NIH Panel: Menopause Is Not a Disease
Report Calls for Less Emphasis on Hormone Treatment
March 23, 2005 -- Menopause should be "demedicalized" and treated as
a normal phase of women's lives instead of as a disease, a federal scientific
panel concluded Wednesday.
The group issued a report concluding that many women go through menopause
with few symptoms and without hormone treatment; only women with more severe
and debilitating menopausal symptoms should use hormone replacement therapy
"Most physicians should not treat this as a medical condition. It is not
something that has to be treated automatically," says Carol Mangione, MD,
who chaired a National Institutes of Health consensus panel on menopause
Widespread use of estrogen alone or in combination with a progestin by
menopausal women was thrown into doubt in 2002 when a large study was halted
because of evidence that using the drugs increased the risk of heart disease,
breast cancer, and dangerous blood clots. This study was not designed to study
women with menopausal symptoms but rather to test whether hormone therapy could
prevent chronic diseases.
The study, known as the Women's Health Initiative, suddenly raised questions
as to whether using hormones to prevent hot flashes, dizziness, and other
symptoms of menopause was worth a potential increased risk of disease. It also
led the Food and Drug Administration and others to recommend that
women using hormone therapy take the lowest effective dose for the shortest
possible duration as a way to minimize the risk of dangerous side
The study also helped expand an already rapidly growing market in
alternative treatments ranging from dietary and herbal supplements to
behavioral and psychological treatments.
Experts said Wednesday that relatively little research has been conducted on
the effectiveness and safety of most alternative treatments, making it
impossible to make recommendations on which work and which don't. Instead they
called for more research on alternative therapies as well as trials testing the
effectiveness of hormone treatment in a racially diverse group of women with
The report also narrowed the list of menopause symptoms that have shown
solid evidence of being treatable with hormones. Hormone therapy has shown
effectiveness against night sweats, hot flashes, increased vaginal dryness, and
sleep problems. But other symptoms, including lowered mood, memory
problems, and urinary incontinence have shown little
evidence of responding to hormone treatment, it states.
"It gives women and health care providers the information they need to
insulate themselves from quacks and poor choices," says Deborah
Briceland-Betts, PhD, senior vice president of the Sutton Group, and a member
of the NIH panel.
The group endorsed already-recommended strategies of using lower doses for
shorter periods of time for women with more severe symptoms, though it
cautioned that research has not conclusively shown which doses can be deemed
Mangione, who is a professor of medicine at the University of California at
Los Angeles, said that some women do experience debilitating menopausal
symptoms and that such women should weigh the benefits of symptom relief with
the risk of side effects. But most other women tend to improve without drugs or
other treatments, she added.
She noted that several studies have shown that up to one-third of women
taking placebos instead of drugs still see their symptoms subside. It's a
larger improvement than is seen with placebos in most medical studies, though
researchers still do not understand why the effect is so large.
"It suggests that there is a big segment of the population out there who
probably are going to be better without any treatments," she says.