NIH Panel: Menopause Treatment May be Overused

More Studies Needed for Natural, Alternative Remedies

March 28, 2005

A panel of experts convened by the National Institutes of Health to study menopause found that many women can get through hot flashes, night sweats and vaginal dryness without hormones or drugs, and that there has been a tendency to “medicalize” the condition and overuse menopause treatments that may be unsafe.

Susan H. McDaniel, Ph.D., a clinical psychologist and associate chair of the UR Department of Family Medicine, was a member of the 12-person, state-of-the-science panel that spent two days last week deliberating and discussing the most up-to-date science before issuing guidelines on the best and safest therapies.

McDaniel and Diane Hartmann, M.D., associate professor of Obstetrics and Gynecology at the UR Medical Center with clinical expertise in the areas of menopause and geriatric gynecology, discussed the panel’s recommendations during Managing Menopause: The Latest Expert Opinions, a live web chat on March 30.  (For a transcript of the chat, log on to www.urmc.rochester.edu/menopause)

Menopause was thrust into the spotlight in 2002, after a major study found that hormone replacement therapy (HRT), the standard treatment for decades, slightly increased the risk of blood clots, heart attack, stroke and breast cancer. Since then millions of women have abandoned HRT, and are searching for other ways to easy symptoms.         

 Among the recommendations and findings of the NIH panel:

  •  Many women, particularly those with surgically induced menopause, do experience intense, persistent symptoms that seriously diminish quality of life. For them, the panel found nothing as effective as estrogen. Low-dose estrogen can work for some women, although larger doses are often required to control hot flashes.

·        Before starting estrogen or any other treatment, women and their doctors should carefully weigh their personal risks and potential benefits. In addition to learning more about the safe use of hormones, the panel urged further research into non-hormonal treatment approaches.

·        Although there is increasing interest in bioidentical or “natural” hormones for treating menopause symptoms, the panel found scant data on their safety and effectiveness.

·        Similarly, there are few well-designed studies on the safety and effectiveness of complementary, botanical and alternative approaches (such as black cohosh, soy extract or acupuncture) to managing symptoms. This includes behavioral interventions such as exercise or deep breathing. While many studies in this arena have been published, most have important limitations that make their findings unclear, weak, or inconsistent. Also, there are major methodological problems with many of the studies.

An archived web cast of the session and the full text of the of the NIH panel’s draft statement will be available shortly at http://consensus.nih.gov/ . The final version of the statement will be available in about four weeks at the same web address, according to the NIH.

The panelists were selected for their expertise in the fields of 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 for their skills in examining scientific evidence. The panel members came to the session free of academic or financial bias, according to the NIH.

Chairwoman of the panel was Dr. Carol Mangione, Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “One of the challenges in this area of research is teasing out which symptoms are associated with menopause and which are simply the results of aging,” she said. “We found very few symptoms that are tied to the natural fluctuations in hormone levels during menopause, and this distinction many have serious implications for women’s treatment decisions.”

For example, while hot flashes, night sweats and vaginal dryness are clearly tied to the menopausal transition, the evidence of a link between menopause and mood swings, cognitive disturbance and urinary incontinence is weak, the panel found.

The primary sponsors of the conference were the National Institute on Aging
and the Office of Medical Applications of Research, NIH. Co-sponsors 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. 

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Leslie Orr
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