Perimenopause is a natural stage of life. It is not a disease or a disorder. Therefore, it does not automatically require any kind of medical treatment. However, in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the life of the woman experiencing them, palliative medical therapy may sometimes be appropriate. Hormone replacement therapy In the context of the<unk> , hormone replacement therapy (HRT) is the use of estrogen in women without a uterus and estrogen plus progestin in women who have an intact uterus. HRT may be reasonable for the treatment of<unk> l symptoms, such as hot flashes. It is the most effective treatment option, especially when delivered as a skin patch. Its use, however, appears to increase the risk of strokes and blood clots. When used for<unk> l symptoms some recommend it be used for the shortest time possible and at the lowest dose possible. Evidence to support long-term use, however, is poor. It also appears effective for preventing bone loss and osteoporotic fracture, but it is generally recommended only for women at significant risk for whom other therapies are unsuitable. HRT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer. There is some concern that this treatment increases the risk of breast cancer. Adding testosterone to hormone therapy has a positive effect on sexual function in postmenopausal women, although it may be accompanied by hair growth, acne and a reduction in high-density lipoprotein (HDL) cholesterol. These side effects diverge depending on the doses and methods of using testosterone. Selective estrogen receptor modulators SERMs are a category of drugs, either synthetically produced or derived from a botanical source, that act selectively as agonists or antagonists on the estrogen receptors throughout the body. The most commonly prescribed SERMs are raloxifene and tamoxifen. Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium. Tamoxifen is in widespread use for treatment of hormone sensitive breast cancer. Raloxifene prevents vertebral fractures in postmenopausal, osteoporotic women and reduces the risk of invasive breast cancer. Other medications Some of the SSRIs and SNRIs appear to provide some relief from vasomotor symptoms. Low dose paroxetine is the only non-hormonal medication that was FDA-approved to treat moderate-to-severe vasomotor symptoms associated with<unk>  as of 2016. They may, however, be associated with appetite and sleeping problems, constipation and nausea. Gabapentin or clonidine may help but do not work as well as hormone therapy. Gabapentin can decrease the amount of hot flashes. Side effects associated with its use include drowsiness and headaches. Clonidine is used to improve vasomotor symptoms and may be associated with constipation, dizziness, nausea and sleeping problems. Therapy One review found mindfulness and cognitive behavioural therapy decreases the amount women are affected by hot flushes. Another review found not enough evidence to make a conclusion. A 2018 study found that 85% of study participants reported reduced hot flashes and night sweats when using a climate control system in their beds. Exercise Exercise has been thought to reduce postmenopausal symptoms through the increase of endorphin levels, which decrease as estrogen production decreases. Additionally, high BMI is a risk factor for vasomotor symptoms in particular. However, there is insufficient evidence to support the benefits of weight loss for symptom management. There are mixed perspectives on the benefits of physical exercise. While one review found that there was a lack of quality evidence supporting a benefit of exercise, another review recommended regular healthy exercise to reduce comorbidities, improve mood and anxiety symptoms, enhance cognition, and decrease the risk of fractures. Yoga may help with postmenopausal symptoms similar to other exercise. There is insufficient evidence to suggest that relaxation techniques reduce<unk> l symptoms. Alternative medicine There is no evidence of consistent benefit of alternative therapies for<unk> l symptoms despite their popularity. The effect of soy isoflavones on<unk> l symptoms is promising for reduction of hot flashes and vaginal dryness. Evidence does not support a benefit from phytoestrogens such as coumestrol, femarelle, or the non-phytoestrogen black cohosh. As of 2011 there is no support for herbal or dietary supplements in the prevention or treatment of the mental changes that occur around<unk> . Hypnosis may reduce the severity of hot flashes. In addition, relaxation training with at-home relaxation audiotapes such as deep breathing, paced respiration, and guided imagery may have positive effects on relaxing muscles and reducing stress. There is no evidence to support the efficacy of acupuncture as a management for<unk> l symptoms. A 2016 Cochrane review found not enough evidence to show a difference between Chinese herbal medicine and placebo for the vasomotor symptoms. Other efforts *Lack of lubrication is a common problem during and after perimenopause. Vaginal moisturizers can help women with overall dryness, and lubricants can help with lubrication difficulties that may be present during intercourse. It is worth pointing out that moisturizers and lubricants are different products for different issues: some women complain that their genitalia are uncomfortably dry all the time, and they may do better with moisturizers. Those who need only lubricants do well using them only during intercourse. *Low-dose prescription vaginal estrogen products such as estrogen creams are generally a safe way to use estrogen topically, to help vaginal thinning and dryness problems (see vaginal atrophy) while only minimally increasing the levels of estrogen in the bloodstream. *In terms of managing hot flashes, lifestyle measures such as drinking cold liquids, staying in cool rooms, using fans, removing excess clothing, and avoiding hot flash triggers such as hot drinks, spicy foods, etc., may partially supplement (or even obviate) the use of medications for some women. *Individual counseling or support groups can sometimes be helpful to handle sad, depressed, anxious or confused feelings women may be having as they pass through what can be for some a very challenging transition time. *Osteoporosis can be minimized by smoking cessation, adequate vitamin D intake and regular weight-bearing exercise. The bisphosphonate drug alendronate may decrease the risk of a fracture, in women that have both bone loss and a previous fracture and less so for those with just osteoporosis. *A surgical procedure where a part of one of the ovaries is removed earlier in life and frozen and then over time thawed and returned to the body has been tried. While at least 11 women have undergone the procedure and paid over £6,000, there is no evidence it is safe or effective.
Menopause
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Adrenopause
Menstruation
Premenstrual syndrome
Lactational amenorrhea
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