The Agency for Healthcare Research and Quality (AHRQ) has released the results of a systematic review on managing menopause-related symptoms. The full report, Evidence Report/Technology Assessment No. 120, “Management of Menopause-Related Symptoms,” is available online at http://www.ahrq.gov/clinic/epcsums/menosum.htm.

By definition, menopause is the permanent cessation of menses caused by reduced ovarian hormone secretion. Menopause usually occurs in women 40 to 58 years of age, and it may take several years to fully transition from onset to completion. During this time, many women experience symptoms that can cause reduced quality of life. Common menopause-related symptoms include:

• Hot flashes

• Vaginal dryness

• Sleep disturbance

• Mood symptoms

• Cognitive disturbances

• Somatic complaints

• Urinary complaints

• Uterine bleeding

Many therapies exist to manage these symptoms, including hormone therapy, antidepressants and other drugs, behavioral interventions, and complementary and alternative medicine.

The AHRQ evidence report evaluates the benefits and harms of common interventions to relieve menopause-related symptoms. The review included American women who were going through menopause and who presented with at least one of the above symptoms. A technical expert panel, which was made up of experts and clinicians in the field, and expert reviewers provided input for this review.

Managing Menopausal Symptoms

ESTROGEN

Estrogen was the most consistently effective intervention for vasomotor symptoms. The therapy also helped manage urogenital symptoms, along with sleep, mood, sexual, and quality-of-life outcomes compared with placebo. The most common adverse effects of estrogen therapy were breast tenderness and uterine bleeding.

TESTOSTERONE AND ESTROGEN

The reviewers found few trials evaluating testosterone therapy. However, one trial showed no difference between combination testosterone and estrogen therapy and estrogen therapy alone for hot flashes, vaginal dryness, or sleep problems. The results of two trials showed that testosterone and estrogen therapy improved sexual symptoms better than estrogen alone or placebo. However, women receiving combination therapy had significantly more incidences of acne and hirsutism compared with those in the estrogen-only group.

PROGESTIN

Trials showed varying results regarding progestin in the management of vasomotor symptoms.

TIBOLONE

A few trials of fair to good quality showed that tibolone (Livial) helped manage vasomotor symptoms, sleep, and somatic complaints compared with placebo. Tibolone was similar to estrogen in the management of some symptoms. Patients treated with tibolone experienced more uterine bleeding, body pain, weight gain, and headaches compared with patients who were treated with placebo.

SOY ISOFLAVONES AND OTHER ALTERNATIVE THERAPIES

Although results varied and more research is needed, alternative therapies were beneficial in managing some nonvasomotor symptoms.

Conclusion

Trials evaluating therapies for the management of menopause-related symptoms were conclusive only for estrogen in the management of vasomotor and urogenital symptoms. After further research, other therapies may demonstrate beneficial results.

LIMITATIONS

The trials included in this evidence review had the following limitations:

• Highly selected, small sample groups

• Short duration

• Inadequate reporting of loss to follow-up, maintenance of comparable groups, contamination, methods of analysis, and adverse events

• Some nonstandardized and nonvalidated measures and outcomes

• Unclear inclusion and exclusion criteria

• Industry sponsorship

FURTHER RESEARCH

Research is needed to fill in the gaps of this evidence review. Researchers should focus on determining optimal effective dosing, combination regimens, duration of use, and timing of therapy. Trials also should include head-to-head and placebo comparisons of estrogen alone and combined with other therapies, including nondrug interventions, as well as the best way to discontinue estrogen therapy after the symptoms subside.