What to do about menopause? Even experts confused

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Menopause does not usually cause severe symptoms apart from hot flashes, and little is known about alternatives to hormone replacement therapy with its risks of cancer and heart attack, experts said on Wednesday.

Emerging after three days of debate and presentations on what menopause is and how best to manage it, the panel of experts said there is not enough research to give a definitive answer to women clamoring for information.

Since learning in 2002 that hormone replacement therapy can raise the risk of heart attack, stroke, breast cancer and other serious conditions, millions of women have stopped taking HRT and sought alternatives.

The panel convened by the National Institutes of Health had little advice to offer them, other than to figure it out with the advice from their doctors.

“There isn’t really a best treatment that we could identify,” Dr. Carol Mangione of the University of California Los Angeles told a news conference. “It is clear that estrogen is the most effective treatment,” she said. But its risks are also clear.

“The majority of patients don’t have disabling symptoms,” so they may not need any therapy, she said.

Many symptoms attributed to menopause may be natural consequences of aging, the panel said. Reduced libido, higher risks of heart attack and forgetfulness may have little to do with hormone levels, they said.

Panelists said menopause is a natural transition and should not be treated as a disease.

And there is a lack of solid studies to show whether alternatives to HRT work to reduce symptoms in women who have them. This leaves some women vulnerable to misinformation, the experts told a news conference.

Patients need to “insulate themselves from quacks and poor choices,” said Deborah Briceland-Betts, senior vice president at the research firm Sutton Group.

“When there is a paucity of knowledge, that gap is being filled with the Internet or late night TV or what-not,” Dr. David Espino of the University of Texas Health Science Center at San Antonio said.

There is evidence for some therapies, they said. Testosterone improves libido, but does little for hot flashes, vaginal dryness or sleep disturbances and it can cause acne, hairiness and weight gain.

Antidepressants may reduce hot flashes somewhat. So may soy extracts, but not soy in the diet, the panel said.

There is little information about so-called bioidentical or plant-based hormones.

Herbs can be toxic, the panel said. “There is little evidence that black cohosh is an effective treatment for hot flashes,” according to the panel’s report. And it may damage the liver.

Kava can reduce anxiety, but there is no evidence it helps hot flashes and it is associated with liver damage.

Red clover, dong quai and ginseng do not appear to have strong beneficial effects, according to the report.

Some women can safely take HRT, Mangione noted, especially younger, healthier women with severe menopausal symptoms. The Food and Drug Administration recommends taking the lowest possible dose for the shortest time, but it does not provide more specific information.

“We don’t know what the lowest dose is and we don’t know what the shortest amount of time is,” Mangione said. “We can’t really say ‘half-strength is safe - go ahead’.”

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