Progesterone Therapy for Symptomatic Perimenopause

Learning Objectives: 1. Perimenopause, although characterized as a time of dropping estradiol, involves chaotic estrogen levels that average >20% higher and intermittently are extremely high and ovulatory disturbances with decreasing progesterone levels. 2. Perimenopause begins and is most symptomatic when cycles remain regular. 3. Perimenopause is highly symptomatic for more than 20% of women— symptoms typically include heavy menstrual flow, night sweats, infertility, breast tenderness and sleep disturbances. 4. Progesterone, because it normally counterbalances estradiol’s actions, is effective treatment for heavy flow, probably for night sweats, infertility and breast tenderness and definitely decreases anxiety and improves sleep.