What are the symptoms of perimenopause?

From the Guidelines

Perimenopause symptoms should be managed with selective serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications to help mitigate vasomotor symptoms, as recommended by the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1. Perimenopause symptoms include irregular periods, hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, decreased fertility, changes in sexual function, loss of bone density, and changing cholesterol levels. These symptoms occur as the body transitions toward menopause, typically beginning in a woman's 40s but sometimes earlier.

Key Symptoms and Management

• Irregular menstrual cycles are often the first sign, with periods becoming longer or shorter and flow varying from light to heavy.
• Hot flashes and night sweats result from hormonal fluctuations affecting the body's temperature regulation.
• Sleep problems often follow, either directly from night sweats or from hormonal changes affecting sleep quality.
• Mood swings, irritability, and increased risk of depression or anxiety occur due to hormonal effects on brain chemistry.
• Vaginal dryness and decreased libido happen as estrogen levels decline. Managing these symptoms may involve lifestyle changes like regular exercise, stress reduction techniques, and dietary adjustments.

Treatment Options

For more severe symptoms, treatments might include:

• Hormone therapy
• Antidepressants for mood symptoms
• Vaginal estrogen for dryness However, the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women is not recommended by the U.S. Preventive Services Task Force 1.

Considerations

It's essential to consider the individual patient's needs and circumstances when making treatment decisions, taking into account the potential benefits and harms of each option, as well as the patient's preferences and values.

From the Research

Perimenopause Symptoms

• Perimenopause, or the menopausal transition, is a period of time during which newly arising symptoms can present complex management decisions for providers 2.
• The symptoms of perimenopause can include hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns 2.
• Vasomotor symptoms, such as hot flashes and night sweats, are common during the perimenopause and can persist for more than a decade 3.
• Genitourinary symptoms, such as vulvovaginal irritation and dryness, dyspareunia, and urinary problems, are also common during the perimenopause 4.
• Other symptoms of perimenopause can include mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health 3.

Management of Perimenopause Symptoms

• Hormone therapy (HT) is effective for perimenopausal symptoms, but its use has been limited by concerns about health risks observed in postmenopausal HT users who are older than 60 and/or women who have been postmenopausal for greater than 10 years 5.
• Non-hormonal treatment options, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and gabapentin, are also available for the management of vasomotor symptoms 4.
• Cognitive behavior therapy and clinical hypnosis can be effective for short-term reduction of vasomotor symptoms and associated sleep disturbances 4.
• Hormone-free vaginal moisturizers are noninferior to estrogen-based therapies for treating genitourinary syndrome of menopause 4.
• Other treatment options for vaginal dryness and dyspareunia associated with menopause include ospemifene and intravaginal dehydroepiandrosterone 4.

Treatment Considerations

• The management of perimenopause symptoms should involve shared decision-making that is informed by the best available evidence and individual risks and preferences 4.
• Estrogen-based hormonal therapies are the most effective treatments for many of the symptoms of perimenopause, but have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause 3.
• Non-hormonal medications and other treatment options should be considered for women who are not candidates for hormonal therapies or who prefer alternative treatments 3.