Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after the last menstrual period. Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt the woman’s sleep, sap her energy and — at least indirectly — trigger feelings of sadness and loss. Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if the woman entered perimenopause . many things will be considered , age, menstrual history, and what symptoms or body changes experienced ., Hormone testing is rarely necessary or useful to evaluate perimenopause. Cardiovascular disease is the most common cause of death in postmenopausal women. If there were no symptoms, there would be no controversy , Some menopausal symptoms require treatment .Some signs and symptoms persist for years. Both physicians and the lay public do not address postmenopausal hormone therapy as an ordinary medication. Menopause symptoms and the incidence of illnesses associated with menopause or HRT may vary to a large extent in different parts of the world, as well as priorities in medical care. Each regional/national menopause society should adapt the general framework according to its local situation and needs.