NIH Consens State Sci Statements. 2005;22(1):1-38.
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of menopause-related symptoms.
A non-DHHS, nonadvocate 12-member panel representing the fields of obstetrics and gynecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics. In addition, 26 experts in fields related to the conference topic presented data to the panel and to the conference audience.
Presentations by experts and a systematic review of the medical literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.
Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://consensus.nih.gov.
Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment. Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These women need safe and effective treatment. It is difficult to differentiate those symptoms that are truly associated with menopause from those due to aging. Hot flashes, night sweats, and vaginal dryness are clearly tied to the menopausal transition, and there is some positive evidence of a menopausal link for sleep disturbance. Vasomotor symptoms are reported with high frequency during the menopausal transition. Estrogen, either by itself or with progestins, is the most consistently effective therapy for these symptoms. However, the Women's Health Initiative (WHI) has identified important risk factors associated with use of these therapies. Decision making for women regarding treatment for menopausal symptoms requires personal knowledge and balancing of these risks. There are many potential alternatives to estrogen. However, their effectiveness and long-term safety need to be studied in rigorous clinical trials in diverse populations of women. Much more research is needed to clearly define the natural history of menopause, associated symptoms, and effectiveness and safety of treatments for bothersome symptoms. Natural histories are important for both science and policy. Knowing how many women transit menopause with few or no symptoms, and how many manage menopause largely on their own, can lead to public health information that empowers women and increases their self-reliance. Medical care and future clinical trials are best focused on women with the most severe and prolonged symptoms. The state of the science in management of menopausal symptoms should be reassessed periodically. Menopause is "medicalized" in contemporary U.S. society. 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. Medical care and future clinical trials are best focused on women with the most severe and prolonged symptoms. Barriers to professional care for these women should be removed.
为医疗保健提供者、患者及普通大众提供对当前有关更年期相关症状管理的现有数据的负责任评估。
一个由12名成员组成的非美国卫生与公众服务部（DHHS）、非倡导组织的小组，代表妇产科、普通内科、内分泌学、风湿病学、家庭与健康心理学、老年医学、卫生服务研究、人口统计学、生物化学、流行病学、临床研究和生物统计学领域。此外，26名与会议主题相关领域的专家向小组和会议听众展示了数据。
专家的报告以及俄勒冈循证实践中心通过医疗保健研究与质量局的循证实践中心项目对医学文献进行的系统综述。科学证据优先于临床轶事经验。
小组根据公开论坛上展示的科学证据和已发表的科学文献，回答预先确定的问题，起草其声明。声明草案在会议最后一天全文宣读，并分发给听众征求意见。然后，小组举行执行会议审议收到的意见，并于当天晚些时候在http://consensus.nih.gov上发布了一份修订声明。本声明是小组的独立报告，并非美国国立卫生研究院（NIH）或联邦政府的政策声明。本声明的最终版本以及其他近期会议声明可在同一网址http://consensus.nih.gov上获取。
更年期是女性月经自然永久停止的时期，通常发生在50岁出头。许多女性几乎没有或没有症状；这些女性无需医疗治疗。因手术、化疗或放疗导致更年期的绝经前或围绝经期女性更有可能经历令人烦恼甚至致残的症状。这些女性需要安全有效的治疗。很难将真正与更年期相关的症状与因衰老引起的症状区分开来。潮热、盗汗和阴道干燥显然与更年期过渡有关，并且有一些关于睡眠障碍与更年期存在关联的积极证据。血管舒缩症状在更年期过渡期间报告频率很高。雌激素单独使用或与孕激素联合使用是治疗这些症状最一致有效的疗法。然而，妇女健康倡议（WHI）已经确定了与使用这些疗法相关的重要风险因素。女性在更年期症状治疗方面的决策需要了解这些风险并进行权衡。雌激素有许多潜在的替代方法。然而，它们的有效性和长期安全性需要在不同女性群体的严格临床试验中进行研究。需要更多的研究来明确界定更年期的自然史、相关症状以及令人烦恼症状的治疗效果和安全性。自然史对科学和政策都很重要。了解有多少女性在更年期几乎没有或没有症状，以及有多少女性在很大程度上能够自行应对更年期，能够产生增强女性权能并提高其自立能力的公共卫生信息。医疗保健和未来的临床试验最好聚焦于症状最严重和持续时间最长的女性。更年期症状管理的科学现状应定期重新评估。在当代美国社会，更年期被“医学化”了。非常需要开发和传播强调更年期是女性生活中正常、健康阶段并促进其非医学化的信息。医疗保健和未来的临床试验最好聚焦于症状最严重和持续时间最长的女性。应消除这些女性获得专业护理的障碍。
