Consensus panel cautious on menopause treatment.(News)

BETHESDA, MD. -- Night sweats, hot flashes, vaginal dryness, and sleep disturbances appear to be connected to the onset of menopause, but other midlife symptoms--such as mood disorders, urinary incontinence, and somatic complaints--may not be, according to a consensus statement issued by a federal advisory panel.

"We reviewed the evidence for [about 10] symptoms often stated as happening at time of menopause and possibly due to menopause ... and we pruned the list," said panelist Lois M. Verbrugge, Ph.D., research professor and senior research scientist at the University of Michigan's Institute of Gerontology in Ann Arbor.

Dr. Verbrugge and her colleagues on the 12-member panel drafted a consensus statement at a conference on management of menopause-related symptoms sponsored by the National Institutes of Health.

The panel also looked at the available evidence on treatment of menopause symptoms and determined that low-dose estrogen, given for short periods to women who are not at high risk of breast cancer, has been shown to be effective for many patients who suffer from hot flashes. The panel defined "low-dose" as doses equivalent to 0.3 mg conjugated estrogen, 0.5 mg oral micronized estradiol, 25 mcg transdermal estradiol, or 2.5 mcg ethinyl estradiol.

The panel noted that although higher doses of estrogen--equivalent to 0.625 mg conjugated estrogen--increase the risk of stroke and deep vein thrombosis and, when combined with progestin, breast cancer, the exact risk of those outcomes with low-dose estrogen, has not been quantified.

"Risk-benefit analyses are important for women whose vasomotor symptoms are severe and create a burden on daily life. These women may be willing to assume greater risk for the sake of reducing their symptoms," the panelists wrote.

Women at high risk for serious medical outcomes with the use of estrogen include those with a history of breast cancer or an elevated risk of breast or ovarian cancer based on genetic factors or family history, and those who have or are at risk for cardiovascular disease, the panel noted.