Clinical challenges of perimenopause: consensus opinion of The North American Menopause Society.

OBJECTIVE: Perimenopause refers to the time period around menopause. The clinical goal of peri-menopause therapy is to optimize the woman's health during and after this transitional period. However, clinical trial data are insufficient to establish evidence-based treatment standards regarding the diagnosis and treatment for both acute and chronic symptoms and conditions of perimenopausal women. Accordingly, The North American Menopause Society (NAMS) sought to develop a consensus opinion on clinical approaches to perimenopause.

DESIGN: NAMS held a closed conference of experts in the field to review the current literature, share clinical experience, and make recommendations about how to help women achieve optimal health throughout perimenopause. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion of the Society.

RESULTS: On the basis of the conference proceedings, NAMS established the following recommendations for the treatment of perimenopausal women: (1) The annual health examination is valuable in the perimenopausal woman and should include comprehensive screening for physical and psychological problems as well as for appropriate lifestyle counseling. (2) Sufficient clinical data exist to provide recommendations for developing management plans for acute perimenopausal symptoms, as well as counseling for potential chronic diseases related to postmenopause. (3) The importance of individualized screening and management approaches for each woman is evident, as is the need for including the woman in the management decision-making process. (4) Because clinical research data on women in perimenopause are limited, healthcare providers may consider extrapolating data on postmenopausal women, as well as relying on clinical experience when considering management options. (5) Management of perimenopausal symptoms may include doing nothing (many symptoms may be self-limiting) or recommending a combination of treatments.

CONCLUSIONS: Although perimenopause is largely unstudied, many therapeutic approaches to the management of perimenopause disturbances exist, both prescription and nonprescription. NAMS established these consensus opinions to be a resource for clinicians when designing a healthcare plan for a perimenopausal woman. The perimenopausal woman's health and quality of life can be maintained and improved through preventive care, lifestyle modifications, early diagnosis of disease or increased risk for disease, and interventions when appropriate. However, more research is needed in all areas concerning perimenopausal women.