- The Washington Times - Wednesday, March 23, 2005


American women may be overusing treatments for symptoms of menopause, including hormone therapies that can pose risks, a National Institutes of Health consensus panel said yesterday.

“For women who don’t have very serious symptoms, waiting it out may be the best strategy,” said Dr. Carol M. Mangione of the University of California at Los Angeles.

One challenge is determining which symptoms are associated with menopause and which are simply the result of aging.

“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 Dr. Mangione, the panel’s chairwoman.

Hot flashes, night sweats and vaginal dryness are strongly associated with menopause, and there is evidence linking sleep disturbances, the panel reported. It found less evidence that menopause leads to mood swings, difficulty in thinking, back pain and tiredness.

Although hormone therapy can be effective for women with severe menopause symptoms that diminish the quality of life, the treatments may have serious side effects that women should consider carefully before deciding on therapy, 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.

“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,” Dr. 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.”

Dr. 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.

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