What is the effect of adding Human Chorionic Gonadotropin (HCG) peptide on fatigue and tiredness in a perimenopausal woman?

HCG Peptide Has No Role in Managing Perimenopausal Fatigue

Human Chorionic Gonadotropin (HCG) peptide is not indicated, studied, or recommended for treating fatigue or tiredness in perimenopausal women, and should not be used for this purpose. 1, 2

Why HCG is Not Appropriate

• HCG is a pregnancy hormone that has no established therapeutic role in perimenopause management 3
• The only documented relevance of HCG in perimenopausal women is as a potential source of diagnostic confusion—some perimenopausal women naturally have mildly elevated HCG levels (<14 IU/L) due to pituitary production, which can mislead clinicians into unnecessary workups for pregnancy or malignancy 3
• No guidelines or high-quality evidence support HCG use for menopausal symptoms, fatigue, or any chronic condition prevention 1, 2

Evidence-Based Approach to Perimenopausal Fatigue

Hormone Therapy Considerations

If fatigue is accompanied by vasomotor symptoms (hot flashes), sleep disturbances, or mood changes, hormone therapy may be considered—but only for symptom management, not chronic disease prevention. 2

• The U.S. Preventive Services Task Force explicitly states that hormone replacement therapy (HRT) should NOT be used for primary prevention of chronic conditions (Grade D recommendation) 1, 2
• HRT is only appropriate when menopausal symptoms significantly impact quality of life 1, 2

Specific Hormone Therapy Algorithm

For women with intact uterus:

• Must use estrogen PLUS progestin (or bazedoxifene) to prevent endometrial cancer 2
• Unopposed estrogen is contraindicated due to increased endometrial cancer risk 2

For women post-hysterectomy:

• Can use estrogen alone (unopposed) 2

Dosing principle:

• Use the lowest effective dose for the shortest duration consistent with treatment goals 1, 2

Risk-Benefit Profile You Must Discuss

For every 10,000 women aged 50-79 taking estrogen-progestin for 1 year, expect: 1, 2

• Harms: 7 additional CHD events, 8 more strokes, 8 more pulmonary emboli, 8 more invasive breast cancers
• Benefits: 6 fewer colorectal cancers, 5 fewer hip fractures

Alternative Therapies to Avoid

Phytoestrogens (soy isoflavones):

• The USPSTF found inconclusive evidence for efficacy in managing menopausal symptoms 1, 4
• Not recommended due to insufficient evidence and potential safety concerns 4

Critical Contraindications to Hormone Therapy

• Breast cancer survivors should NOT use HRT due to hormonally-mediated cancer risk 2
• The American Heart Association advises against HRT for cardiovascular disease prevention, as it increases CHD risk rather than preventing it 2
• Risks (especially breast cancer and stroke) increase substantially with duration beyond 5 years 2

Addressing the Underlying Fatigue

Look for these specific perimenopausal contributors to fatigue:

• Vasomotor symptoms disrupting sleep (80% of perimenopausal women experience these) 5, 6
• Erratic estradiol fluctuations (levels average 26% higher than baseline with wide swings) 5
• Insufficient or absent progesterone due to anovulatory cycles 5
• Abnormal uterine bleeding causing anemia 7, 5, 6
• Mood and sleep disturbances independent of hot flashes 5, 6

If progesterone deficiency is suspected:

• Oral micronized progesterone (300 mg at bedtime) given cyclically (cycle days 14-27) can improve sleep and vasomotor symptoms in menstruating perimenopausal women 5
• This is a physiological approach that addresses the progesterone insufficiency characteristic of perimenopause 5

Common Pitfall to Avoid

Do not assume estrogen deficiency is causing perimenopausal symptoms—evidence shows estradiol levels are actually elevated and erratic during perimenopause, not deficient 5. The primary hormonal issue is progesterone insufficiency relative to high, fluctuating estrogen levels 5.