We evaluate evidence that the following symptoms are, or are not, related to menopause and assess the treatments for them: hot flashes, night sweats, vaginal dryness and painful intercourse, sleep problems, mood and cognitive problems, somatic symptoms, urinary incontinence, bleeding problems, sexual dysfunction, and overall quality of life. Menopausal symptoms vary in combination, intensity, and duration, and we assess the evidence for these as well. Estrogen, either by itself or with progestins, has been the therapy of choice for decades for relieving menopause-related symptoms. Epidemiologic studies in the 1980s and 1990s suggested that estrogen-containing therapy might protect women from heart disease and other serious medical problems. The Women's Health Initiative (WHI) was a large clinical trial of postmenopausal women (age range, 50 to 79 years [mean, 63.2 years]) that was designed to see whether estrogen with or without progestin therapy could prevent chronic conditions, such as heart disease and dementia. The estrogen with progestin portion of the trial ended early because of increased incidence of breast cancer. There were increases in blood clots, stroke, and heart disease among women who received this treatment as well. These findings raised serious questions about the safety of estrogen to treat symptoms of menopause. Many women stopped hormone replacement therapy, and some searched for alternative therapies. To reflect a shift of focus from “replacement” to use of hormones for relief of symptoms, we will use the term menopause hormonal therapy, which includes a range of doses and preparations of estrogen and progestin.