'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.'

The panel indicated concern over the tendency among women and their healthcare providers in the U.S. to medicalize menopause, saying it could lead to overuse of treatment approaches that are known to carry serious risks, or whose safety is as yet unclear.

Panel Urges Weighing Risks, Benefits

Many women, particularly those with surgically induced menopause, do experience significant symptoms that greatly diminish quality of life, the NIH group acknowledged. 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.

Menopause or Aging?

“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," Dr. Mangione noted, "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.

Alternative Approaches Unstudied

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 Wednesday morning, following two days of expert presentations, open public discussions, and panel deliberations.