Menopause Not A Disease, Say Institute Of Health
A panel convened by the National Institutes of Health has found that many women move through the menopausal transition with few disabling symptoms and that it is essential that menopause not be viewed as a disease. The tendency among women and their healthcare providers to medicalize menopause concerned the panel because it can lead to the overuse of treatments known to carry serious risks or whose safety is as yet unknown.
The panel found, however, that many women, particularly those with surgically induced menopause, experience significant symptoms that significantly diminish their quality of life. For women whose menopausal symptoms are severe and persistent, the panel found estrogen therapy was most effective for alleviating those symptoms. Low-dose estrogen is effective for many women, although some require larger doses to relieve hot flashes. The panel said women should carefully weigh their risks and potential benefits before starting treatment, noting that the benefits of symptom relief may outweigh the risks for some women whose symptoms create a severe burden on daily life. 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, from the David Geffen School of Medicine. "We found very few symptoms 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 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 not be appropriate. Although there is increasing interest in bioidentical or "natural" hormones for treating menopausal symptoms, the panel found scant data on these compounds' benefits and adverse effects.
The panel also found that there have been very few well-designed studies to evaluate the safety and effectiveness of complementary and alternative approaches to menopausal symptom management. While many studies have been published, most have limitations that make their findings unclear. The panel said that the evidence on most botanical products used or advocated for treating menopausal symptoms is weak.