Perimenopausal Symptoms and Treatments: A Review
A new review article explores the current research findings of perimenopausal women's symptoms and the treatment options available to reduce the impact they may have on quality of life. The full review is published in the Journal of Women's Health.
Research has made menopausal symptoms increasingly clear to identify. Almost 90% of women visit their healthcare provider seeking advice on how to cope but are clinicians equipped with the tools to help their patients maintain a high quality of life?
The four most prominent symptoms include hot flashes, adverse mood, vaginal dryness and sleep changes. When these typical symptoms are associated with menopausal transition, hormonal therapy is likely the most effective way to improve quality of life. These types of perimenopausal therapies are lower dosed compared with a woman's premenopausal fluctuations. For some women, oral contraceptives may be more efficacious than lower-dose hormone preparations.
Estrogen in combination with a levonorgestrel intrauterine system is another hormone treatment option that can be considered. Commonly, clinician guidelines recommend the use of non-oral estrogens, however, clinicians should individualize their treatment so that it is best for their patient.
The review also highlights a list of alternative options for patients where hormone therapy is not an option. Paroxetine mesylate 7.5mg is indicated for vasomotor symptoms; ospemifene 60mg, a selective estrogen receptor modulator (SERM), is indicated for vaginal dryness; and selective serotonin reuptake inhibitors (SSRIs) used for depression may be an option for mood-related symptoms. For women who have hot flashes that are bothersome only at night, gabapentin 100–300mg nightly may be highly effective.
Non-pharmacologic or botanical remedies for menopausal symptoms have proven ineffective across many clinical trials. These treatments include yoga, omega-3 fatty acid supplementation, and black cohosh.
Multiple menopausal symptoms can interact and worsen the effects of each other, where hot flashes exacerbate sleep disruption and cause depressive symptoms. Ideally, a single agent would be used to treat multiple symptoms, especially as the chances of a perimenopausal-aged woman taking concomitant medications will already be high.
Women with hot flashes and depression can be treated with hormone therapy if the depression is mild to moderate in severity, but an SSRI/SNRI agent may be a good alternative. Women with concomitant hypertension and vasomotor symptoms may be treated with clonidine, a centrally active alpha-1-adrenergic blocker, and if successful, the single medication may treat both problems.
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