Menopause Care in Seattle - The KPM Approach

Perimenopause & MEnopause Treatments

Below are the most effective solutions, but remember that some of the symptoms may be associated with other serious conditions and need to be discussed with your doctor.

Medical Interventions

As we discussed above, perimenopause can be a murky diagnosis, and women in their 40s who are not clearly displaying classic menopausal symptoms (i.e., having hot flashes and large periods of time without a menstrual cycle) are often given non-HRT interventions.

Birth control

Oral birth control containing synthetic estrogens and progestins can relieve some perimenopause symptoms like menstrual irregularity, heavy bleeding, menstrual pain, and vasomotor symptoms. Progestin IUDs are often suggested as a way to manage heavy or irregular bleeding.

Off-Label Medications

Antidepressant prescription medications are frequently used off-label for menopause and have shown some efficacy in treating select perimenopausal symptoms. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and low-dose gabapentin are all shown to improve hot flashes.

Anticholinergic medications like oxybutynin can be prescribed to address hot flashes.

Every medication can have side effects. Specifically, antidepressants and birth control might help with some symptoms but frequently reduce libido and decrease a woman’s ability to achieve orgasm, along with other potential side effects. The cost-benefit of these versus hormone therapy should be discussed with your doctor, ideally one who is educated in all the treatment options.

Hormone Replacement Therapy (HRT)

Sometimes referred to as menopausal hormone therapy or MHT, this is a treatment used during perimenopause and menopause to replenish estrogen and progesterone that naturally decline as your reproductive years wind down.

HRT is the most effective treatment for managing menopause symptoms that result from declining estrogen and progesterone (i.e., hot flashes and vaginal dryness). Standard HRT includes progesterone and estrogen. When a woman with a uterus is prescribed estrogen, she must also take progesterone to protect the uterine lining from becoming too thick (a potential risk factor for endometrial cancer). Also, these medications together generally provide the most thorough symptom relief as they both perform important biologic and neurochemical tasks.

However, if a woman does not have a uterus, it is not standard of care to prescribe progesterone. Standard of care suggests progesterone is only needed to protect the uterine lining. However, for those with no uterus (i.e., had a hysterectomy), certain forms of progesterone may still be recommended off-label to help improve symptoms like sleep issues, night sweats, and mood changes.

While not every woman is a candidate for HRT, most can safely take it, according to the Menopause Society, which is the leading organization in understanding and researching the health of mid-life women. Discuss HRT with your doctor so you can make the right decision for you, your symptoms, and your approach to health.

HRT can frequently help with the following symptoms:

• Irregular periods

• Breast tenderness

• Mood swings

• Bloating

• Sleep disturbances

• Mood changes

• Hot flashes and night sweats

• Vaginal dryness

• Discomfort during sex

• Frequent UTIs

• Brain fog/poor word recall - mental clarity

Lifestyle Interventions

There is some evidence to suggest that lifestyle factors can mitigate the experience of perimenopause to some degree. Super annoying because perimenopause also contributes to weight gain. That said, studies have shown that carrying extra weight, overconsumption of alcohol, and lack of exercise are all associated with more severe symptoms. For what it’s worth, the following are some lifestyle targets to keep in mind:

• Get enough exercise. A general target is 150 minutes a week of some kind of physical activity, ideally combining cardio and strength training.

• Perform weight-bearing exercises such as hiking, walking, or strength training.

• Eat a whole foods-focused diet centered on vegetables, slow-burn carbs, lean proteins, and healthy fats.

• Stress - to the best of your ability, minimize your life stressors because high cortisol can make symptoms worse.

• Botanicals - there are a few supplements like black cohosh, Vitex, and maca that can provide modest support.