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Management of Menopause-Related Symptoms
Evidence Reports/Technology Assessments, No. 120
Heidi D Nelson, MD, MPH, Elizabeth Haney, MD, Linda Humphrey, MD, MPH, Jill Miller, MD, Anne Nedrow, MD, Christina Nicolaidis, MD, MPH, Kimberly Vesco, MD, Miranda Walker, BA, Christina Bougatsos, BS, and Peggy Nygren, MA.
Structured Abstract
Context:
Although many symptoms have been attributed to the menopausal transition, it is unclear which symptoms are actually associated and how to effectively manage them.
Objective:
To describe the evidence about symptoms associated with menopause, factors that influence them, benefits and adverse effects of therapies, factors that influence therapies, and future research needs.
Data Sources:
Relevant studies were identified from multiple searches of MEDLINE®, PsycINFO, DARE, the Cochrane database, MANTIS, and AMED (1953 to November 2004); and from recent systematic reviews, reference lists, reviews, editorials, websites, and experts.
Study Selection:
Specific inclusion and exclusion criteria were developed to determine study eligibility. The target population includes adult women in the U.S. undergoing the menopausal transition.
Data Extraction:
All eligible studies were reviewed and relevant data were extracted, entered into evidence tables, and summarized by descriptive methods. Two reviewers independently rated the quality of studies using predefined criteria.
Data Synthesis:
Forty-eight studies conducted among 14 cohorts and 22 studies from other populations provide data about symptoms. Vasomotor symptoms and vaginal dryness are most consistently associated with menopause; sleep disturbance, somatic complaints, urinary complaints, sexual dysfunction, mood, and quality of life are inconsistently associated. No studies provide data on cognition and uterine bleeding problems, duration and severity of specific symptoms, or conclusive data on the influence of race/ethnicity, age of onset of menopause, body mass index, oophorectomy status, depression, or smoking. Results of 192 randomized controlled trials of therapies indicate that for vasomotor symptoms, estrogen is effective; tibolone demonstrates benefit, but most studies are poor-quality; paroxetine, veralipride, gabapentin, soy isoflavones, and other phytoestrogens report benefit in some trials. Results for other symptoms are mixed, adverse effects are inadequately reported, and placebo effects are large. No trials describe the influence of bilateral oophorectomy, premature ovarian failure, use of potentially interacting agents, lifestyle and behavioral factors, recent discontinuation of hormones, or body mass index. For women with breast cancer, clonidine, venlafaxine, and megestrol acetate improve vasomotor symptoms, and results for other symptoms are mixed.
Conclusions:
Vasomotor symptoms and vaginal dryness are most consistently associated with the menopausal transition. Results of treatment trials are consistent and conclusive only for estrogen. For other agents, the evidence base is limited by lack of studies demonstrating effectiveness, poor quality of existing studies, and incomplete information on adverse effects.
Keywords:
Menopause, menopause transition, menopause symptoms, treatment of menopause symptoms
Contents
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0024. Prepared by: Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon.
Suggested citation:
Nelson HD, Haney E, Humphrey L, Miller J, Nedrow A, Nicolaidis C, Vesco K, Walker M, Bougatsos C, Nygren P. Management of Menopause-Related Symptoms. Evidence Report/Technology Assessment No. 120. (Prepared by the Oregon Evidence-based Practice Center, under Contract No. 290-02-0024.) AHRQ Publication No. 05-E016-2. Rockville, MD: Agency for Healthcare Research and Quality. March 2005.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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