From the Guidelines
Perimenopause is diagnosed primarily through a woman's reported symptoms and age, as there is no definitive test for this transitional phase. The symptoms of perimenopause can vary widely among women, but common symptoms include:
- Irregular menstrual cycles
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood changes
- Vaginal dryness
- Decreased libido
- Increased PMS symptoms These symptoms occur due to fluctuating estrogen and progesterone levels affecting multiple body systems, as noted in guidelines for assessing and managing menopausal symptoms after breast cancer 1.
Diagnosis typically involves a detailed medical history and symptom review for women in their 40s or early 50s experiencing these changes. While blood tests measuring follicle-stimulating hormone (FSH) may be performed, they're not always reliable during perimenopause due to hormone fluctuations, highlighting the importance of clinical assessment over laboratory tests alone.
The diagnostic criteria for perimenopause focus on the presence of these symptoms, particularly irregular menstrual cycles and vasomotor symptoms like hot flashes and night sweats, in the context of a woman's age and medical history. Treatment options include lifestyle modifications, hormone therapy, and targeted treatments for specific symptoms, with the goal of alleviating symptoms and improving quality of life, as considered in the management of menopausal symptoms 1. Women should track their symptoms and menstrual cycles before consulting their healthcare provider, as this information helps establish an accurate diagnosis and appropriate management plan.
From the Research
Symptoms of Perimenopause
- Hot flashes, night sweats, or both (vasomotor symptoms) are experienced by approximately 50% to 75% of women during the menopausal transition 2, 3
- Genitourinary symptoms (genitourinary syndrome of menopause [GSM]) are experienced by more than 50% of women during the menopausal transition 2
- Poor sleep, depressed mood, and increased anxiety are common symptoms that often interact with one another 3
- Vaginal dryness and dyspareunia become more likely as women enter the latter stages of the transition, affecting about 1/3 of the population 3
- Mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health are also common symptoms and conditions 4
Diagnostic Criteria for Perimenopause
- The menopausal transition, or perimenopause, is associated with profound reproductive and hormonal changes 3
- The diagnosis of perimenopause is based on the presence of menopausal symptoms and the exclusion of other pathological or physiological causes 2
- The annual health examination is valuable in the perimenopausal woman and should include comprehensive screening for physical and psychological problems as well as for appropriate lifestyle counseling 5
- Individualized screening and management approaches for each woman are necessary, and the woman should be included in the management decision-making process 5
Treatment Options for Perimenopause
- Hormonal therapy with estrogen is the first-line therapy for bothersome vasomotor symptoms and GSM symptoms, but nonhormonal medications (such as paroxetine and venlafaxine) also can be effective 2, 3
- Low-dose vaginal estrogen is associated with subjective improvement in GSM symptom severity by approximately 60% to 80% 2
- Compounded bioidentical transdermal hormone therapy may offer a different risk/benefit profile and has been shown to significantly relieve menopausal symptoms in peri/postmenopausal women 6