Symptoms, Diagnosis and Treatment of Peri-menopause

There is reduction of ovarian mass as well as fertility after age of 35 years. Many changes occur during peri-menopause (time few years before menopause and after menopause) and most common being irregularity in menstruation (shortening of menstrual cycle is most common).

Symptoms of Peri-menopause:

These are symptoms that occur during preceding (peri-menopause precede menopause by 2-8 years) few years of menopause. The common symptoms include hot flashes, irregular menstrual bleeding, dryness of vagina, night sweat, disturbance of sleep etc. These symptoms are age related or due to ovarian dysfunction are not clear. Other perimenopausal symptoms include mood swings, depression, impaired memory or concentration, urinary incontinence, sexual dysfunction etc. and there is high individual variation of intensity, duration, frequency of these symptoms. But all these symptoms can affect quality of life in varying degree in different women.

Diagnosis of Peri-menopause:

Generally low FSH (follicular stimulating hormone, which stimulate ovarian follicles), especially during early follicular phase (days 2–5), during middle age is indicative of peri-menopause. But there is extreme individual variation and this can not be relied upon. Menstrual irregularity is the most common manifestation of peri-menopause and uterine disorders (such as leiomyomata or polyps or hyperplastic changes in uterus) should be ruled out before diagnosing peri-menopause. Transvaginal ultrasound, examination of endometrial aspiration can be done for this.

Treatment of Peri-menopause:

If there is heavy loss of blood during menstruation or there irregular menstrual bleeding, low dose combined oral contraceptive pills can be prescribed. Other alternatives include medroxyprogesterone or Progestin-only formulations, which are preferred for women who smoke or have cardiovascular risk factors, because combined oral contraceptive pills are contraindicated in liver disease, a history of thromboembolism disease, cardiovascular disease, breast cancer, unexplained vaginal bleeding and in women who smokes.

Non hormonal alternatives include use of NSAIDs (nonsteroidal anti-inflammatory drugs) such as mefenamic acid (initial dose of 500 mg at start of menstrual bleeding, then 250 mg four times a day for 2–3 days, to be continued in subsequent cycles) and endometrial ablation.

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