Introduction on Menopause
Menopause is a natural process in women's lives as they age. Many women go through the menopausal transition with few or no symptoms, while some have significant or even disabling symptoms. Menopause is defined as the permanent cessation of menstrual periods that occurs naturally or is induced by surgery, chemotherapy, or radiation. Natural menopause is recognized after 12 consecutive months without menstrual periods. The hormonal changes during the menopausal transition can span several years. It often begins with variations in length of the menstrual cycle.
The following three categories were defined by experts at the Stages of Reproductive Aging Workshop (STRAW) in 2001:
- Reproductive stage: From menarche (first menstrual period) to the beginning of the perimenopause (when cycles become variable)
- Perimenopause: The time around menopause during which menstrual cycle and endocrine changes are occurring, including the first 12 months without periods
- Postmenopause: Begins at the time of the final menstrual period (FMP), overlapping with perimenopause by 12 months
In this report, we use the term "menopausal transition" to mean the time from late reproductive stage into postmenopause. The focus of this report is the management of menopausal symptoms, such as hot flashes, night sweats, vaginal dryness, problems with sleeping, loss of sexual desire, or urinary and bleeding problems. These symptoms vary in combination, intensity, and duration.
Estrogen either by itself or with progestins has been the therapy of choice for decades for relieving menopause-related symptoms. The Women's Health Initiative (WHI) is a large clinical trial that was designed to see if estrogen with or without progestin therapy could prevent chronic conditions, such as heart disease and dementia. The estrogen and progestin stratum ended early because of serious health problems, including blood clots, stroke, heart disease, and breast cancer among estrogen users. These findings raised serious questions about the safety of estrogen use to treat symptoms of menopause. Many women stopped hormone replacement therapy and some searched for alternative therapies. To reflect a shift of focus from "replacement" to use of hormones for relief of symptoms, we will use the term menopause hormonal therapy (MHT). MHT includes a range of doses and preparations of estrogen and progestin.
Women and their health care providers need to know the safest and most effective medical and nonmedical treatments for menopausal symptoms. To address this need, the National Institute on Aging and the Office of Medical Applications of Research, of the NIH, sponsored a State-of-the-Science Conference on Management of Menopause-Related Symptoms, March 21