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Optimal treatment of perimenopausal symptoms minimizes systemic hormone levels while also providing effective contraception. In a manufacturer-funded pilot study to assess the efficacy of transdermal estradiol plus a levonorgestrel-releasing intrauterine device (LNG-IUD) for managing symptoms including hot flashes, sleep quality, daytime fatigue, and depression, investigators enrolled 38 women (mean age, 43; mean body-mass index, 25 kg/m2) with regular menstrual cycles. All participants received LNG-IUDs (20 µg LNG released daily) and were randomized 90 days later to treatment with low-dose estradiol gel (0.75 mg daily) or placebo gel.
Estradiol treatment, but not placebo, significantly reduced hot flashes in the subset of women with this sy…