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Full Title: Management of Menopause-Related Symptoms
View or download Summary/Report
Objectives: To describe the evidence about symptoms associated with menopause, factors that influence these symptoms, benefits and adverse effects of therapies, factors that influence therapies, and future research needs.
Data Sources: Searches of MEDLINE®, PsycINFO, DARE, the Cochrane database, MANTIS, and AMED; and from recent systematic reviews, reference lists, reviews, editorials, Web sites, and experts.
Review Methods: The target population includes adult women in the U.S. undergoing the menopausal transition. All cohort studies reporting menopausal symptoms in >100 subjects were reviewed and relevant data were extracted, entered into evidence tables, and summarized by descriptive methods. Studies of nonmenopausal women, of aging, or not published in English were excluded.
Results: 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, but 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 the lack of studies demonstrating effectiveness, poor quality of existing studies, and incomplete information on adverse effects.
Management of Menopause-Related Symptoms
Evidence-based Practice Center: Oregon
Topic Nominator: Office of Medical Applications of Research (OMAR)
Current as of March 2005