Menopausal transition: ambiguous definitions, diagnostic markers, and treatment strategies

Premenopause (or menopausal transition preceding menopause) is characterized by gradual depletion of ovarian follicular reserve, altered response to gonadotropin hormones, significant fluctuations of hormone levels, and irregular menstruation. Typically, a clinician is faced with a number of issues and difficulties regarding diagnosis and therapy in such patients Aim: to discuss primary pathophysiological processes associated with the menopausal transition, as well as a place of non-hormonal treatment of comorbidities at this stage. A systematic search for guidelines, approaches, and consensus statements regarding premenopause, perimenopause, or menopausal transition published after 2014 was conducted. To identify information gaps, an additional search for randomized studies was performed in the peer-reviewed literature. The review highlights several algorithms to facilitate clinical evaluation and treatment in premenopausal women. The paper discusses reasons for seeking medical help; necessary information to be collected; issues that may affect joint decision-making, and algorithms to determine menopause status, as well as to prescribe hormonal / alternative therapy during perimenopause. Non-hormonal treatment options to mitigate symptoms of menopausal transition have been identified KEYWORDS: menopause, menopausal transition, perimenopause, premenopause, hormones, epidemiology, vasomotor symptoms (VMS), menopausal hormone therapy, alternative therapy, phytotherapy, phytoestrogens, Vitex agnus-castus (VAC), Cimicifuga racemosa (CR). FOR CITATION: Leshchenko O.Ya. Menopausal transition: ambiguous definitions, diagnostic markers, and treatment strategies. Russian Journal of Woman and Child Health. 2025;8(2):106–113 (in Russ.). DOI: 10.32364/2618-8430-2025-8-2-3