From the Guidelines
Diagnosing perimenopause involves a combination of symptom evaluation and limited laboratory testing, with a focus on assessing symptoms such as irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, mood changes, and vaginal dryness, as well as considering the patient's age, as perimenopause commonly begins in the mid-40s but can start in the 30s 1. The diagnostic criteria for perimenopause are primarily based on clinical evaluation, including:
- Symptom assessment: irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, mood changes, and vaginal dryness
- Age consideration: perimenopause commonly begins in the mid-40s but can start in the 30s
- Laboratory tests: may include measuring follicle-stimulating hormone (FSH) levels, which tend to rise during perimenopause, and estradiol levels, which typically decline during perimenopause
- Thyroid function tests: may be ordered to rule out thyroid disorders that can mimic perimenopausal symptoms It's essential to understand that perimenopause is a clinical diagnosis based primarily on symptoms and age rather than specific test results, as hormone levels fluctuate greatly during this time 1. Tracking menstrual cycles and symptoms over several months can provide valuable information for a healthcare provider to make an accurate diagnosis. The most recent and highest quality study, published in 2021, supports this approach to diagnosing perimenopause 1. In clinical practice, a comprehensive evaluation of symptoms and medical history is crucial for an accurate diagnosis of perimenopause, rather than relying solely on laboratory tests 1.
From the Research
Diagnostic Criteria for Perimenopause
The diagnostic criteria for perimenopause are not explicitly defined in the provided studies. However, the studies suggest that perimenopause is associated with various symptoms, including:
- Hot flashes 2, 3
- Night sweats 3
- Disrupted sleep 2, 3
- Genitourinary symptoms, such as vaginal dryness and dyspareunia 2, 3
- Mood fluctuations, such as depressed mood and anxiety 2, 3
- Cognitive changes 3
- Low sexual desire 3
- Bone loss 3
- Increase in abdominal fat 3
- Adverse changes in metabolic health 3
Clinical Approaches to Perimenopause
The studies suggest that clinical approaches to perimenopause should include:
- Annual health examinations to screen for physical and psychological problems 4
- Individualized screening and management approaches for each woman 4
- Consideration of lifestyle modifications and preventive care 4, 5
- Hormonal therapy, which can be safely given to most perimenopausal women on a short-term basis 2, 5
- Non-hormonal treatment options, such as behavioral therapies 2, 3
Management of Perimenopausal Symptoms
The studies suggest that management of perimenopausal symptoms should be individualized and may include:
- Hormonal therapies, such as estrogen-based therapies 3, 5
- Non-hormonal treatment options, such as selective serotonin reuptake inhibitors (SSRIs) and selective estrogen receptor modulators (SERMs) 3
- Lifestyle modifications, such as diet and exercise 5
- Behavioral therapies, such as cognitive-behavioral therapy (CBT) 2