Panel Studies Menopause Symptoms

Worried that women in the United States may be turning too quickly to treatments for symptoms of menopause, a panel of medical experts suggested that those without severe problems simply wait out the changes their bodies are undergoing.

Evidence links sleep disturbances to menopause, which is strongly associated with hot flashes, night sweats and vaginal dryness, a National Institutes of Health consensus panel said Wednesday.

The panel found less evidence that menopause leads to mood swings, difficulty thinking, back pain and tiredness. Studies were mixed as to whether urinary incontinence was a symptom of menopause.

Determining which symptoms are associated with menopause and which are simply the result of aging can be challenging, the panel said.

"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," said the chairwoman of the panel, Dr. Carol M. Mangione of the University of California, Los Angeles. "For women who don't have very serious symptoms, waiting it out may be the best strategy."

Hormone therapies for the treatment of menopause can pose a risk, the panel said. While hormone therapy can be effective for women with severe menopause symptoms that diminish the quality of life, these treatments may have serious side effects that women should consider carefully before deciding on treatment, the panel said.

The group complained that little is known about the effects of some alternative therapies and called for further study involving a wider variety of women and treatments.

For years, hormone replacement therapy was offered as an effective treatment for such symptoms as hot flashes and night sweats.

Use of hormones plummeted after 2002, when a major study found hormone therapy slightly increased users' risks of heart attack, stroke and breast cancer. But as many as one-fourth of women who stopped using the hormones returned to them because of debilitating symptoms.

Risk-benefit analyses are important for women whose symptoms create a burden on daily life, the NIH panel said in a draft statement: "These women may be willing to assume greater risk for the sake of reducing these symptoms."

"One of the things that really struck us ... is the fact that menopause is not a disease, yet at the same time there are subsets of women who clearly have disabling symptoms from menopause that affect their quality of life and their ability to function," Mangione said.

The group sought to determine the best and safest treatment, she said, but "there isn't really a best treatment that we could identify."

Mangione said it is clear that the hormone estrogen is the most effective treatment, "but at the same time, estrogen has some potential big health trade-offs."

For women with moderate to severe symptoms, she urged starting with the lowest dose that seems likely to work. "There is very little downside to starting low and going slow with these medicines," she said.

For most women, natural menopause occurs between the ages of 40 and 58. The group noted that symptoms seem to be most severe for women who undergo menopause early because of surgery, chemotherapy or radiation treatments.

The panel said vaginal dryness is associated with some sexual dysfunction, while other sexual problems, including loss of libido, are more related to aging.

The panel's draft statement suggested that women with a history of breast cancer, with an elevated risk of breast or ovarian cancer and those at high risk of cardiovascular disease may prefer to seek therapies other than hormones.

There has been increasing interest in so-called "natural" hormones for treating menopausal symptoms, but the panel found little data on the benefits and adverse effects of these compounds.

While there are alternative treatments, many have not been well studied, said the panel, concluding that more research is needed in such treatments as the dietary supplement DHEA, the hormone Tibolone used in Europe and Canada, antidepressants, the nutrients isoflavones and phytoestrogens, botanicals, acupuncture and behavioral therapy.

The 12-member panel was asked by the NIH to review the status of menopause treatment. They noted their statement is that of an independent body and not a policy position of NIH or the government.