Perimenopause - diagnosis and treatment (2023)

Diagnose

Perimenopause is a process - a gradual transition. No test or sign is enough to determine if you have entered perimenopause. Your doctor takes many things into account, including your age, your menstrual history, and what symptoms or physical changes you are experiencing.

Some doctors may order tests to check your hormone levels. But aside from checking thyroid function, which can affect hormone levels, hormone tests are rarely necessary or useful to assess perimenopause.

Treatment

Medications are often used to treat perimenopausal symptoms.

• Hormone therapy.Systemic estrogen therapy — which comes in tablet, skin patch, spray, gel, or cream form — remains the most effective treatment option for relieving hot flashes and night sweats in the peri- and menopause. Depending on your personal and family medical history, your doctor may recommend estrogen at the lowest dose needed to relieve your symptoms. If you still have your uterus, you need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
• Vaginal Estrogen.Estrogen can be administered directly into the vagina using a vaginal tablet, vaginal ring, or vaginal cream. With this treatment, only a small amount of estrogen is released, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort during intercourse, and some urinary tract symptoms.
• Antidepressants.Certain antidepressants from a class called selective serotonin reuptake inhibitors (SSRIs) can reduce hot flashes associated with menopause. An antidepressant to treat hot flashes may be useful for women who cannot take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
• Gabapentin (Neurontin).Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful for women who cannot use estrogen therapy for health reasons and those who also have migraines.

Before deciding on any form of treatment, talk to your doctor about your options and the associated risks and benefits. Review your options annually, as your needs and treatment options may change.

Clinical Trials

Explore the Mayo Clinic studiesExperimenting with new treatments, interventions and tests as a means of preventing, detecting, treating or managing this condition.

lifestyle and home remedies

The following healthy lifestyle choices can help relieve some symptoms of perimenopause and promote good health as you age:

• Relieves vaginal discomfort.Use over-the-counter water-based vaginal lubricants (Astroglide, K-Y Liquid, others) or moisturizers (Replens, Vagisil Prohydrate, others). Choose products that don't contain glycerin, which can cause burning or irritation in women who are sensitive to this chemical. Staying sexually active also helps by increasing blood flow to the vagina.
• Eat healthy.As your risk of osteoporosis and heart disease increases during this time, eating healthy is more important than ever. Adopt a low-fat, high-fiber diet rich in fruits, vegetables, and whole grains. Add calcium-rich foods. Avoid alcohol and caffeine if they seem to trigger hot flashes. Ask your doctor if you should also be taking a calcium supplement, and if so, what kind and how much — also ask if you need more vitamin D, which helps your body absorb calcium.
• Be active.Regular exercise and physical activity prevent weight gain, improve your sleep, and elevate your mood. Aim to exercise 30 minutes or more most days of the week, but not right before bed. Regular exercise has been shown to reduce the risk of hip fractures in older women and increase bone density.
• get enough sleepTry to keep a consistent sleep schedule. Avoid caffeine, which can make it difficult to fall asleep, and avoid drinking too much alcohol, which can disrupt sleep.
• Practice stress reduction techniques.Regularly practiced stress reduction techniques like meditation or yoga can promote relaxation and health throughout your life, but they can be especially helpful during the transition to menopause.

alternative medicine

In addition to conventional therapies, many menopausal women want to learn about complementary and alternative approaches to managing symptoms. Researchers are studying these therapies to determine their safety and effectiveness, but evidence is often lacking.

Some of the options explored include:

• black cohosh.This herbal extract is used by some women to treat hot flashes and other menopausal symptoms. There is insufficient evidence to support its use. Experts are also unsure of the risks of ingesting black cohosh. Some studies have shown that black cohosh is harmful to the liver, but other studies have found no evidence of this. Researchers are also wondering if the herbal extract is safe for women with or at risk of breast cancer.

• phytoestrogens.These estrogens occur naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soybeans and other legumes, as well as red clover. Lignans are found in flaxseeds, whole grains, and some fruits and vegetables. There are also herbal compounds that have estrogen-like properties.

  (Video) Perimenopause: Signs, Symptoms, and Solutions

  Studies on phytoestrogens — whether from foods or supplements — are conflicting about whether they help reduce menopausal symptoms. Studies are also conflicting about what beneficial effects phytoestrogens might have on breast cancer risk.

• Bioidentical Hormones.The term "bioidentical" implies that the hormones in the product are chemically identical to those your body produces. However, compound bioidentical hormones are not regulated by the U.S. Food and Drug Administration (FDA), so quality and risks may vary. There is also no evidence that compound bioidentical hormones are safer or more effective than traditional hormone therapy.
• Dehydroepiandrosteron (DHEA).This natural steroid, produced by your adrenal gland, is available as a dietary supplement and has been used by some to relieve pain during intercourse due to vaginal atrophy. However, the evidence for its effectiveness is mixed, and there are some concerns about possible harmful effects.

Talk to your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. TheFDAdoes not regulate herbal products, and some may be dangerous or interact with other medications you are taking and put your health at risk.

Low-risk complementary therapies that may help reduce stress and improve psychological well-being include:

• Acupuncture.Research on acupuncture to reduce hot flashes is inconclusive but promising.
• relaxation techniques.Yoga and meditation, for example, can help reduce stress, which in turn can help improve menopause symptoms.

Prepare for your appointment

You probably start by discussing your symptoms with your GP. If you do not already see a doctor who specializes in the female reproductive system (gynecologist), your GP can refer you to one.

Consider taking a family member or friend with you. Sometimes it can be difficult to remember all the information given during an appointment. Someone walking with you may remember something you missed or forgot.

What you can do

How to prepare for your appointment:

• Take a record of your menstrual cycles with you.Keep a journal of your menstrual cycles over the past few months, including the first and last dates of bleeding for each cycle and whether the bleeding was light, moderate, or heavy.
• Make a list of all the signs and symptoms you have.Add detailed descriptions. Include any symptoms that appear unrelated.
• Write down important personal information.Include major stresses or recent life changes.
• Make a list of all medications and the dosages.Include prescription and non-prescription drugs, herbs, vitamins, and supplements you take.
• Prepare questions.Your time with your doctor may be limited. Therefore, prepare a list of questions so that you can make the most of your time together.

Some basic questions to ask yourself are:

• What is likely causing my symptoms?
• What are other possible causes of my symptoms?
• What types of tests do I need?
• Is my condition likely transient or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you propose?
• I have some other health problems. How can I best manage them together?
• Are there any restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed materials I can have? Which websites do you recommend?
• What determines if I should schedule a follow-up visit?

Questions your doctor may ask

To start a conversation about your perimenopause experience, your doctor may ask questions such as:

• Are you still having menstrual bleeding? If yes, how are they?
• What are your symptoms?
• How long have you suffered from these symptoms?
• How distressing are your symptoms?
• What medications, herbs, vitamins, or other supplements do you take?