This topic may seem only relevant to half the population (and only at a particular point in one’s life). However, what I will discuss is applicable to everyone. So don’t let the title steer you away, keep reading!

What is perimenopause? It is the time around when a female’s menstrual cycle starts to change and eventually cease (menopause). It can last months to years. Symptoms include: mood changes, hot flashes, vaginal dryness, headaches, joint and muscle aches, and more.  All of this occurs due to changes in hormones. Every human will experience hormonal fluctuations throughout a lifetime. Some more drastic than others. Examples include: menopause, pre-menstruation, post-partum, puberty, gender reassignment, and more. So, in other words, how do we manage symptoms associated with hormonal changes and fluctuations?

Maintain a Healthy Lifestyle

1. Nutrition
2. Movement- incorporate strength training
3. Sleep
4. Stress management
5. Limit alcohol and caffeine
6. Avoid tobacco products

Sounds familiar, right? Now, let’s talk vitamins, minerals, and supplementation during perimenopause specifically. Please note: I do not recommend herbals as they are not well regulated or studied, interact with other medications, and/or have serious adverse effects.

Vitamins/Minerals

1. Multivitamin- containing essential micronutrients. Particularly important in those acute phases where you may have higher requirements of certain nutrients which are difficult to attain even in a well-balanced diet.
2. Calcium- prevent bone loss. This is of greater interest when estrogen levels decrease. Multivitamins will not have the recommended amount (1200 mg daily). Warning: may cause constipation. Calcium citrate has been found to have less constipation than other products.

Foods that aid hormone regulation through appetite management, improved gut health, insulin and glucose control, reduced inflammation, and/or estrogen modulation.

1. Cruciferous vegetables
2. Avocado
3. Fish
4. Berries
5. Seeds/nuts/beans
6. Soy- There might be something here! Soy containing products (soy milk, edamame, tofu) are high in isoflavones, which is functionally similar to estrogen. However, it is best to avoid or discuss with your healthcare provider if you do have a history of hormone receptor positive cancer.

If (peri)menopausal symptoms are interfering with your day-to-day life you may discuss prescription medications with your doctor. Below are some common examples.

1. Hormone Replacement Therapy (HRT)- What once was mainstay treatment has fallen to the wayside due to potential serious side effects. Particularly with estrogen containing products, there is an increased risk of blood clots, stroke, heart attack, and certain cancers. When considering HRT you must also consider the risk vs benefit.
2. Brisdelle (paroxetine)- This is an SSRI (selective serotonin reuptake inhibitor), most often used to treat depression or anxiety, also approved for hot flashes in menopause. It is a smaller dosage than typically used in other conditions. There was modest benefit in clinical trials. A black box warning exists for SSRIs: increased risk for suicidal ideation.
3. Veozah (fezolinetant)- first neurokinin 3 (NK3) receptor antagonist approved to treat hot flashes. Clinical trials found a reduction in hot flashes by about 60% compared to 45% in the placebo group.

Takeaway:

• Hormone fluctuations and changes can cause a slew of unwanted symptoms.
• To help manage symptoms maintain a healthy lifestyle through nutrition, movement, rest, and avoiding or limiting triggers (i.e. alcohol, caffeine, tobacco).
• Evidence is limited to support herbal supplementation.
• It is important to attain those essential micronutrients through diet and/or supplements.
• There are foods that aid in hormone regulation which may provide some symptom relief.
• Additionally, there are few prescription medications, but risk vs benefit should be highly considered.

As always, please reach out with any questions or for further discussion.

Lindsey, PharmD, BCPS