2026 Urogynecology for the Advanced Practice Provider-Harmonizing the Cacophony of Perimenopause: A Case-Based Approach

Video Transcription

Video Summary

The lecture covered how to evaluate and manage common hormonal symptoms in perimenopause, PCOS, POI, FHA, and PMDD. The speaker emphasized that these conditions often overlap and that hormone responses are highly individual, so counseling and expectation-setting are essential.<br /><br />Key points included:<br />- In women under 40 with hypoestrogenic symptoms, always rule out primary ovarian insufficiency (POI), since untreated POI has major long-term risks.<br />- PCOS is diagnosed by exclusion and can present with irregular cycles, androgenic symptoms, and insulin resistance; metabolic screening is important.<br />- Functional hypothalamic amenorrhea (FHA) is also a diagnosis of exclusion and is linked to physical or emotional stress, not just restrictive eating.<br />- Perimenopause can cause a wide range of symptoms, and PMDD may worsen during this transition due to abnormal hormone sensitivity.<br /><br />Treatment discussions focused on:<br />- Estrogen/progesterone strategies for bleeding control, sleep, mood, and vasomotor symptoms.<br />- Ovulation suppression with oral contraceptives or higher-dose progesterone when appropriate.<br />- Metformin and lifestyle changes for insulin resistance.<br />- Vaginal estrogen for dyspareunia and localized symptoms.<br />- Testosterone only for carefully selected patients with sexual dysfunction, since evidence for other benefits is limited.<br /><br />Overall, the message was to treat the patient, not just the lab values, and to be flexible as symptoms and hormone needs change over time.

Asset Subtitle

At the end of this lecture, learners will be able to

Identify common symptoms of perimenopause.
Determine appropriateness of labs and how to interpret them.
Understand how hormones play a role in symptoms of perimenopause.
Understand rationale for different treatment approaches.
“troubleshoot” patient symptoms after treatment.

Speaker: Carissa Aboubakare, MSN, WHNP, MSCP

Keywords

perimenopause

PCOS

primary ovarian insufficiency

functional hypothalamic amenorrhea

PMDD

hormonal symptoms

estrogen therapy

metformin