Depression and either worsening or new PMS symptoms are common reasons for physician visits, as are poor concentration and forgetfulness. Sexual difficulties including loss of libido, changes in arousal and orgasm capability, as well as changes in lubrication and the occurrence of dyspareunia. Management of the perimenopausal patient begins with an increased level of awareness and index of suspicion on the part of the physician. Patients should be counseled about lifestyle changes, including dietary change to offset slowing metabolism, the need for increased calcium, and adequate water intake. Exercise should be strongly encouraged, including both aerobic activity and strength training to preserve muscle mass.
Smoking cessation is extremely important.
Many patients are interested in using, or are already using herbal therapies to control perimenopausal and menopausal symptoms. These therapies may interact with other therapies or cause problems on their own. Cyclic or continuous combined HRT that is currently available should not be used during perimenopause. The current levels of hormone in HRT are not suppressive to the ovary, and allowing the ovary to continue functioning erratically can further complicate the bleeding patterns associated with both HRT and perimenopause together. Estrogen augmentation can, however, be used alone during times of estrogen depletion or withdrawal symptoms.