Hormone Management in Perimenopausal Women

Introduction to Perimenopause

• The American College of Obstetricians and Gynecologists recommends that perimenopausal women with bothersome vasomotor symptoms be considered for hormone replacement therapy, with a benefit-risk profile most favorable for women under 60 years or within 10 years of menopause onset 2

Management of Perimenopausal Symptoms

• The North American Menopause Society suggests that perimenopausal women remain at risk for pregnancy despite irregular cycles and should continue contraception if pregnancy is not desired 2
• The American College of Obstetricians and Gynecologists recommends evaluating perimenopausal women for vasomotor symptoms, genitourinary symptoms, sleep disturbances, and mood changes, and assessing the impact of menstrual irregularity on quality of life 3

Prevention of Osteoporosis

• The National Osteoporosis Foundation recommends considering baseline DEXA scan in perimenopausal women given declining estrogen exposure and increased fracture risk, and ensuring adequate calcium and vitamin D intake 1, 3

Hormone Replacement Therapy

• The American College of Obstetricians and Gynecologists recommends transdermal estradiol 50 μg daily plus micronized progesterone 200 mg orally at bedtime as the preferred regimen for perimenopausal women with an intact uterus 2