NIH State-of-the-Science Panel Calls for "Demedicalization" of Menopause
An independent panel convened this 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 U.S. 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
behavioral 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 this morning,
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/ <http://consensus.nih.gov/> .
The full text of the panel's draft statement will be available
late today at http://consensus.nih.gov <http://consensus.nih.gov/> .
The final version will be available at the same web address in
approximately four weeks. Statements from past conferences and
additional information about the NIH Consensus Development Program
are also available at the web site or by calling 1-888-644-2667.
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 gynecology, 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. Following
the conference, both a summary and the full text of the Evidence
Report on Management of Menopause-Related Symptoms will be available
<http://www.ahrq.gov/clinic/epcix.htm>. Printed copies
also will be available from the AHRQ Publications Clearinghouse
by calling 1-800-358-9295.
The primary sponsors of this conference are the National Institute
on Aging and the Office of Medical Applications of Research, NIH.
The meeting was cosponsors were the Office of Research on Women’s
Health, the National Center for Complementary and Alternative Medicine,
the National Cancer Institute, the National Heart, Lung, and Blood
Institute, the National Institute of Child Health and Human Development,
the National Institute on Mental Health, the U.S. Food and Drug
Administration, and the Office on Women’s Health of the U.S.
Department of Health and Human Services.
Note to Radio Editors: An audio report of the conference results
will be available after 4:00 p.m. today from the NIH Radio News
Service by calling 1-800-MED-DIAL (1-800-633-3425).
Note to TV
Editors: The news conference at 2:00 p.m. today will be broadcast
live via satellite on the following coordinates:
|Galaxy 3 Transponder 06 C-Band
||Test time: 1:30 – 2:00 p.m. EDT
|Orbital slot: 95 degrees West
||Broadcast: 2:00 – 3:00 p.m. EDT
|Downlink Freq: 3820 Vertical
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