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Perimenopausal Symptoms
Diagnosis/Definition
- Symptoms occurring prior to or concurrent with menopause that include hot flashes, vaginal dryness, and/or irregular menses occurring in women in the later reproductive years.
- Menopause is defined as cessation of menstrual bleeding caused by ovarian failure in the face of adequate gonadotropin (FSH).
Initial Diagnosis and Management
- Diagnosis should be based on patient’s complaint of symptoms of hot flashes, vaginal dryness, urinary incontinence, and/or irregular/absent menses.
- Management: TSH to rule out thyroid disease. FSH to document menopause.
- Endometrial sampling to rule out malignancy in women with irregular bleeding (will be done in GYN clinic for those not experienced at performing this procedure).
- Current Pap smear.
Ongoing Management and Objectives
- Daily hormone replacement therapy (if no contraindication) to relieve symptoms if FSH levels are menopausal.
- OCP’s if FSH levels are not menopausal (as perimenopausal symptoms can last up to 8 years).
Indications for Specialty Care Referral
Patient request.
Patients with persistent irregular bleeding.
Patients with endometrial hyperplasia or malignancy on sampling.
Persistent symptoms despite estrogen therapy.
Criteria for Return to Primary Care
Completion of specialty care evaluation or resolution of symptoms.
Periodic follow-up in OB/GYN may be required.
