Approach to the Perimenopausal Patient
Other effects
A meta-analysis67 of trials of HRT for urinary incontinence showed no benefit. The HERS study68 showed an increase in urinary incontinence episodes with combined HRT for women with incontinence at baseline (NNH = 8). HRT also increases the risk of gallbladder disease69 and may worsen cognitive function for women with mild to moderate dementia.70
Prognosis
The symptoms of perimenopause are not life threatening and are usually limited in time. Climacteric symptoms are generally more severe and difficult to treat in women who have undergone bilateral oophorectomy before experiencing natural menopause.71 Women with multiple chronic medical conditions,13,72,73 psychiatric illnesses,15,74 or a history of premenstrual syndrome11,12,75 are also likely to experience more difficulty with symptoms attributed to the menopausal transition. Table 3 provides a list of resources for patient education regarding menopause.
TABLE 3
RESOURCES FOR PATIENT EDUCATION ABOUT MENOPAUSE
| Organization | Contact Information | Description |
|---|---|---|
| Ottawa Health Decision Centre | ldrake@civich.Ottawa.on.ca 613-798-5555 | Making Choices: Hormones After Menopause (audiotape and workbook) |
| American Academy of Family Physicians | www.aafp.org 1-800-274-2237 | Brochures: “Menopause: What to Expect When Your Body Is Changing”; “Osteoporosis: Keeping Your Bones Healthy and Strong” |
| American College of Obstetricians and Gynecologists | www.acog.org 1-800-410-ACOG | Brochures: “Midlife Transitions: A Guide to the Menopause Years”; “Hormone Replacement Therapy” |
