The “Change” Doesn’t Have to Be the End

Perimenopause symptoms, treatments reviewed

/ Author:  / Reviewed by: Beth Bolt, RPh

(RxWiki News) Women often dread menopause, recounting the hot flashes and mood swings of their mothers. A new review offers some insight into what it really means to go through the "change of life."

This review examined what it’s like for women to go through perimenopause (the transition into menopause) by looking at perimenopausal symptoms, how those symptoms interact with eachother and the current treatments available.

Author Nanette Santoro, MD, of the University of Colorado School of Medicine, explained that the four main symptoms of perimenopause are hot flashes, poor sleep, depression and vaginal dryness. These symptoms can significantly affect quality of life and drive about 90 percent of women to seek a doctor's advice, Dr. Santoro said.

According to the review, hot flashes are almost universal among women in menopause but also affect between 30 and 70 percent of pre-menopausal women. They are more common among African American and Native American women, as well as women with higher BMIs.

While it is not unusual for hot flashes to last up to 10 years, they diminish over time. Hot flashes affect an estimated 20 percent of women in their late 50s, 10 percent of women in their 60s and 5 percent of women in their 70s, according to Dr. Santoro. Women with hot flashes are also at a higher risk for heart disease.

Many women in their 40s begin to experience sleep pattern changes that worsen as they enter menopause. Older women report insomnia more than other groups, according to the review, although it's unknown whether menopause, estrogen withdrawal or aging is behind this. Historically, women with more severe hot flashes tend to report more insomnia.

Vaginal symptoms, including dryness, irritation and dysuria (painful or difficult urination) are common among women in menopause, according to Dr. Santoro. These conditions are commonly attributed to consistently low levels of estrogen. While perimenopausal women do not have consistently low levels of estrogen, they often experience vaginal symptoms.

Hispanic women are more likely to experience vaginal symptoms than non-Hispanic, white women. Unlike hot flashes, vaginal symptoms and sleep problems rarely improve over time without treatment.

Dr. Santoro explained that mood swings, depression and anxiety can also be symptoms of perimenopause. Depressive symptoms are more common among perimenopausal women, whereas major depression and anxiety are more common in late menopause.

For most women experiencing typical pre-menopausal symptoms, hormone therapy is an effective treatment. For women who cannot take hormones, for whatever reason, there are a variety of other medications available.

When symptoms are intertwined, Dr. Santoro said that it's best to treat patients with as few medications as possible. For instance, women with both hot flashes and depression can be treated with hormone therapy alone as long as their depression is mild.

"The menopausal transition is a challenging period of life for many women, yet these are women who are in the prime of their careers and are often caught in the sandwich generation situation, in which they are caring for both children and parents," Dr. Santoro wrote.

She concludes that it is critical to understand how perimenopause fits into all women’s lives and to address any symptoms that may lesson quality of life.

This review was published Feb. 17 in the Journal of Women's Health.

Dr. Santoro drew on the findings of several studies, including the Melbourne Healthy Women’s Study, the Study of Women’s Health Across the Nation and the Penn Ovarian Aging Study.

No conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
February 20, 2016
Last Updated:
February 24, 2016