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{{CMG}} {{RA}}
{{CMG}} {{RA}}
==Overview==
==Overview==
While [[perimenopause]] is a natural stage of life when the [[symptoms]] are severe, this may be alleviated through medical treatments that include [[Hormone therapy]](HT), non-hormonal therapy, and [[complementary]] or [[Alternative medicine|alternative]] therapies.[[ Hormonal therapy]] (HT) provides the best relief, but [[hormone therapy]] should only be used for the shortest duration of time and at its lowest [[effective dose]], as it increases the [[relative risk]] of [[uterine cancer]] ,[[ovarian cancer]], [[breast cancer]], [[thromboembolism]], and [[coronary heart disease]], especially in [[women]] who start [[Hormone replacement therapy|HT]] after [[menopause]]. Some other [[drugs]] afford limited relief from [[hot flashes]]. A woman and her doctor should carefully review her [[symptoms]] and [[relative risk]] before determining whether the benefits of [[Hormone Replacement Therapy|HT]] or other [[Medicine|therapies]] outweigh the [[risks]].  
While [[perimenopause]] is a natural stage of life when the [[symptoms]] are severe, this may be alleviated through medical treatments that include [[Hormone therapy]](HT), non-hormonal therapy, and [[complementary]] or [[Alternative medicine|alternative]] therapies.[[ Hormonal therapy]] provides the best relief, but [[hormone therapy]] should only be used for a short duration and the lowest [[effective dose]], as it increases the [[relative risk]] of [[uterine cancer]], [[ovarian cancer]], [[breast cancer]], [[thromboembolism]], and [[coronary heart disease]], especially in [[women]] who start [[Hormone replacement therapy|HT]] after [[menopause]]. Some other [[drugs]] afford limited relief from [[hot flashes]]. A woman and her doctor should carefully review her [[symptoms]] and [[relative risk]] before determining whether the benefits of [[Hormone Replacement Therapy|HT]] or other [[Medicine|therapies]] outweigh the [[risks]].  


==Medical therapy==
==Medical therapy==
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==='''Other therapies:'''===
==='''Other therapies:'''===


*Individual counseling or support groups may be helpful to handle sad, [[Depression|depressed]], or confusing feelings [[women]] may be having as their [[Human body|bodies]] change.  
*Individual counseling or support groups may be helpful to handle sad, [[Depression|depressed]], or confusing feelings [[women]] may be having as their [[Human body|bodies]] change.
*Vaginal moisturizers such as [https://www.singlecare.com/blog/vagisil-vs-monistat/ Vagisil] or [http://www.replens.com/Why-Try-Replens/#:~:text=Replens%20is%20a%20vaginal%20moisturizer,cells%20for%20long%20lasting%20hydration. Replens] and lubricants, such as [[K-Y Jelly]] or [https://astroglide.com/faqs/personal-lubricants#:~:text=Let's%20face%20it%2C%20when%20it,flavor%20to%20your%20sex%20life. Astroglide] can help women with thinning [[vaginal]] tissue, [[Vaginal dryness|dryness]], and decrease the pain that may be present during [[intercourse]].  
*Vaginal moisturizers such as [https://www.singlecare.com/blog/vagisil-vs-monistat/ Vagisil] or [http://www.replens.com/Why-Try-Replens/#:~:text=Replens%20is%20a%20vaginal%20moisturizer,cells%20for%20long%20lasting%20hydration. Replens] and lubricants, such as [[K-Y Jelly]] or [https://astroglide.com/faqs/personal-lubricants#:~:text=Let's%20face%20it%2C%20when%20it,flavor%20to%20your%20sex%20life. Astroglide] can help women with thinning [[vaginal]] tissue, [[Vaginal dryness|dryness]], and decrease the pain that may be present during [[intercourse]].
*Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from [[Sex (activity)|sex]] and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during [[intercourse]].<ref name="pmid32990054">{{cite journal| author=Potter N, Panay N| title=Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. | journal=Climacteric | year= 2021 | volume= 24 | issue= 1 | pages= 19-24 | pmid=32990054 | doi=10.1080/13697137.2020.1820478 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32990054  }} </ref><ref name="pmid32990054">{{cite journal| author=Potter N, Panay N| title=Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. | journal=Climacteric | year= 2021 | volume= 24 | issue= 1 | pages= 19-24 | pmid=32990054 | doi=10.1080/13697137.2020.1820478 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32990054 }} </ref> Low-dose [https://medlineplus.gov/druginfo/meds/a606005.html#:~:text=Vaginal%20estrogen%20is%20used%20to,end%20of%20monthly%20menstrual%20periods). vaginal estrogen] is generally a safe way to take [[estrogen]] to solve [[vaginal]] thinning and [[Vaginal dryness|dryness]] problems while only minimally increasing the levels of [[estrogen]] in the [[blood]].
*Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from [[Sex (activity)|sex]] and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during [[intercourse]].<ref name="pmid32990054">{{cite journal| author=Potter N, Panay N| title=Vaginal lubricants and moisturizers: a review into use, efficacy, and safety. | journal=Climacteric | year= 2021 | volume= 24 | issue= 1 | pages= 19-24 | pmid=32990054 | doi=10.1080/13697137.2020.1820478 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32990054  }} </ref>
*Low-dose [https://medlineplus.gov/druginfo/meds/a606005.html#:~:text=Vaginal%20estrogen%20is%20used%20to,end%20of%20monthly%20menstrual%20periods). vaginal estrogen] is generally a safe way to take [[estrogen]] to solve [[vaginal]] thinning and [[Vaginal dryness|dryness]] problems while only minimally increasing the levels of [[estrogen]] in the [[blood]].<ref name="pmid19117185">{{cite journal| author=Al-Baghdadi O, Ewies AA| title=Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. | journal=Climacteric | year= 2009 | volume= 12 | issue= 2 | pages= 91-105 | pmid=19117185 | doi=10.1080/13697130802585576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19117185 }} </ref>
*Drinking cold liquids and removing excess clothing layers when [[hot flashes]] strike, and avoiding [[Hot flashes|hot flash]] triggers such as spicy foods maybe relieve some [[symptoms]] for some [[women]].
*Drinking cold liquids and removing excess clothing layers when [[hot flashes]] strike, and avoiding [[Hot flashes|hot flash]] triggers such as spicy foods maybe relieve some [[symptoms]] for some [[women]].



