The climacteric and menopause are characterized by erratic fluctuations and decline in ovarian steroid hormones that have broad impact on physical and psychological phenomena leading to a number of clinical syndromes encountered in primary care settings. This endocrine transition is abrupt in women and is not often adequately assessed using objective measures, leading to potential overuse of various medications to treat the physiological and psychological consequences of decline in ovarian hormones. This article reviews such issues and explains how primary care physicians may incorporate the endocrine changes more effectively in their evaluation and treatment of midlife women.