From the Guidelines
Treatment of perimenopausal symptoms typically involves a combination of lifestyle modifications and medication, with hormone therapy being the most effective option for managing hot flashes and night sweats, as recommended by the NCCN clinical practice guidelines in oncology 1.
Treatment Options
The following treatment options are available for perimenopausal symptoms:
- Hormone therapy: estrogen alone (for women without a uterus) or estrogen with progesterone (for women with a uterus) is the most effective option for managing hot flashes and night sweats, as stated in the NCCN clinical practice guidelines in oncology 1.
- Low-dose oral contraceptives: containing ethinyl estradiol 20-35 mcg can help regulate periods and manage symptoms.
- Non-hormonal medications:
- Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine 7.5-25 mg daily or venlafaxine 37.5-150 mg daily can reduce hot flashes by 50-60% 1.
- Gabapentin 300-900 mg daily or clonidine 0.1-0.2 mg daily are also options.
- Lifestyle modifications:
- Regular exercise
- Maintaining healthy weight
- Avoiding trigger foods (spicy foods, caffeine, alcohol)
- Practicing stress reduction techniques
- Dressing in layers
- Vaginal dryness treatment: low-dose vaginal estrogen products (creams, tablets, or rings) provide localized relief without significant systemic absorption.
Important Considerations
Adequate calcium (1200 mg daily) and vitamin D (800-1000 IU daily) intake is important for bone health during this transition, as mentioned in the example answer. Additionally, hormone therapy should be used with caution in survivors with coronary heart disease or hypertension, in current smokers, and in those with an increased genetic cancer risk, as stated in the NCCN clinical practice guidelines in oncology 1.
Alternative Options
Yoga may also help survivors manage hot flashes, as shown in a randomized trial that found yoga improved QoL associated with menopause, including an improvement in the vasomotor symptom domain 1.
From the FDA Drug Label
For treatment of moderate to severe vasomotor symptoms, vulvar and vaginal atrophy associated with the menopause, the lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possible. The usual dosage is 10 to 20 mg Estradiol valerate injection, USP every four weeks Estradiol valerate injection, USP is indicated in the: Treatment of moderate to severe vasomotor symptoms associated with the menopause. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with the menopause.
The treatment options for symptoms of perimenopause (perimenopausal syndrome) include Estradiol valerate injection, USP at a dosage of 10 to 20 mg every four weeks for the treatment of moderate to severe vasomotor symptoms and vulvar and vaginal atrophy associated with menopause 2 2.
- The lowest effective dose should be used, and medication should be discontinued as promptly as possible.
- Topical vaginal products should be considered when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy.
From the Research
Treatment Options for Perimenopausal Syndrome
The treatment options for perimenopausal syndrome can be categorized into hormonal and non-hormonal therapies.
- Hormonal therapies, such as estrogen-based treatments, are considered the most effective for many symptoms, including hot flashes, night sweats, and genitourinary discomfort 3.
- Non-hormonal treatment options are also available, and a symptom-driven treatment approach with individualized decision making can improve health and quality of life for midlife women 3, 4.
- The North American Menopause Society (NAMS) recommends an annual health examination for perimenopausal women, including comprehensive screening for physical and psychological problems, as well as lifestyle counseling 4.
- Management of perimenopausal symptoms may include a combination of treatments, and healthcare providers may consider extrapolating data on postmenopausal women, as well as relying on clinical experience when considering management options 4.
- Hormonal contraceptives can confer non-contraceptive benefits for women approaching menopause, including treatment of abnormal uterine bleeding, relief from vasomotor symptoms, and endometrial protection 5.
- Individualized medical therapy and a multidisciplinary approach, considering lifestyle and food habits, are essential for correct perimenopause management 5.
- The optimal management of perimenopausal depression requires attention to hormonal status, antidepressant treatment, and the individual woman's psychosocial and spiritual well-being 6.