need guidance. I would suggest, better teaching needs to occur in medical training. A more uniform approach needs to be established rather than “what do you want to do?” And we need to offer medical advice that is realistic and factual. I regularly see patients that get differing opinions from different specialists. If we can’t agree as clinicians, how are we suppose to help the patients navigate these very complicated waters. Yes, there are many factors, family history, lifestyle, co-morbidities, and personal preference. We need to work out a more improved management for a complicated condition during these “Golden Years”. We are worth it.