|
 |
 |
 |
|
Treatment During Perimenopause
The first step to treating perimenopause is getting the proper diagnosis. Unless you’re concerned about abnormal bleeding, possible pregnancy, or symptoms that make you uncomfortable, a visit to the doctor can often wait until your regular checkup.
Blood tests to check hormone levels can be unreliable during perimenopause (since hormone levels fluctuate during this time), so a gynecologist will usually diagnose perimenopause based on your medical history and current symptoms. To make a diagnosis, your doctor will likely ask:
- Is your menstrual cycle in a different pattern than it was a few years ago?
- Is your cycle shorter?
- Is your flow heavier?
- Are you having trouble sleeping?
Some perimenopausal women experience few or no symptoms. For them, a diagnosis is enough and treatments are unnecessary. However, others experience a variety of symptoms that can affect their quality of life. There are a variety of treatment options available, so you should choose the option that suits your lifestyle and medical history or combine therapies to get the best results.
Hormone Therapy
For decades, the most common form of treatment for perimenopause has been hormone therapy (HT). This type of treatment is frequently prescribed in the form of a low-dose birth control pill, although there are other options available.
Types of Hormone Therapy
There are three general varieties of hormone therapy.
Therapy |
How It’s Given |
What It Does |
Possible
Side Effects |
|||
ET (estrogen) |
|
Improves bone health and may relieve:
|
|
|||
PT (progestin) |
|
|
|
|||
EPT (mix of estrogen and progestin, either together or in an alternating cycle) |
|
Improves bone health and may relieve:
|
|
The hormone medications above come from several sources:
- Estrogen: The most commonly prescribed form of estrogen comes from the urine of pregnant horses. Other forms of estrogen are manmade.
- Progestin: Progestin is a synthetic form of progesterone and is produced in a lab.
Progestin is used in most medications, but sometimes natural progesterone can be used in certain products.
Estrogen
In most cases, estrogen alone (ET) is prescribed only to patients who have had a hysterectomy and no longer have a uterus. That’s because estrogen therapy causes the uterine lining to thicken. During a woman’s reproductive years, the thick lining provides a soft resting place for a fertilized egg. If fertilization doesn’t occur, progesterone causes the lining to shed during a normal menstrual cycle. If a perimenopausal woman still has her uterus and takes estrogen alone, the lining will continue to build up, which can lead to uterine cancer.
Medical Conditions and Hormone Therapy
Hormone therapy is not right for every woman. In particular, if you have a history of breast or uterine cancer, you should never take hormone therapy. Additionally, if you have one or more of the following health conditions, make your doctors aware of it before starting any form of hormone therapy:
- Abnormal vaginal bleeding
- Heart disease
- Diabetes
- High blood pressure
- High triglyceride levels
- Fibromyalgia
- Liver disease
- History of stroke or blood clots
Hormone Therapy Controversies
In the past, many scientists believed that taking estrogen and progestin not only relieved hot flashes but also prevented heart disease and other ailments that afflict women later in life. As a result, doctors often advised their patients to continue the treatment postmenopause. In 2002, however, the National Institutes of Health (NIH) announced that continuing HT for several years postmenopause actually has the reverse effect—it puts patients at risk for heart attacks. They recommended that women stop taking hormones on a long-term basis after reaching menopause.
Today, both the NIH and Food and Drug Administration (FDA) suggest hormone therapy for women in their forties and fifties who are perimenopausal and want to minimize:
- Hot flashes
- Night sweats
- Vaginal dryness
Taking HT on a long-term basis after menopause is not advisable because for some women it increases the risk of:
- Heart disease
- Strokes
- Blood clots
- Breast cancer
- Uterine cancer
The following table summarizes when hormone therapy is recommended, worth considering,
or not recommended.
