NIH State-of-the-Science Panel*
NIH State-of-the-Science Panel*. National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms. Ann Intern Med. 2005;142:1003-1013. doi: 10.7326/0003-4819-142-12_Part_1-200506210-00117
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Published: Ann Intern Med. 2005;142(12_Part_1):1003-1013.
Reproductive stage: From menarche (first menstrual period) to the beginning of the perimenopause (when cycles become variable).
Menopausal transition: The time of an increase in follicle-stimulating hormone and increased variability in cycle length, 2 skipped menstrual cycles with 60 or more days of amenorrhea (absence of menstruation), or both. The menopausal transition concludes with the final menstrual period (FMP) and the beginning of postmenopause.
Postmenopause: Begins at the time of the FMP, although it is not recognized until after 12 months of amenorrhea.
Exercise resulted in improved quality of life but did not affect vasomotor symptoms, vaginal dryness, or other menopause-related symptoms.
Health education resulted in improved knowledge about menopause and menopause-related symptoms but did not change the symptoms themselves.
Paced respiration (a type of slow, deep breathing that requires training) for hot flashes showed early promise in a very small group of patients.
Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment.
Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These women need safe and effective treatment.
It is difficult to differentiate those symptoms that are truly associated with menopause from those due to aging. Hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence of a menopausal link for sleep disturbance.
Vasomotor symptoms are reported with high frequency during the menopausal transition. Estrogen, either by itself or with progestins, is the most consistently effective therapy for these symptoms. However, the WHI has identified important risks associated with use of these therapies. Decision making for women regarding treatment for menopausal symptoms requires personal knowledge and balancing of these risks.
There are many potential alternatives to estrogen. However, their effectiveness and long-term safety need to be studied in rigorous clinical trials in diverse populations of women.
To address the charge to this panel, much more research is needed to clearly define the natural history of menopause, associated symptoms, and effectiveness and safety of treatments for bothersome symptoms. Natural histories are important for both science and policy. Knowing how many women transit menopause with few or no symptoms, and how many manage menopause largely on their own, can lead to public health information that empowers women and increases their self-reliance. Medical care and future clinical trials are best focused on women with the most severe and prolonged symptoms.
The state of the science in management of menopausal symptoms should be reassessed periodically.
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