US Pharm. 2024;49(9):15-16.

A Decline in Hormones

Perimenopause is the time before menopause and is usually when menopausal symptoms are first noticed. Perimenopause can last several years. In contrast, menopause is the absence of a period for a full year. Perimenopause is a natural condition that results from decreasing levels of estrogen and progesterone secreted from the ovaries. During this time, women may experience changes in their menstrual flow, changes in the length of or more irregular menstrual cycles, hot flashes, night sweats, mood changes, vaginal dryness, and sleep problems, among other symptoms. Perimenopause does not necessarily require treatment; however, there are lifestyle changes and certain medications that can help manage bothersome symptoms. Talking to the doctor can help appropriately diagnose perimenopause and determine the best treatment options.

Hot Flashes Are a Hallmark Symptom

Most women notice the symptoms of perimenopause in their mid-40s to mid-50s, although women may experience them in their mid-30s. Aside from irregular periods, other symptoms of perimenopause include hot flashes, night sweats, sleep issues, and mood changes. About 10% to 15% of women have mild or no symptoms. Hot flashes are the most common symptom, and they cause a sudden feeling of heat in the upper chest and face that spreads throughout the body. These can last a few seconds to several minutes and can happen several times a month or several times a day.

Women can experience insomnia, or trouble falling asleep or staying asleep, or restless legs syndrome. Sometimes, night sweats or hot flashes that occur during sleep can also contribute to difficulty sleeping. In addition, the tissue in the urinary tract and vagina can become thin and dry and cause symptoms that can feel like a urinary tract infection or result in pain during sex. Women may experience mood swings and changes in mood, such as depression and irritability. Women with a history of depression may experience it again during perimenopause. Fertility is much lower during perimenopause, but it is still possible to become pregnant.

Perimenopause Risk Factors

Risk factors that can contribute to early perimenopause include smoking, tobacco product use, family history of early menopause, history of certain cancer treatments, having a condition that can affect hormone levels, and not having a uterus or ovaries. The doctor can help diagnose perimenopause based on medical history, physical examination, age, menstrual history, and symptoms. Keeping track of symptoms—such as when they start, how often they occur, and how long they last—and monitoring menstrual periods, such as when they happen, how heavy they are, how long they last, and how much time passes between periods, can help in diagnosis. It is important to promptly let the healthcare provider know if there are blood clots in the vaginal discharge, spotting between periods, vaginal bleeding after sex, pain during sex, or periods occurring sooner than 3 weeks, as there may be a reason for these symptoms aside from perimenopause.

Perimenopausal symptoms can be very bothersome, and there are some ways to manage or treat them. For example, there are lifestyle changes that can help with symptoms, such as having a healthy, balanced diet that includes fresh fruits and vegetables, whole grains, lean protein, and healthy fats; limiting alcohol and caffeine; and quitting smoking or tobacco. Physical activity, especially weight-bearing exercise, can improve mood and sleep and help maintain a healthy weight. Meditation and stress-management techniques can help with mood swings. Practicing good sleep hygiene, such as avoiding device screens, can help improve insomnia. A vaginal moisturizer can improve vaginal dryness.

Hormone Therapy Considerations

For severe symptoms, hormone therapy may be used. These products come in a tablet, skin patch, spray, gel, or cream. They are most effective for hot flashes and night sweats but can help with other symptoms, too, and they can also prevent bone loss and decrease fracture risk. Unfortunately, hormone therapy can increase the risk for uterine cancer, stroke, heart attack, blood clots, and gallbladder disease, so it is important to talk to a doctor to determine if hormone therapy is the right treatment.

For women who cannot use hormone therapy, antidepressants, fezolinetant, or gabapentin can be utilized. If vaginal dryness is the only symptom, vaginal estrogen can be used instead. There are many herbal supplements that are promoted as natural remedies for managing symptoms, such as soy or black cohosh; however, there are insufficient data to support their safety or effectiveness, and they are not regulated. Additionally, they may have severe interactions with other drugs or supplements.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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