A 46-year-old woman presents with concerns because she has not had a period for the...

Amenorrhea for ≥12 consecutive months in a woman over age 45 is diagnostic of menopause and does not require laboratory confirmation in the absence of atypical features. MCCQE objectives emphasize that routine measurement of estrogen or progesterone levels is unnecessary in typical cases, as hormone levels fluctuate widely during the perimenopausal transition. This patient has mild menopausal symptoms (sleep disturbance and cognitive “fog”) without vasomotor symptoms, abnormal bleeding, or pelvic pain.

Pelvic ultrasound or endometrial biopsy is not indicated because she has no postmenopausal bleeding. SSRI therapy may be considered for significant vasomotor or mood symptoms but is not first-line for mild cognitive or sleep complaints in otherwise healthy menopausal women. Sleep apnea investigation is not suggested by the history.

Therefore, the most appropriate step is to explain that she is menopausal and provide reassurance, along with education about lifestyle strategies for sleep and cognitive symptoms, and discussion of treatment options if symptoms become bothersome.