What are the treatment options for symptoms of perimenopause?

From the Guidelines

Treatment options for perimenopausal symptoms should prioritize lifestyle modifications and non-hormonal approaches, with hormone therapy considered on a case-by-case basis, taking into account the individual's medical history, risk factors, and personal preferences, as recommended by the most recent guidelines 1.

Overview of Treatment Options

Perimenopausal symptoms can be managed through a combination of lifestyle modifications, non-hormonal therapies, and, in some cases, hormone therapy. The goal is to alleviate symptoms while minimizing risks and considering the individual's overall health and preferences.

Lifestyle Modifications

Lifestyle changes are crucial for managing perimenopausal symptoms and include:

• Regular exercise to reduce hot flashes and improve overall health
• Stress reduction techniques, such as yoga or cognitive behavioral therapy, to manage mood changes and sleep disturbances
• Avoiding triggers like alcohol and spicy foods that can exacerbate hot flashes
• Maintaining a healthy weight to reduce the risk of osteoporosis and other health issues
• Dressing in layers to manage hot flashes

Non-Hormonal Therapies

For women who cannot use hormones or prefer not to, non-hormonal options are available:

• SSRIs/SNRIs like paroxetine or venlafaxine can reduce hot flashes
• Local estrogen (creams, rings, or tablets) or moisturizers can treat vaginal dryness
• Sleep hygiene practices, melatonin, or low-dose antidepressants can help with sleep disturbances
• Cognitive behavioral therapy can address mood changes

Hormone Therapy

Hormone therapy, including estrogen with or without progesterone, can be effective for managing hot flashes and night sweats but should be used with caution and under medical supervision, especially considering the risks associated with its use, as highlighted in various studies 1.

Individualized Approach

Treatment should be tailored to the individual's symptom severity, medical history, and personal preferences, with regular follow-up to assess effectiveness and adjust the treatment plan as needed. This approach ensures that the benefits of treatment outweigh the risks and that the individual's quality of life is improved.

Recent Guidelines

The most recent guidelines, such as those from the Gynecologic Cancer InterGroup (GCIG) 1, emphasize the importance of a personalized approach to managing menopausal symptoms in cancer survivors, considering the type of cancer, treatment history, and individual risk factors. These guidelines support the use of hormone therapy in certain cases but also highlight the need for careful consideration of the risks and benefits.

From the FDA Drug Label

TABLE 6 lists adverse reactions greater than or equal to 2 percent of women who received cyclic progesterone capsules 200 mg daily Headache 31 Breast Tenderness 27 Joint Pain 20 Depression 19 Dizziness 15 Abdominal Bloating 12 Hot Flashes 11 Urinary Problems 11 Abdominal Pain 10 Vaginal Discharge 10 Nausea / Vomiting 8 Worry 8 Chest Pain 7 Diarrhea 7 Night Sweats 7

The treatment options for symptoms of perimenopause may include hormone therapy to alleviate symptoms such as:

• Hot flashes
• Night sweats
• Mood changes (e.g., depression, anxiety)
• Vaginal dryness However, the provided drug label does not directly address the treatment of perimenopause symptoms, but rather lists potential adverse reactions associated with progesterone capsules, which may be used in hormone therapy. Key considerations for treatment include:
• Individualized treatment plans
• Monitoring for adverse reactions
• Regular follow-up appointments 2

From the Research

Symptoms of Perimenopause

• Hot flashes and night sweats (vasomotor symptoms) are the most common symptoms, experienced by 50-75% of women 3
• Genitourinary symptoms, such as vaginal dryness and dyspareunia, are also prevalent, affecting about 1/3 of women 4
• Mood fluctuations, cognitive changes, and sleep disruptions are additional symptoms that can occur during perimenopause 5, 4
• Low sexual desire, bone loss, and adverse changes in metabolic health are other potential symptoms 5

Treatment Options for Perimenopause Symptoms

• Estrogen-based hormonal therapies are the most effective treatments for many symptoms, with a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause 5, 3
• Non-hormonal treatment options, such as citalopram, desvenlafaxine, and gabapentin, are available for women who are not candidates for hormonal therapies 3
• Low-dose vaginal estrogen and vaginal prasterone can improve genitourinary symptoms 3, 4
• Bioidentical estrogens and hormone therapy with estrogen are also effective for treating vasomotor symptoms and genitourinary symptoms 3, 6

Management of Perimenopause Symptoms

• A symptom-driven treatment approach with individualized decision making can improve health and quality of life for midlife women 5
• Clinical approaches to managing perimenopause symptoms often involve hormone therapy, which can be safely given to most perimenopausal women on a short-term basis 4, 7
• Nonhormonal and behavioral therapeutic strategies can also be deployed to manage symptoms 4, 7