An independent panel convened by the US National Institutes of Health has warned about the current tendency in the US to medicalise the menopause, which it says can lead to overuse of treatment options with serious risks or whose safety is as yet unclear.

Although the panel agreed that many women, particularly those with surgically-induced menopause, do need medical intervention to help alleviate the symptoms of the menopause, it cautioned that women should carefully weigh their personal risks and potential benefits before starting oestrogen treatment. It said that, for some women whose symptoms create a serious burden on daily life, the benefits of treatment may outweigh the risks. For women whose menopausal symptoms are severe and persistent, the panel found that nothing was as effective as oestrogen therapy for alleviating those symptoms.

“One of the challenges in this area of research is teasing out which symptoms are associated with menopause and which are simply the result of aging,” noted the panel chair, Dr Carol Mangione, a professor of medicine at the University of California, Los Angeles. “We found very few symptoms that are tied to the natural fluctuations in hormone levels during menopause, and this distinction may have serious implications for women’s treatment decisions.” For example, the panel noted that hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence for a menopausal link to sleep disturbance. However, the evidence of a link between menopause and mood symptoms, cognitive disturbance, and urinary incontinence is weak, and it concluded that treating these symptoms with hormones could be inappropriate.

In addition to learning more about safe use of hormones, the panel urged further research into non–hormonal treatment approaches.