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Maturitas Jun 2024Abnormal uterine bleeding is a frequent symptom in the perimenopause. Causes are numerous, ranging from physiological reactions due to decreasing/unstable ovarian... (Review)
Review
Abnormal uterine bleeding is a frequent symptom in the perimenopause. Causes are numerous, ranging from physiological reactions due to decreasing/unstable ovarian function to premalignant and malignant conditions. Benign findings such as endometrial polyps and myomas increase with age, leading to more abnormal uterine bleeding in the perimenopause. Cervical and vaginal causes of abnormal uterine bleeding should be excluded by speculum examination. Sexually transmitted diseases or pregnancy should be ruled out. Measurement of haemoglobin and iron levels, human chorion gonadotropin and thyroid hormones are relevant in selected cases. Transvaginal ultrasound is an ideal first step for the evaluation of perimenopausal abnormal uterine bleeding. Saline or gel contrast sonohysterography improves the diagnostic accuracy. Based on the ultrasound findings, invasive procedures such as endometrial biopsy or hysteroscopy can be planned. Once premalignant and malignant causes are excluded, the necessity for treatment can be evaluated in collaboration with the patient. Heavy menstrual bleeding causing anaemia will need immediate treatment. In less severe cases and in intermenstrual bleeding, expectant management can be considered. Hormonal treatment, such as oral progestogens, combined oral contraceptives or insertion of the levonorgestrel intrauterine system, may be a possibility if anovulatory bleeding is interfering with quality of life. The amount of bleeding can be reduced both by antifibrinolytic and non-steroidal anti-inflammatory drugs, progestogens and the levonorgestrel intrauterine system. Focal intrauterine lesions such as endometrial polyps or submucous myomas may require operative hysteroscopic procedures. Endometrial ablation or endometrial resection are good choices in selected cases, but some women will need a hysterectomy to treat their abnormal uterine bleeding in perimenopause.
Topics: Humans; Female; Perimenopause; Uterine Hemorrhage
PubMed: 38412750
DOI: 10.1016/j.maturitas.2024.107944 -
Journal of Affective Disorders Apr 2019Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this... (Review)
Review
BACKGROUND
Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this phase. Perimenopausal depression is characterized by affective symptoms as well as menopause-specific somatic complaints. Currently, a variety of questionnaires are used to assess mood during the perimenopause. The aim of this review is to determine the instruments employed to assess perimenopausal depression.
METHODS
We searched the databases PubMed, Cochrane Library and PsycINFO for human studies investigating perimenopausal depression, and subsequently screened for the assessment instruments used to measure mood and menopause. A total of 37 articles were included.
RESULTS
Altogether, 14 different instruments were applied to assess mood during menopause. The CES-D was by far the most frequently used depression scale, appearing in 16 out of the 37 studies. The methods used to identify perimenopausal status and symptoms were inconsistent.
LIMITATIONS
Due to lacking information about data and methodology, a selection bias is conceivable. Additionally, a publication bias is possible. Finally, there is inevitable subjectivity in the screening process of a systematic search.
CONCLUSIONS
The assessment of depression in the menopausal transition is highly heterogeneous, reducing the overall comparability of study results. Furthermore, menopausal complaints are not sufficiently taken into account. Accordingly, the use of a menopause-specific depression scale is highly recommended in order to account for physical and mood-related symptoms in the menopausal transition.
Topics: Depression; Depressive Disorder, Major; Female; Hot Flashes; Humans; Mass Screening; Middle Aged; Perimenopause; Prevalence; Psychiatric Status Rating Scales; Quality of Life; Risk Factors; Surveys and Questionnaires
PubMed: 30776662
DOI: 10.1016/j.jad.2019.02.029 -
Maturitas Aug 2014Perimenopause and migraine are closely linked. The hormonal instability during the perimenopausal period not only causes vasomotor symptoms and mood disturbances, but... (Review)
Review
Perimenopause and migraine are closely linked. The hormonal instability during the perimenopausal period not only causes vasomotor symptoms and mood disturbances, but also increases migraine incidence. Women do report new onset migraine during this period, but the increased incidence is reported by women with menstrually related migraine (MRM). The hormonal fluctuations can be stabilized with hormone replacement therapy (HRT), while simultaneously improving the migraine in some patients. The increased stroke risk in women with migraine with aura (MA) should be taken into consideration when intending to treat perimenopausal women with migraine with HRT.
