In primary care and gynecologic settings, midwives will manage the care of women during the perimenopause transition as well as throughout the postmenopausal period. As such, they will need to understand the issues that are at the heart of the debate regarding menopause and aging. This article reviews the endocrinology of menopause, the history of menopause treatment in this century, and the various physical, psychological, and role changes that accompany the developmental processes of menopause. Bleeding pattern changes, hot flashes, sleep disturbances, and genital, skin, and weight changes are discussed. Sexuality, breast, cardiovascular, skeletal, as well as hormone therapy issues are examined. The basics of the midlife health office visit are included.