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News Briefs
NIH Panel Wants Menopause Demedicalized,’ Women’s Health Physician Asks NIH to Study Alternative Therapies
An independent panel convened by the National Institutes of Health (NIH) in March would not recommend the use of any bioidentical or natural hormones for treating menopausal symptoms, saying there is scant data on the benefits and adverse effects of these compounds. However, one physician who has had success with some alternative treatments, such as a fermented soy product, believes alternative therapies should be encouraged.
"The panel could not endorse alternatives because of scant data, but we should not accept this statement," says Joseph L. DeStefano, head of women’s health care at the AtlantiCare Regional Medical Center in New Jersey. "Women and physicians should be writing to NIH and our political leaders for NIH to begin studies to provide us with this data. After all, it took more than 50 years to obtain the accurate and meaningful data on hormone therapy.
"I hope I am one voice out of many that will demand this panel to begin scientific studies of alternative therapies."
In its report, the NIH State-of-the-Science Conference on Management of Menopause-Related Symptoms says that many women go through menopause without being disabled by symptoms. Therefore, they say that period of life should not be considered a disease.
Women and their health care providers have a tendency to "medicalize" menopause, the panel says. This can lead to overuse of treatment approaches that are known to carry serious risks, or whose safety is as yet unclear.
"There is great need to develop and disseminate information that emphasizes menopause as a normal, healthy phase of women’s lives and promotes its demedicalization," the panel says in the conclusion of its report.
DeStefano agrees menopause is not a disease state, and believes "it should be viewed as a transitional state in a woman’s life and as part of the aging process."
If menopause is considered a disease state, such as hypothyroidism, he explains, the panel would have had to conclude that all women should receive medial treatment. "The proven risks of the NIH (Women’s Health Initiative) study of 2002 and 2004 do not justify this."
He does take issue with a published comment made by the panel chair to the Salt Lake City Tribune. "For women who don’t have very serious symptoms, waiting it out may be the best strategy," says Carol M. Mangione, MD, MSPH, professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles.
"Acceptance of the aging process is not a realistic expectation in our present society, as evident by the multi-billion dollar anti-aging industries, including cosmetic, plastic surgery, and anti-aging nutritional products," DeStefano says. "It is an outrageous and archaic statement, which would be easily acceptable if it were 1900, when a woman’s life span was 48 years old, but unacceptable when that frontier has been advanced to 79 years, with an average of 30 years in a menopausal state."
In addition, the majority of symptomatic menopausal women are reaching out and searching for symptomatic relief on their own, he says.
One of the challenges in this area of research is determining which symptoms are associated with menopause and which are the results of aging, Mangione says in a statement. The panel found links between menopause and hot flashes, night sweats, vaginal dryness, and possibly sleeps disturbances. However, the evidence of a link between menopause and mood symptoms, cognitive disturbance, and urinary incontinence was weak.
DeStefano disagrees with this, as well. "It is my opinion from 35 years of clinical practice that irritability, mood changes, cognitive disturbances, and urinary incontinence are symptoms that reflect a combination of hormone lack and the aging process and should be treated on an individualized basis."
For women whose menopausal symptoms are severe and persistent, the panel says nothing seems to be as effective as estrogen therapy. The alternatives for other women, however, were not clear since the panel would not recommend complementary and alternative medicine therapies until clinical trials have assessed both their safety and efficacy.
"For the NIH consensus panel to tell women that there are no naturally safe or effective treatment options is counterproductive, discouraging and misleading," DeStefano says in a press statement. "There is significant research available into natural, plant-derived options that have been used for centuries."
In DeStefano’s experience, all women have symptoms of menopause to varying degrees. "Most seek treatment for severe hot flashes and lack of sleep and subsequent fatigue, but for others it may be vaginal atrophy and inability to function sexually," he says. "It is outrageous that we give one partner Viagra to keep him sexually young and active,’ and the sexual partner is unable to function because of demedicalization.’"
However, it is an achievement for alternative treatments to even be mentioned or discussed in the report, DeStefano says. "We have come a long way to even achieve this recognition by a scientific panel. This is the area when we as physicians must begin to practice the Art of Medicine’ and guide our patients to the safest alternative therapies for relief of symptoms. We cannot just put our heads in the sand and make believe [patients] are not taking these therapies, because they are and without medical guidance."
For more information about the panel’s conclusions, see http://consensus.nih.gov/ta/025/025MenopauseINTROpostconf.htm.
NIH Panel Wants Menopause Demedicalized, Womens Health Physician Asks NIH to Study Alternative TherapiesSubscribe Now for Access
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