Menopause
Is A Normal Stage of Life; HRT Is Not Recommended to Prevent Heart
Disease in Women, Says NIH International Expert Panel Headed by Emory
Cardiologist
Most women today
live long enough to become menopausal, and because they do, menopause
should not be treated as a disease, but rather a normal physiologic
event in a woman's life that offers physicians the opportunity to assess
a woman's health and her need for health promotion and disease prevention
measures, according to Nanette K. Wenger, M.D., professor of medicine
in the Division of Cardiology at the Emory University School of Medicine,
and chief of cardiology at Grady Memorial Hospital in Atlanta.
Dr. Wenger is chairperson
of the NIH Expert Panel and senior editor of the monograph, entitled
Women's Health and Menopause: A Comprehensive Approach. The
co-editors are Dr. Claude Lenfant, director of National Heart, Lung,
and Blood Institute; Dr. Vivian Pinn, NIH Office of Research on Women's
Health; and Dr. Rodolfo Paoletti of the Giovanni Lorenzini Medical Science
Foundation of Milan, Italy. The group's final position paper has been
posted this week on the NIH Web site at: http://www.nhlbi.nih.gov/health/prof/heart/other/wm_menop.htm.
"The unique contribution
of this monograph is that it is evidence-based," Dr. Wenger said. "For
each of the recommendations cited, the level of evidence is provided
and specific citations to the literature are offered. This provides
the clinician with a spectrum of evidence to enable a multi-disciplinary
approach to the enhancement of menopausal health."
In the area of coronary heart
disease, the position paper indicates that there is no definitive evidence-based
rationale to recommend hormone replacement therapy for the prevention
of coronary heart disease, and that coronary heart disease prevention
should rely on identifying and treating the classic risk factors. With
regards to stroke, the position paper asserts that hormone replacement
therapy has not been consistently linked to stroke protection, and in
the first clinical trial in women with prior stroke, there was no reduction
in risk for a recurrent stroke resulting in death, and a likely increased
risk for more severe strokes in the first few months after initiation
of therapy.
The paper also points to
evidence that hormone replacement therapy increases the risk of venous
thromboembolism (blood clots).
The paper also addresses
the issue of osteoporosis, making the bones fragile and susceptible
to fractures.
"The question of choosing
among estrogen preparations and other medications, including raloxifene,
bisfosphonates, and calcitonin, remains challenging for the individual
patient," says Dr. Wenger.
"There is no one-size-fits-all
solution. The patient and her physician should consider for the issues
of prevention versus treatment, the need for bone-specific versus broad-spectrum
effect, what sort of tradeoffs are acceptable to the patient, her individual
tolerance for the various drugs available to us, and cost," Dr. Wenger
said.
The position paper is a cooperative
venture between the National Heart, Lung and Blood Institute, the NIH
Office of Research on Women's Health, and the Giovanni Lorenzini Medical
Science Foundation of Milan. The paper represents the culmination of
seven years of cooperation between the three organizations in a public/private
partnership in the development and co-sponsorship of four international
conferences on Women's Health and Menopause since the mid-1990s. All
four conferences have addressed not only cardiovascular disease, but
other health problems such as cancer, osteoporosis, and Alzheimer's
disease, as well as the impact of hormone replacement therapy.
The topics addressed in the
monograph include menopause and aging, symptoms and the menopause; sociocultural
issues; physiological role of estrogen and estrogen receptors and pharmacologic
modulation of estrogen receptor activity; sexuality; cardiovascular
and pulmonary disease osteoporosis and oral bone loss; risks and therapy;
gynecologic and urologic aspects; menopausal therapies and cancer; neurological
function; mental health; and eye.
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