Submitted by Dr. Joe Edwards on Sun, 2010-02-07 23:57

The perimenopause
is the name given the constellation of symptoms that women experience
prior to the onset of menopause. The transition time may vary from a
few months to several years.

Most gynecologists find the
timeframe between 45 and 55 difficult to treat especially if the woman
still has her uterus. One of the most frequent complaints is
breakthrough bleeding.

The ability to provide cycle control and control the symptoms of impending menopause become difficult.

If
the patient smokes, the use of oral contraceptives is no longer an
option because of the inherent risks. There are many noncontraceptive
benefits to oral contraceptives.

The use of hormone replacement
therapy in this age group may not be enough to suppress ovarian
function. Thus, the patient may experience breakthrough bleeding. 

The
need for hormone replacement therapy should be individualized. The
decision should be based on the patient's history, the physical
examination, and the patient's symptoms. 

WOMEN WHO HAVE NO SYMPTOMS PROBABLY DO NOT NEED HORMONE THERAPY.

The
classic perimenopausal symptoms usually begin with changes in the
patient's menstrual cycle and also the development of hot flushes (hot
flashes).

The patient may experience insomnia, weight gain,
vaginal dryness, drying of the skin, mood swings (who does not have
those), and painful intercourse.

Low dose oral contraceptives is
generally the better option in my opinion because the doses of estrogen
are high enough to suppress her symptoms. The progesterone in the pill
also will provide cycle control in women who still have her uterus. 

For
those who smoke and have a uterus, cycle control may require other
interventions followed by estrogen and progesterone therapy.

For
those who no longer have the uterus, her symptoms will begin without
the usual clue of cycle changes. Low dose hormone therapy may be an
excellent option for those symptomatic women. 

Some women will
decline any hormonal intervention. Other options may include
antidepressants, which may lessen the symptoms of the perimenopause.
Most people hesitate to take these medications because of the stigma
associated with these medications.

I have found these medications
to be life-saving for some women. Remember, the decision should be
individualized and what works for one person may not work for the other.

As
the patient enters the menopause, the amount of hormones may be
decreased. The concept of medical therapy should be the least amount
that does the most good.

The idea of treating the symptomatic
patient is to replace the hormones that used to be produced in the
woman's ovaries prior to the onset of the perimenopause.

The decision should be based on quality of life issues. Hormones are not for everyone. There are pros and cons to each decision.

In
my opinion, the use of hormone replacement therapy to restore the
hormones lost from the aging ovaries makes sense in the woman who is
symptomatic. 

Women often ask how long they will continue to have hot flashes. The times varies from a few months to the rest of her life.

The
other frequent question is what new treatments are there to increase a
woman's sex drive. They want the female version of viagra. Believe me,
gynecologists would love to have a therapy that works.

Some
therapies for decrease sex drive include wellbutrin (generic does not
work as well) and testosterone medication (compound products and brands
used off label).

In the cases of vaginal dryness, the use of
local estrogen can make a significant difference, The products consist
of estrogen creams, estrogen tablets, and estrogen rings. These
products do a great job of restoring vaginal health. 

Sometimes,
the dosing of hormones are not high enough to affect vaginal health.
Thus, use of hormones and vaginal estrogen therapy may be necessary.

Finally,
the decision to treat the perimenopause and menopuse will be up to each
individual patient. Likewise, the time to end therapy should also be
individualized.

Other considerations during this time in a
woman's life should include weight management, exercise, lipid
evaluation, smoking cessation, and diet.

We all can do better with our health. I think I will start tomorrow because it is MONDAY.

Have a great week and congratulation to the SAINTS!

Joe Edwards III M.D.