From the Guidelines
Low-dose hormonal birth control pills containing estrogen and progestin are the most effective medication option for managing irregular menstrual cycles during perimenopause, as they provide cycle regularity while alleviating symptoms like hot flashes. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd edition 1, hormonal treatment with low-dose COCs or estrogen can be considered for short-term treatment (10–20 days) if an underlying gynecologic problem is not found and the woman wants treatment.
When considering treatment options, it is essential to first rule out any underlying gynecological problems, such as interactions with other medications, an STD, pregnancy, or new pathologic uterine conditions (e.g., polyps or fibroids) 1. If an underlying gynecologic problem is found, treating the condition or referring for care is necessary.
For women experiencing irregular bleeding, the following treatment options can be considered:
- NSAIDS for short-term treatment (5–7 days)
- Hormonal treatment (if medically eligible) with low-dose COCs or estrogen for short-term treatment (10–20 days) 1. If irregular bleeding persists and the woman finds it unacceptable, counseling her on alternative methods and offering another method if desired is recommended 1.
In real-life clinical practice, the choice of medication depends on symptom severity, bleeding patterns, contraceptive needs, and other health factors, making consultation with a healthcare provider essential for personalized recommendations.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Options for Irregular Menstrual Cycles in Perimenopause
- The use of drospirenone, a progestogen with antialdosterone activity, has been studied in the context of hormone replacement therapy (HRT) and oral contraceptives 2.
- Drospirenone has been shown to be effective in inhibiting ovulation and regulating menstrual cycles when used in combination with ethinylestradiol 2, 3.
- A combination of drospirenone and ethinylestradiol has been approved for the treatment of premenstrual dysphoric disorder (PMDD) and has been shown to reduce premenstrual symptoms in women with PMDD 4, 5.
- The safety and efficacy of drospirenone have been demonstrated in several studies, with a favorable bleeding profile and minimal side effects 2, 3.
- Perimenopause is characterized by highly variable levels of estradiol and progesterone, leading to symptoms such as irregular menstrual cycles, menorrhagia, and mood disorders 6.
- Treatment options for perimenopause may include hormone replacement therapy (HRT) or oral contraceptives, such as those containing drospirenone, to regulate menstrual cycles and alleviate symptoms 2, 6.