BETHESDA, MARYLAND--Top scientists at a 3-day consensus conference on managing the symptoms of menopause concluded today that, despite its risks, short-term estrogen treatment is the best way to alleviate debilitating problems like hot flashes. But the 10-member independent panel, convened by the National Institutes of Health (NIH) also stated that other problems traditionally attributed to menopause, like depression and joint pain, were more likely a result of aging and should not be treated with hormones.
Since being approved in the U.S. in the early 1940s, estrogen and progestin therapy has been widely used to ease menopausal symptoms as well as prevent many chronic diseases, such as osteoporosis and heart disease. Then, in 2002, a 16,000-women study named the Women's Health Initiative (WHI) dropped a bombshell: participants were likelier to suffer from heart attacks and breast cancer if they took combination estrogen and progestin hormones. Sales of hormone replacement therapy nosedived, and many older women were left wondering how best to address their symptoms.
A "state-of-the-science" statement released by the panel concurs with a number of professional societies, who since the WHI finding have recommended that hormone therapy should be used at the lowest possible dose for the shortest possible time. But the panel recommends treatment trials of ethnically diverse women to help assess the proper time course and dose for these therapies. It also urges research into possible alternative treatments, including botanicals and certain antidepressants.
In addition, "we pruned the list" of symptoms linked to menopause, said panelist Lois Verbrugge, of the University of Michigan, Ann Arbor, and a visiting professor currently at the National University of Singapore. Depression, irritability, forgetfulness, joint pain, urinary incontinence, and changes in libido can't be easily linked to menopause, the panel concluded, while hot flashes, vaginal dryness, and possibly sleep disturbance are more clearly triggered by the condition.
The panel found that in some cases, hormonal treatment is appropriate, and confers only a very small increase in absolute risk of disease for many middle-aged women. "I think we're overdoing our enthusiasm for avoiding these drugs," said presenter Deborah Grady of the University of California, San Francisco--though she, too, cautioned that women stay on hormone therapy for as brief a time as possible.