Menopausal transition (premenopause) is the phase in the ageing process of women representing the transition from the reproductive stage of life to the non-reproductive stage. With improvements in average life expectancy, women live an increased proportion of their lives in the postmenopause. The consequences of oestrogen loss are the early symptoms (psychological and vasomotor), the genitourinary syndrome (intermediate), as well as postmenopausal osteoporosis with increased risk of fractures and cardiovascular diseases (late). The diagnosis of climacteric syndrome is based on typical clinical symptoms. Perimenopausal women should understand physiological changes occurring in menopausal transition. They should be encouraged to live a healthy lifestyle. Menopausal hormone therapy is indicated for relief of the acute symptoms of menopause and for treatment of urogenital atrophy. It should be administered in the lowest effective dose for the shortest period of time. The treatment should be initiated before the age of 60 years or within 10 years after menopause in order to decrease its risks. The benefit/risk profile needs to be individually re-assessed every year.