Are women overtreating menopause?

WASHINGTON — American women may be overusing treatments for symptoms of menopause, including hormone therapies that can pose a risk, a National Institutes of Health consensus panel said Wednesday.

"For women who don't have very serious symptoms, waiting it out may be the best strategy," said Carol M. Mangione of the University of California, Los Angeles.

One challenge is determining which symptoms are associated with menopause and which are simply the result of aging.

"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," said panel chairwoman Mangione.

Hot flashes, night sweats and vaginal dryness are strongly associated with menopause, and there is also evidence linking sleep disturbances, the panel reported. It found less evidence that menopause leads to mood swings, difficulty thinking, back pain and tiredness. Studies were mixed as to whether urinary incontinence was a symptom of menopause.

While hormone therapy can be effective for women with severe menopause symptoms that diminish the quality of life, these treatments may have serious side effects that women should consider carefully before deciding on treatment, the panel said.

The group complained that little is known about the effects of some alternative therapies and called for further study involving a wider variety of women and treatments.

For years hormone replacement therapy was offered as an effective treatment for such symptoms as hot flashes and night sweats.

Use of hormones plummeted after 2002, when a major study found hormone therapy slightly increased users' risks of heart attack, stroke and breast cancer.

But as many as one-fourth of women who stopped using the hormones returned to them because of debilitating symptoms.

Risk-benefit analyses are important for women whose symptoms create a burden on daily life, the NIH panel said in a draft statement: "These women may be willing to assume greater risk for the sake of reducing these symptoms."

"One of the things that really struck us . . . is the fact that menopause is not a disease, yet at the same time there are subsets of women who clearly have disabling symptoms from menopause that affect their quality of life and their ability to function," said Mangione.