Age |
Condition |
Recommended |
Worth Considering |
Not Recommended |
||||
Under 40 |
Premature menopause with significant symptoms |
 |
||||||
Under 40 |
Premature menopause with few symptoms |
|
||||||
40–55 |
Perimenopause with significant symptoms |
|
||||||
40–55 |
Perimenopause with few symptoms |
|
||||||
Over 55 |
Perimenopause with significant symptoms |
|
||||||
Over 55 |
Perimenopause with few or no symptoms |
|
||||||
Over 55 |
Postmenopause |
|
||||||
All ages |
Estrogen-related cancer |
|
Currently, the NIH and other institutions continue to research hormone therapy and its
effects pre- and postmenopause. In general, patients considering HT should plan to take the lowest dose for the shortest time possible. HT should be taken within 10 years of the onset of perimenopausal symptoms and for no more than 4–5 years (to avoid an increased risk of heart disease).
Other Medications
Doctors might also prescribe other medications to help minimize perimenopausal symptoms. These medications include:
- Antidepressants for anxiety
- Sleeping pills for insomnia
- Bisphosphonates to prevent bone loss
With any drug regimen, there are possible risks and side effects. Your physician can advise you which treatments will work best for your symptoms.
Alternative Therapies
Some women turn to alternative therapies to help alleviate the symptoms of perimenopause. There are a variety of options to consider, including herbal supplements, acupuncture, and mind-body therapies.
Herbal Supplements
In the days before modern medicine, people turned to plants to help relieve their symptoms. Today, some perimenopausal women view herbal supplements as an alternative to conventional medicine, while others take them as a complement to traditional hormone therapy. Many herbs used to treat perimenopausal symptoms are phytoestrogens, or plant estrogens. These natural sources of estrogen seem to produce some of the same effects as taking hormone pills or patches. However, they are much weaker than synthetic or animal hormones. As with other forms of estrogen, taking phytoestrogens without progestin may increase your risk of developing uterine cancer.
There are a variety of herbal supplements and holistic therapies that women take during perimenopause, including:
- Black cohosh: In Germany, doctors have prescribed this herb for their patients for more than 40 years. Many German patients take 20 mg pills twice a day for six months or less. Black cohosh may relieve hot flashes, vaginal dryness, tension, restless sleep, and stress. However, recent studies suggest that taking it may lead to liver damage. Stomach upset is another possible side effect.
- Ginkgo biloba: This herb is said to improve memory, libido, and general feeling of well-being. However, it also interferes with blood clotting and should not be used if you are taking Coumadin® or other blood thinners.
- Ginseng: Ginseng helps improve memory and minimize anxiety. There are a variety of types grown in different parts of the world. Unlike other phytoestrogens, ginseng does not seem to thicken the uterine lining. However, it may cause mania when combined with certain antidepressants and shouldn’t be taken by women with hormone-sensitive conditions.
- Soy: Some women eat soy products, such as tofu and soy milk, to help with hot flashes. Many believe that eating one or two servings daily could have even greater benefits than taking herbal supplements (the recommended dosage is 40–80 mg per day). Some studies have suggested that soy relieves hot flashes by 15–30%, but other studies show no effect at all. Soy also contains isoflavones (estrogen-like compounds), which may help to combat cancer.
- Red clover: This herb can help relieve vaginal dryness. It also contains isoflavones, which makes it act like a mild estrogen.
If you’re considering taking herbal supplements, it’s important to consult your doctor and possibly a pharmacist before starting any treatments. Herbal supplements can have side effects just as conventional medications can.
Acupuncture
Acupuncture is another alternative therapy that might help relieve perimenopausal symptoms. Used for thousands of years, it is a form of Eastern medicine in which an acupuncturist inserts long, thin needles into specific points on the body to treat pain or disease. Acupuncture is thought to work through the central nervous system, increasing circulation and prompting your body to produce chemicals, such as endorphins, that relieve pain and discomfort. Some studies suggest that acupuncture can help reduce hot flashes and night sweats.
Unlike herbal supplements, acupuncture is covered by many health insurance carriers. Most doctors will be able to provide a referral to a licensed acupuncturist.
Mind-Body Therapy
Some women use different mind-body therapies, such as the following, to help relieve symptoms of perimenopause:
Another mind-body therapy is biofeedback, which uses monitoring instruments to gather information about your body. The results of biofeedback tests can be used in a variety of ways, such as learning how to alter breathing patterns to relieve migraines. No matter which form of therapy you choose, it’s important to consult a doctor to find the one that best suits your lifestyle and medical history.
| Acknowledgments & Disclaimer |
