3 Questions Primary Care Physicians Should Ask About Menopause Symptoms, With Stephanie Faubion, MD

Primary care clinicians may miss menopause when patients present with fatigue, brain fog, joint pain, or sleep disturbance rather than reporting hot flashes, according to Stephanie S. Faubion, MD, MBA, professor of medicine and director of the Mayo Clinic Center for Women’s Health. Speaking at The Menopause Society 2026 Annual Meeting in San Diego, Faubion urged PCPs to make menopause symptom assessment part of routine midlife care.

Faubion noted that the menopause transition can begin in the late 30s, making age alone an imperfect prompt. She recommended that clinicians consider menopause when a patient around age 40—or younger—reports otherwise nonspecific symptoms. An electronic health record prompt or standardized instrument such as the Menopause Rating Scale could help surface concerns that may not emerge during a conventional review of systems.¹

The initial screen does not need to be complicated. Faubion suggested directly asking about hot flashes, night sweats, and sleep disturbance. Sleep problems are particularly easy to separate from the menopause transition even when they occur alongside vasomotor symptoms. A positive response should lead to a focused discussion of symptom burden, functional effects, menstrual history, comorbidities, and the patient’s priorities.

Treatment selection should begin with the symptoms being targeted and patient preference. For patients with hot flashes, night sweats, and sleep disruption, clinicians can discuss hormonal and nonhormonal strategies while assessing contraindications to systemic hormone therapy. Hormone therapy remains the most effective treatment for vasomotor symptoms in appropriate candidates, whereas evidence-based nonhormonal options are important for patients who cannot or prefer not to use hormones.²˒³ Faubion identified the neurokinin-targeted agents fezolinetant and elinzanetant as options within that nonhormonal pathway.

The practical opportunity is earlier recognition. Three direct questions during routine visits may uncover clinically significant menopause symptoms, open shared decision-making, and prevent patients from navigating a diffuse symptom burden without an explanation or treatment plan.

References

1. Metintas S, Arýkan I, Kalyoncu C, Ozalp S. Menopause Rating Scale as a screening tool in rural Turkey. Rural Remote Health. 2010;10(1):1230. doi:10.22605/RRH1230
2. The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
3. The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200