Topics: Estrogen Replacement Therapy; Hormones; Humans; Menstruation; Migraine Disorders; Perimenopause; Stroke
PubMed: 24954701
DOI: 10.1016/j.maturitas.2014.05.018 -
Maturitas Jan 2020The menopausal transition is a critical phase for psychological disorders such as depression and anxiety, with prevalence rates of depression ranging up to 20% during... (Review)
Review
The menopausal transition is a critical phase for psychological disorders such as depression and anxiety, with prevalence rates of depression ranging up to 20% during the menopause. Nevertheless, the majority of women cope adequately with this reproductive transition phase and thus appear to be resilient. We assert that a variety of psychological factors influence the menopausal transition and result in an individual state on a continuum from successful adjustment to maladjustment. The purpose of this review is to offer a conceptual framework of resilience factors during the menopausal transition and to reveal which dimensions of resilience have already been verified for a healthy menopausal transition. We searched the databases PubMed and PsycINFO for studies investigating resilience factors during the menopausal transition which influence psychological and physical adjustment or maladjustment. A total of 23 articles were included. Altogether, we identified 15 different resilience factors, assessed with 23 different questionnaires. These factors can be grouped into six categories: core resilience, spirituality, control, optimism, emotion and self-related resilience. They are associated with a better adjustment to menopausal symptoms, milder physical symptoms, a better quality of and satisfaction with life, better well-being, less perceived stress and fewer depressive symptoms compared with women with lower levels of the respective resilience factors. Our conceptual framework includes resilience factors which have already been verified by empirical data. Further research is needed to determine whether these resilience factors can be assigned to a common factor and to incorporate biological resilience markers.
Topics: Adaptation, Psychological; Adult; Anxiety; Cross-Sectional Studies; Depression; Female; Humans; Longitudinal Studies; Menopause; Middle Aged; Perimenopause; Prevalence; Resilience, Psychological; Surveys and Questionnaires
PubMed: 31787147
DOI: 10.1016/j.maturitas.2019.10.015 -
Climacteric : the Journal of the... Feb 2019The perimenopause is accompanied by important biological and psychosocial changes. The choice of contraceptive methods for women in the perimenopause, none of which is... (Review)
Review
The perimenopause is accompanied by important biological and psychosocial changes. The choice of contraceptive methods for women in the perimenopause, none of which is limited by age alone, will depend on the efficacy, safety, tolerability, and potential benefit of each method in relation to the biopsychosocial profile of the individual woman. Copper intrauterine devices are highly effective in the typical user and are a very safe method with, in general, good tolerability but are of limited use in women with heavy menstrual bleeding and subserous myomata. An additional benefit of copper intrauterine devices is protection against endometrial cancer. All progestogen-based methods share a favorable cardiovascular profile, making their use safe in most perimenopausal women. Long-acting implants and intrauterine systems are user independent and highly effective. Injectables and pills depend on user compliance. There is no evidence of a significant impact on breast cancer. Their impact on the endometrium can be either a negative side-effect (irregularity) or a benefit regarding reduction of heavy menstrual bleeding. Combined hormonal contraceptives have the highest cardiovascular risk. They can act as a promoting factor for breast cancer and cervical cancer, but they have the strongest potential regarding benefits (protection against endometrial and ovarian cancer, positive effect on bone mineral density, menstrual complaints, hyperandrogenic symptoms, hot flushes, and reduced risk regarding benign ovarian cysts and benign breast tumors).
Topics: Contraception; Contraceptive Agents, Female; Counseling; Female; Humans; Intrauterine Devices, Medicated; Perimenopause; Pregnancy; Women's Health
PubMed: 30562124
DOI: 10.1080/13697137.2018.1540566 -
International Journal of Sports Medicine Jun 2023Midlife women experience changes in cardiometabolic, physical, and psychosocial health during menopause that negatively impacts their overall quality of life. Factors... (Review)
Review
Midlife women experience changes in cardiometabolic, physical, and psychosocial health during menopause that negatively impacts their overall quality of life. Factors that contribute to these increases in cardiometabolic risk include weight gain as well as increases in fat mass (particularly abdominal adiposity), insulin resistance, and vascular dysfunction. Other deleterious changes in physical health (e. g. reduced sleep health, bone density, and balance) as well as changes in psychosocial health (e. g. mood, anxiety, and depression) often coincide and are linked to these increases in cardiometabolic risk. Physical activity and exercise are important lifestyle components that have been demonstrated to improve cardiometabolic, physical, and psychosocial health, yet physical activity and exercise is known to decline during perimenopause and into the postmenopausal years. In this narrative review, we summarize these changes in overall health during menopause as well as how declining physical activity contributes to these changes. Additionally, we discuss how incorporating physical activity and exercise during menopause can potentially ameliorate health declines. We conclude that there exists a significant, positive impact of physical activity on cardiometabolic, physical, and psychological health among midlife women, particularly if undertaken during the perimenopausal and postmenopausal years.