Latest revision as of 06:57, 18 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Rahmah Al-Edresi, M.D.[2]

Overview

While perimenopause is a natural stage of life when the symptoms are severe, this may be alleviated through medical treatments that include Hormone therapy(HT), non-hormonal therapy, and complementary or alternative therapies.Hormonal therapy provides the best relief, but hormone therapy should only be used for a short duration and the lowest effective dose, as it increases the relative risk of uterine cancer, ovarian cancer, breast cancer, thromboembolism, and coronary heart disease, especially in women who start HT after menopause. Some other drugs afford limited relief from hot flashes. A woman and her doctor should carefully review her symptoms and relative risk before determining whether the benefits of HT or other therapies outweigh the risks.

Medical therapy

Hormonal replacement therapy(HRT)

Selective Estrogen Receptor Modulators (SERMs)

Other forms of hormone therapy:

Adverse effects:


Non Hormonal therapy:

Non hormonal therapy includes serotonin-norepinephrine reuptake inhibitors(SNRIs), selective serotonin reuptake inhibitors (SSRIs), clonidine, and gabapentin.

Complementary and alternative therapies:

Other therapies:

  • Individual counseling or support groups may be helpful to handle sad, depressed, or confusing feelings women may be having as their bodies change.
  • Vaginal moisturizers such as Vagisil or Replens and lubricants, such as K-Y Jelly or Astroglide can help women with thinning vaginal tissue, dryness, and decrease the pain that may be present during intercourse.
  • Moisturizers and lubricants are different products for different types of issues. Some women feel dry apart from sex and they may do better with moisturizers all the time. Those who just need lubricants are fine just using the lubrication products during intercourse.[13]
  • Low-dose vaginal estrogen is generally a safe way to take estrogen to solve vaginal thinning and dryness problems while only minimally increasing the levels of estrogen in the blood.[14]
  • Drinking cold liquids and removing excess clothing layers when hot flashes strike, and avoiding hot flash triggers such as spicy foods maybe relieve some symptoms for some women.



References

  1. Kaunitz AM, Manson JE (2015). "Management of Menopausal Symptoms". Obstet Gynecol. 126 (4): 859–876. doi:10.1097/AOG.0000000000001058. PMC 4594172. PMID 26348174.
  2. North American Menopause Society (2012). "The 2012 hormone therapy position statement of: The North American Menopause Society". Menopause. 19 (3): 257–71. doi:10.1097/gme.0b013e31824b970a. PMC 3443956. PMID 22367731.
  3. Maclennan AH, Broadbent JL, Lester S, Moore V (2004). "Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes". Cochrane Database Syst Rev (4): CD002978. doi:10.1002/14651858.CD002978.pub2. PMC 7004247 Check |pmc= value (help). PMID 15495039.
  4. An KC (2016). "Selective Estrogen Receptor Modulators". Asian Spine J. 10 (4): 787–91. doi:10.4184/asj.2016.10.4.787. PMC 4995266. PMID 27559463.
  5. Files JA, Ko MG, Pruthi S (2011). "Bioidentical hormone therapy". Mayo Clin Proc. 86 (7): 673–80, quiz 680. doi:10.4065/mcp.2010.0714. PMC 3127562. PMID 21531972.
  6. Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M; et al. (2003). "Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial". JAMA. 290 (13): 1739–48. doi:10.1001/jama.290.13.1739. PMID 14519708.
  7. Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D (1995). "Hormone replacement therapy and endometrial cancer risk: a meta-analysis". Obstet Gynecol. 85 (2): 304–13. doi:10.1016/0029-7844(94)00383-O. PMID 7824251.
  8. Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL; et al. (2013). "Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials". JAMA. 310 (13): 1353–68. doi:10.1001/jama.2013.278040. PMC 3963523. PMID 24084921. Review in: Evid Based Med. 2014 Jun;19(3):105
  9. "Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society". Menopause. 22 (11): 1155–72, quiz 1173-4. 2015. doi:10.1097/GME.0000000000000546. PMID 26382310.
  10. Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH (2017). "Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women". J Okla State Med Assoc. 110 (5): 272–274. PMC 5482277. PMID 28649145.
  11. Johnson A, Roberts L, Elkins G (2019). "Complementary and Alternative Medicine for Menopause". J Evid Based Integr Med. 24: 2515690X19829380. doi:10.1177/2515690X19829380. PMC 6419242. PMID 30868921.
  12. Kim MY, Choi SD, Ryu A (2015). "Is complementary and alternative therapy effective for women in the climacteric period?". J Menopausal Med. 21 (1): 28–35. doi:10.6118/jmm.2015.21.1.28. PMC 4452811. PMID 26046035.
  13. Potter N, Panay N (2021). "Vaginal lubricants and moisturizers: a review into use, efficacy, and safety". Climacteric. 24 (1): 19–24. doi:10.1080/13697137.2020.1820478. PMID 32990054 Check |pmid= value (help).
  14. Al-Baghdadi O, Ewies AA (2009). "Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview". Climacteric. 12 (2): 91–105. doi:10.1080/13697130802585576. PMID 19117185.


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