NIH State-of-the-Science Panel*
*Panel statement from an NIH State-of-the-Science Conference held on 21–23 March 2005 at the National Institutes of Health, Bethesda, Maryland. For a list of the members of the NIH State-of-the-Science Panel, see the Appendix.
Notice from the Editors: This National Institutes of Health (NIH) State-of-the-Science Conference statement is an independent report of a panel of health professionals and public representatives assembled by the NIH. The conference occurred on 21–23 March 2005 in Bethesda, Maryland. The panel based the statement on a systematic literature review prepared by the Oregon Evidence-based Practice Center under contract with the Agency for Healthcare Research and Quality (systematic review available at www.ahrq.gov/clinic/tp/menopstp.htm), presentations during the conference's 2-day public sessions by investigators working in relevant topic areas, comments and questions from public session attendees, and closed panel deliberations on 21–23 March 2005. This statement is not a policy statement of the NIH, the federal government, the American College of Physicians, or Annals of Internal Medicine. Annals of Internal Medicine is publishing the statement to help to disseminate it to clinicians. Readers should be aware that because NIH policy prohibits substantive revision of panel statements, this document was not subject to Annals' usual peer review process. The statement that appears in the journal is the text of the final statement that the panel submitted to NIH. A list of panel members and their conflict of interest disclosures appears at the end of the statement.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the NIH Consensus Development Program Web site (www.consensus.nih.gov) and in print through the NIH Consensus Development Program Information Center (888-644-2667).
Current Author Addresses: Dr. Mangione: Resource Center for Minority Aging Research, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Plaza, Room 313, Box 951736, Los Angeles, CA 90095-1736.
Dr. Briceland-Betts: Sutton Group—Solutions for Social Change, 4590 MacArthur Boulevard NW, Suite 200, Washington, DC 20007.
Dr. Ellenberg: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 611 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Emerson: Department of Biostatistics, University of Washington, Box 357232, Seattle, WA 98195.
Dr. Espino: Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900.
Dr. Fife: Indiana University School of Medicine, 535 Barnhill Drive, Room RT 150, Indianapolis, IN 46202.
Dr. Folkman: Osher Center for Integrative Medicine, University of California, San Francisco, 1701 Divisadero, Suite 150, San Francisco, CA 94115.
Dr. Henderson: New York Medical College, Our Lady of Mercy Medical Center, 600 East 233rd Street, Fifth Floor, Bronx, NY 10466.
Dr. McDaniel: Wynee Center for Family Research, Department of Family Medicine, University of Rochester School of Medicine & Dentistry, 777 South Clinton Avenue, Rochester, NY 14620.
Dr. Verbrugge: Institute of Gerontology, University of Michigan, 300 North Ingalls Building, Ann Arbor, MI 48109-2007.
Dr. Washington: Veterans Affairs Greater Los Angeles Healthcare System, University of California, Los Angeles, 11301 Wilshire Boulevard, 111G, Los Angeles, CA 90073.
Dr. Woolf: Department of Medicine, Crozer Chester Medical Center, One Medical Center Boulevard, Upland, PA 19013-3995.
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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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.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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