Interventions for amenorrhea: counseling and education- when caused by hypothalamic disturbances, stress, weight loss, strenuous exercise, etc. Includes: dysmenorrhea, premenstrual syndrome (pms), & premenstrual dysphoric. Irritability, dysphoria, anxiety, depression, fatigue, appetite changes, difficulty concentrating: management of pms and pmdd, education, diet and exercise- inc. whole grains, fruits, veggies, 60 mins. Exercise daily limit sugar, salt, red meats, alcohol, caffeine: no smoking, medication, diuretics, nsaids, progesterone, vit b6, vit. Leuprolide, nafarelin, goserelin: use of heat to ease pain, support groups for low self-esteem, oligomenorrhea = infrequent period, hypomenorrhea = small amount of bleeding at normal intervals, menorrhagia = excessive bleeding, metrorrhagia = bleeding occurs between periods. Be sure to provide self-care and emotional support for these women. Major health risks of perimenopausal women: osteoporosis, decreased bone mass >> increased risk of bone fractures, estrogen stimulates bone formation; when estrogen decreases, bones deteriorate faster than new bone is formed.