Patient presents with symptoms consistent with the diagnosis of menopausal symptoms, perimenopause, or menopausal transition.  The patient reports experiencing a range of menopausal symptoms including hot flashes, night sweats, sleep disturbances including insomnia, mood changes such as irritability and anxiety, and vaginal dryness leading to dyspareunia.  The patient's last menstrual period (LMP) was [Date or duration since LMP - e.g., 14 months ago, uncertain].  Menstrual cycle changes, such as irregular periods or changes in flow, were also noted.  Physical examination revealed [relevant findings, e.g., normal pelvic exam, atrophic vaginal mucosa].  Differential diagnoses considered include thyroid dysfunction, other hormonal imbalances, and medication side effects.  Laboratory tests, such as follicle-stimulating hormone (FSH) and estradiol levels, may be considered to confirm the diagnosis of menopause and rule out other conditions.  The patient was counseled on the natural course of menopause, lifestyle modifications including diet and exercise, and management options for menopausal symptoms, including hormone replacement therapy (HRT), non-hormonal therapies for hot flashes and sleep disturbances, and vaginal lubricants.  The risks and benefits of each treatment option were discussed, and the patient will consider her options and follow up for further discussion and management as needed.  ICD-10 code N95.1 (menopausal and postmenopausal status) is considered for this encounter.  Focus of this visit:  Menopausal symptoms management.