An independent panel convened last week by the National Institutes of Health found that many women move through the menopausal transition with few disabling symptoms, and that it is important that menopause not be viewed as a disease. The tendency among women and their healthcare providers in the US to medicalize menopause concerned the panel because the tendency can lead to overuse of treatment approaches that are known to carry serious risks, or whose safety is as yet unclear.
However, many women, particularly those with surgically induced menopause, do experience significant symptoms that greatly diminish quality of life.
For women whose menopausal symptoms are severe and persistent, the panel found nothing as effective as estrogen therapy for alleviating those symptoms. Low-dose estrogen has been shown to be effective for many women, although some require larger doses to relieve hot flashes. Concerns about the risks associated with estrogen use may rule out this treatment option for some groups of women. The panel cautioned women to carefully weigh their personal risks and potential benefits before starting treatment, noting that for some women whose symptoms create a serious burden on daily life, the benefits of symptom relief may outweigh the risks. In addition to learning more about safe use of hormones, the panel urged further research into non-hormonal treatment approaches.
"One of the challenges in this area of research is teasing out which symptoms are associated with menopause and which are simply the result of aging," noted the panel chair, Dr Carol Mangione, Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles. "We found very few symptoms that are tied to the natural fluctuations in hormone levels during menopause, and this distinction may have serious implications for women's treatment decisions." Hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence for a menopausal link to sleep disturbance. But the evidence of a link between menopause and mood symptoms, cognitive disturbance, and urinary incontinence is weak. This would suggest that treating these symptoms with hormones may be inappropriate.
Although there is increasing interest in bioidentical or "natural" hormones for treating menopausal symptoms, the panel found scant data on the benefits and adverse effects of these compounds.
The panel also found that overall, there have been very few well-designed studies to evaluate the safety and effectiveness of complementary and alternative approaches to menopausal symptom management, including behavioural interventions. While many studies have been published, most have important limitations that make their findings unclear. The evidence on most botanical products used or advocated for treating menopausal symptoms is weak or inconsistent. There are major methodological problems associated with products that are not standardized.
The panel released its findings in a public session, following two days of expert presentations, open public discussions, and panel deliberations. The archived webcast of the conference sessions will be available shortly at http://consensus.nih.gov/ . The full text of the panel's draft statement will be available at http://consensus.nih.gov . The final version will be available at the same web address in approximately four weeks.
The 12 members of this State-of-the-Science panel were selected for their expertise in several fields related to the conference topic: obstetrics and gynaecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics, and because they are viewed by their peers as highly skilled in critically examining scientific evidence. The panel members came to this process free of academic or financial bias regarding the conference topic. As conditions for their inclusion on the panel, they must have never published data or opinions that could be used to answer the conference questions and they must hold no financial interest in an entity that could be benefited or harmed by the conference findings. Their statement represents an impartial assessment of the scientific evidence available to date on management of menopause-related symptoms.
The panel is an independent body whose report is not a policy statement of the NIH or the Federal Government. The NIH Consensus Development Program, of which this conference is a part, was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner. NIH has conducted 119 consensus development conferences, and 24 state-of-the-science (formerly "technology assessment") conferences, addressing a wide range of issues.
Among the evidence considered by the state-of-the-science panel was a report prepared by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ). EPC evidence reports are comprehensive, systematic reviews and analyses of published scientific evidence.