Women's Health: Perimenopause: Myths and Management

Join Dr. Joy Bulgar Beck, MD, MS, FACP, Associate Professor of Medicine at the University of Arizona and our host, Dr. Sharon Hung, MD, FACP, Clinical Assistant Professor at Stanford University to explore the often-misunderstood topic of perimenopause—a transitional phase leading up to menopause marked by fluctuating hormone levels and a variety of symptoms. The conversation addresses prevalent myths, such as the misconception that menstrual irregularities are necessary for diagnosing perimenopause and the belief that hormone level testing is beneficial during this stage. The discussion outlines the expected changes in menstrual cycles during perimenopause and discusses when it is appropriate to evaluate abnormal uterine bleeding. Learners will gain insights into a range of symptoms, including vasomotor, genitourinary, and sexual changes, as well as cognitive fluctuations and mood disturbances. Additionally, we’ll cover various treatment options, from combined oral contraceptives and vaginal estrogens to menopausal hormone therapy, equipping healthcare providers with the knowledge to better support their patients during this significant life transition.

1. Define perimenopause and discuss its common symptoms
2. Review treatment options available for managing perimenopausal symptoms

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
 
Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

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Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography
1. Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405–420. doi:10.1001/jama.2022.24140

2. Duralde ER, Sobel TH, Manson JE. Management of perimenopausal and menopausal symptoms. BMJ. 2023 Aug 8;382:e072612. doi: 10.1136/bmj-2022-072612. Erratum in: BMJ. 2023 Aug 29;382:p1977. doi: 10.1136/bmj.p1977. Erratum in: BMJ. 2023 Nov 13;383:p2636. doi: 10.1136/bmj.p2636.

3. Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN; Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018 Oct;25(10):1069-1085. doi: 10.1097/GME.0000000000001174.

4. Nelson SM, Davis SR, Kalantaridou S, Lumsden MA, Panay N, Anderson RA. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Hum Reprod Update. 2023 May 2;29(3):327-346. doi: 10.1093/humupd/dmac045.

5. Stute P, Walker LJ, Eicher A, Pavicic E, Kolokythas A, Theis S, von Gernler M, von Wolff M, Vollrath S. Progestogens for endometrial protection in combined menopausal hormone therapy: A systematic review. Best Pract Res Clin Endocrinol Metab. 2024 Jan;38(1):101815. doi: 10.1016/j.beem.2023.101815. Epub 2023 Aug 22.

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     Name: Emily Manche
     Title: Compliance Coordinator
     Email: [email protected]

For CME general questions, please contact 
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Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity. 

Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Sharon Hung, MD
Director of Women’s Health
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Stanford Health Care

Course Director

Nothing to disclose

Joy E Bulger Beck , MD, MS
Clinical Assistant Professor
Banner University of Arizona Tucson

Faculty

Nothing to disclose