From the Guidelines
The general treatment for perimenopause focuses on managing symptoms and maintaining health during this transitional phase, with hormone therapy (HT) often recommended for moderate to severe symptoms, typically using low-dose estrogen combined with progesterone for women with an intact uterus. The treatment approach for perimenopause aims to alleviate symptoms such as hot flashes and vaginal dryness while considering the overall health and well-being of the woman. According to the most recent evidence 1, the use of combined estrogen-progestin therapy is recommended for women with an intact uterus, while estrogen alone is used for those without a uterus.
Key Considerations
- Hormone therapy should be individualized based on the woman's symptoms, medical history, and risk factors, as noted in the study by Denlinger et al. 2.
- Non-hormonal options, such as selective serotonin reuptake inhibitors (SSRIs), can be used for managing hot flashes, as mentioned in the study 2.
- Lifestyle modifications, including regular exercise, maintaining a healthy weight, and ensuring adequate calcium and vitamin D intake, are also essential for supporting overall health during this transition to menopause.
Treatment Options
- Hormone therapy: low-dose estrogen (such as 0.3-0.625 mg conjugated estrogens or 0.5-1 mg estradiol) combined with progesterone (such as 100-200 mg micronized progesterone daily or 2.5-5 mg medroxyprogesterone acetate) for women with an intact uterus.
- Non-hormonal options for hot flashes: SSRIs like paroxetine (7.5-25 mg daily) or venlafaxine (37.5-150 mg daily).
- Vaginal dryness treatment: local estrogen products (creams, rings, or tablets) or moisturizers.
Important Considerations
- The timing hypothesis suggests that menopausal hormone therapy has a beneficial effect on blood pressure and cardiovascular outcomes if initiated during a certain time window around menopause in women with risk factors, with a limited treatment duration of 5 to 10 years, as discussed in the study 1.
- The use of hormone therapy should be carefully considered in women with a history of hormonally mediated cancers, as noted in the study by Denlinger et al. 2.
From the Research
General Treatment for Perimenopause
The general treatment for perimenopause involves a range of options, including:
- Hormone therapy (HT) to alleviate symptoms such as hot flashes, night sweats, and mood changes 3
- Menopausal hormone therapy (MHT) to maintain skeletal health and prevent osteoporosis 4
- Hormonal contraceptives to improve quality of life, prevent unwanted pregnancies, and treat abnormal uterine bleeding 5
- Bioidentical hormone therapy (BHT) to treat vasomotor symptoms, with various forms and doses available 6
- Nonhormonal treatments and alternative therapies, such as selective serotonin reuptake inhibitors and phytoestrogens, for women who cannot or prefer not to use hormone therapy 7
Treatment Options
Treatment options for perimenopause may include:
- Estrogen therapy to maintain bone mineral density and reduce fracture risk 4
- Progestogen therapy to prevent endometrial hyperplasia in women with a uterus taking estrogen 6
- Combination therapy with estrogen and progestogen to alleviate symptoms and prevent osteoporosis 4
- Individualized medical therapy and a multidisciplinary approach considering lifestyle and food habits 5
Considerations
When considering treatment options for perimenopause, it is essential to:
- Evaluate the risks and benefits of each treatment option 3
- Consider the individual woman's risk factors, comorbidities, and preferences 5
- Monitor for potential adverse effects, such as headache, vaginal bleeding, and breast tenderness 6
- Discuss the possibility of continuing contraception until reaching menopause and beyond 5