From the Guidelines
Hormone Replacement Therapy (HRT) is likely the most effective option for relieving symptoms of perimenopause, including cognitive impairment, muscle atrophy, insomnia, xerosis (dry skin), vasomotor symptoms (night sweats), arthralgias, and oligomenoria (irregular periods). Consider starting with a combination of estrogen and progesterone, such as 0.5-1mg oral estradiol or a 0.05mg estradiol patch twice weekly, along with 100mg micronized progesterone daily (if you still have your uterus) 1. For your specific symptoms, estrogen can help with brain fog, muscle tone, skin dryness, and hot flashes, while progesterone may improve sleep quality. Start with a lower dose and adjust as needed. Non-hormonal options include lifestyle modifications like regular exercise, stress management techniques, and avoiding caffeine and alcohol near bedtime. Supplements such as black cohosh (40mg twice daily) or evening primrose oil (500-1000mg daily) help some women, though with less evidence than HRT. Consult your healthcare provider before starting any treatment, as they can confirm perimenopause through hormone testing and ensure HRT is appropriate for you based on your medical history. HRT works by replacing declining hormones that regulate body temperature, mood, sleep cycles, and tissue health, which explains why it effectively addresses multiple symptoms simultaneously. Some studies suggest that HRT may be associated with a small increased risk of breast cancer and cardiovascular and thromboembolic morbidity, and its routine use is not currently recommended 1. However, HRT may be considered in women who experience severe menopausal symptoms, but should generally be used only for a limited period of time and at the lowest effective doses 1. It is essential to weigh the benefits and risks of HRT and discuss them with your healthcare provider to determine the best course of treatment for your individual needs. Additionally, other options such as selective serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications may be considered to help mitigate vasomotor symptoms of premature menopausal symptoms 1.
From the FDA Drug Label
INDICATIONS AND USAGE PREMARIN therapy is indicated in the: Treatment of moderate to severe vasomotor symptoms due to menopause. The treatment options for relieving symptoms of perimenopause include:
- Conjugated estrogens (PO) for the treatment of moderate to severe vasomotor symptoms due to menopause 2 There is no direct information in the provided drug label to support treatment options for cognitive impairment, muscle atrophy, insomnia, xerosis (dry skin), arthralgias, or oligomenoria (irregular periods).