Patient presents with symptoms consistent with menopausal syndrome (perimenopause, menopause symptoms, postmenopause).  The patient reports experiencing vasomotor symptoms including hot flashes, night sweats, and sleep disturbances.  She also describes mood changes such as irritability, anxiety, and low mood.  Additionally, the patient complains of vaginal dryness and dyspareunia, impacting her quality of life.  Menstrual history indicates irregular periods over the past 12 months with a documented decline in estradiol levels.  Differential diagnoses considered include thyroid dysfunction, anxiety disorders, and other hormonal imbalances.  Physical examination reveals normal vital signs and no significant findings other than vaginal atrophy.  Laboratory testing, including a follicle-stimulating hormone (FSH) level, is ordered to confirm the diagnosis and rule out other conditions.  Patient education provided on menopausal transition, hormone replacement therapy (HRT) risks and benefits, and alternative treatment options including lifestyle modifications such as diet, exercise, and stress management techniques.  Initial management plan includes recommending over-the-counter vaginal lubricants for dyspareunia and exploring the possibility of hormonal therapy  after discussion of risks and benefits and pending lab results.  Follow-up appointment scheduled in four weeks to assess symptom improvement and review lab findings.  ICD-10 code N95.1 is considered pending confirmation of diagnosis.  This documentation supports medical necessity for treatment and facilitates accurate medical billing and coding.