What are the treatment options for perimenopause symptoms and menorrhagia?

From the Guidelines

Treatment for perimenopause symptoms and menorrhagia should prioritize hormonal options, such as low-dose combination estrogen-progestin or estrogen alone, and non-hormonal options like nonsteroidal anti-inflammatory drugs or tranexamic acid, considering the individual's symptom severity, bleeding patterns, and personal preferences. When considering treatment options, it's essential to evaluate the severity of symptoms and the impact on the individual's quality of life. For perimenopause symptoms, hormone therapy is often effective, typically using low-dose combination estrogen-progestin (for women with a uterus) or estrogen alone (for those without) 1. For menorrhagia, hormonal options include combined oral contraceptives, the levonorgestrel intrauterine system (Mirena), or cyclic progestins like medroxyprogesterone acetate (10mg daily for 10-14 days per month) 1. Non-hormonal options include nonsteroidal anti-inflammatory drugs like ibuprofen (600mg three times daily during menses) or tranexamic acid (1000-1300mg three times daily during bleeding) 1. Lifestyle modifications, such as regular exercise, stress reduction techniques, and dietary changes, can also help manage perimenopause symptoms. In cases of severe menorrhagia unresponsive to medical management, surgical options like endometrial ablation or hysterectomy may be considered, taking into account the individual's overall health and preferences. It's crucial to individualize treatment based on symptom severity, bleeding patterns, contraceptive needs, and personal preferences, ensuring the best possible outcome for morbidity, mortality, and quality of life. Key considerations include the potential benefits and risks of each treatment option, as well as the individual's medical history and current health status. By prioritizing the individual's needs and preferences, healthcare providers can develop effective treatment plans that address perimenopause symptoms and menorrhagia while minimizing potential harms and optimizing quality of life.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation)

The treatment options for perimenopause symptoms and menorrhagia may include hormonal therapies, such as combination oral contraceptives, which can help regulate menstrual cycles and reduce heavy bleeding.

• Key benefits of using combination oral contraceptives for perimenopause symptoms and menorrhagia include:
  • Regulation of menstrual cycles
  • Reduction of heavy bleeding
  • Suppression of gonadotropins
• However, it is essential to consider the potential risks and side effects, such as thrombophlebitis, venous thrombosis, and arterial thromboembolism, as reported in the adverse reactions section of the drug label 2. It is crucial to weigh the benefits and risks and consult a healthcare professional to determine the best course of treatment for individual cases of perimenopause symptoms and menorrhagia.

From the Research

Treatment Options for Perimenopause Symptoms and Menorrhagia

• Hormonal contraceptives, such as oral contraceptives, can help manage perimenopause symptoms, including menorrhagia, by regulating menstrual cycles and reducing heavy bleeding 3, 4, 5.
• Intrauterine levonorgestrel is also an effective treatment for perimenopausal menorrhagia, as well as other medical therapies such as oral progestogens, tranexamic acid, and gonadotrophin-releasing hormone (GnRH) analogues 6.
• Estrogen-based hormonal therapies are the most effective treatments for many menopausal symptoms, including vasomotor symptoms and genitourinary symptoms, and have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause 7.
• Non-hormonal treatment options are also available for managing perimenopause symptoms and menorrhagia, although hormonal therapies are often the most effective treatment option 7.

Benefits of Hormonal Contraceptives for Perimenopausal Women

• Reduce the risk of postmenopausal hip fractures and regularize menses in women with dysfunctional uterine bleeding 3.
• Reduce the long-term risk of endometrial and ovarian cancers 3, 4.
• Relieve vasomotor symptoms in perimenopausal women 3, 4.
• Improve quality of life and prevent a wide range of conditions affecting perimenopausal women 5.

Considerations for Managing Perimenopause Symptoms and Menorrhagia

• Individualized medical therapy and a multidisciplinary approach considering lifestyle and food habits are important for correct perimenopause management 5.
• Selecting the most adequate contraceptive option for each woman, considering her risk factors, comorbidities, and the possibility of continuing contraception until reaching menopause and even further, is crucial 5.
• A symptom-driven treatment approach with individualized decision making can improve health and quality of life for midlife women 7.