Section VI. Special Populations - Perimenopausal

Question 1

How do you define the perimenopausal period?

Answer 1

• transition to menopause
• beginning of ovarian failure
• when menstrual cycle becomes 7 days longer or shorter than usual

Question 2

What are the 1st line recommendation for Treatment of perimenopausal depression?

Answer 2

Desvenlafaxine (level 1)
CBT (level 2)

Question 3

What are the 2nd line recommendation for Treatment of perimenopausal depression?

Answer 3

Transdermal estradiol (level 2)

Citalopram, duloxetine, escitalopram, mirtazepine, quetiapine XR, Venlafaxine XR (level 3)

Omega 3, Fluoxetine, Nortripyline, Paroxetine, Sertraline (level 4)

Question 4

What are the 3rd line recommendation for Treatment of perimenopausal depression?

Answer 4

Mindful-based CBT, supportive psychotherapy

Question 5

What are the contraindications for oral or transdermal estrogen-based therapies [7]?

Answer 5

• Known, suspected, or history of breast cancer
• Known or suspected history of other estrogen-based cancer, i.e., uterine cancer. Women who have had a hysterectomy and have no remaining evidence of disease are still candidates for HRT
• Active deep venous thrombosis (DVT) or a history of DVT or pulmonary embolism (PE)
• History of blood clotting disorder, the most common being Factor V Leiden mutation carriers
• Active or history of arterial thrombotic diseases such as myocardial infarction or stroke
• Chronic liver disease or dysfunction
• Migraine with aura