NIH Panel: Menopause Is Not a Disease
Report Calls for Less Emphasis on Hormone Treatment
WebMD News Archive
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 drugs.
"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 treatment.
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 effects.
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 menopause symptoms.
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.