Topics: Female; Humans; Quality of Life; Menopause; Perimenopause; Exercise; Cardiovascular Diseases
PubMed: 36807278
DOI: 10.1055/a-2003-9406 -
CMAJ : Canadian Medical Association... Jul 2023
Topics: Female; Humans; Perimenopause
PubMed: 37524397
DOI: 10.1503/cmaj.148952-l -
Gynecological Endocrinology : the... Mar 2021Perimenopause represents a transition period of a woman's life during which physiological, affective, psychological, and social changes mark progression from a woman's... (Review)
Review
Perimenopause represents a transition period of a woman's life during which physiological, affective, psychological, and social changes mark progression from a woman's fertile life to menopause, with wide sexual hormones fluctuations until the onset of hypergonadotropic hypogonadic amenorrhea. Contraception during menopause should not only avoid unwanted pregnancies, but also improve quality of life and prevent wide range of condition affecting this population. Hormonal contraceptives confer many noncontraceptive benefits for women approaching menopause: treatment of abnormal uterine bleeding, relief from vasomotor symptoms, endometrial protection in women using estrogen therapy, musculoskeletal protection, and mood disorders protection. The main point remains selecting the most adequate contraceptive option for each woman, considering her risk factor, comorbidities, and keeping in mind the possibility of continuing contraception until reaching menopause and even further, creating a bridge between perimenopause and menopause hormonal therapy. Correct perimenopause management should rely on individualized medical therapy and multidisciplinary approach considering lifestyle and food habits as part of general good health of a woman.
Topics: Adult; Autonomic Nervous System Diseases; Contraception; Female; Hormone Replacement Therapy; Humans; Middle Aged; Perimenopause; Pregnancy; Risk Assessment
PubMed: 33263443
DOI: 10.1080/09513590.2020.1852544 -
Pharmacotherapy Feb 2022Hormonal contraceptives have been used in perimenopausal women to manage a variety of symptoms and prevent unintended pregnancy. However, it is unclear what... (Review)
Review
Hormonal contraceptives have been used in perimenopausal women to manage a variety of symptoms and prevent unintended pregnancy. However, it is unclear what contraceptive regimen is best for these women. To evaluate hormonal contraceptive methods in women experiencing perimenopause using two prespecified outcomes: perimenopausal symptom management and long-term effects. A literature search of PubMed and EMBASE databases was performed (January 1990 to October 2021) using search terms "perimenopause" and "contraception." Relevant full-text articles in English were included. Fifteen clinical articles were reviewed: Fourteen were internationally based, and one study was conducted in the United States. Nine articles evaluated symptom resolution, and six of these nine reported statistically significant changes in favor of treating perimenopausal women with hormonal contraceptives compared with no treatment. Seven studies evaluated long-term outcomes including bone loss and metabolic parameters, and six of these seven showed statistically significant improvements with hormonal contraceptives. Based on limited data and a lack of comparative studies, the use of a levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen has positive results for the management of disruptive perimenopausal symptoms and long-term outcomes. Hormonal contraception in perimenopausal women improves symptom management and long-term outcomes if patients do not have contraindications. When selecting a contraceptive for women in perimenopause, clinicians and pharmacists need to address specific patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences.
Topics: Contraception; Contraceptive Agents; Female; Humans; Menopause; Perimenopause; Pregnancy; Risk Factors
PubMed: 34967466
DOI: 10.1002/phar.2657 -
Menopause (New York, N.Y.) Dec 2017
Topics: Adolescent; Depression; Estradiol; Female; Humans; Menopause; Middle Aged; Perimenopause; Postmenopause
PubMed: 29040218
DOI: 10.1097/GME.0000000000001016