Hormonal Options for Perimenopause

Perimenopause is a clinically heterogeneous stage of reproductive aging with unique physiology distinct from menopause. It is variably defined, lacks specific guidelines or practice recommendations, and can be challenging for clinicians to manage. Patients may present with myriad symptoms, including mood and cognitive changes, abnormal uterine bleeding, sleep disruption, and vasomotor symptoms, as well as sexual concerns. Managing such complaints while taking into consideration contraceptive needs and evolving cardiometabolic risk can be nuanced. Hormonal contraceptives are commonly prescribed for the management of perimenopause symptoms, but they are not universally adequate or preferred. This clinical perspective provides a practical toolkit for clinicians, outlining the role of hormonal contraceptives for perimenopause care, alternative hormonal strategies, and options for individualizing treatment through shared decision making.