The panel called for the "demedicalization" of menopause, for example, while still referring to "symptoms" of the life passage.
One section of its report says "many women go through menopause with few disabling symptoms" while another states that "most experience some symptoms."
Other experts estimate that up to 70 percent of women experience menopausal effects that range from mild to disruptive, and another 10 percent have extreme discomfort.
The panel questioned whether aging, rather than menopause, was to blame for some physiological changes women experience as their reproductive years end, yet acknowledged hot flashes, night sweats and vaginal dryness were "clearly tied" to the change.
There is "positive evidence" of menopause-related insomnia, too, the panel found.
The 12 experts (nine women and three men) ruled out ties to such complaints as moodiness, fuzzy thinking, sexual dysfunction and urinary incontinence.
On sex, they said loss of libido was more likely due to age-related factors like "changes in personal relationships, stressors and socioeconomic conditions" and that the "association between sexual dysfunction and vaginal dryness is unknown."
Experts also largely dismissed effectiveness of non-hormonal, bioidentical and botanical treatments for menopause, putting it at odds in some instances with the American Council of Obstetricians and Gynecologists.
The panel's bottom line? Estrogen therapy - despite the elevated risks it brings for heart disease, stroke and breast cancer - remains the best treatment for perimenopausal and menopausal women who experience serious physiological effects and who can take estrogen. The treatment should be taken in the lowest doses for the shortest time possible.
On the other end of the treatment spectrum, it said exercise and education may make women feel better and more informed but won't help hot flashes, night sweats, vaginal dryness or any other symptoms.
The NIH panel's findings on other approaches, with views from other sources:
Bioidentical, or natural, hormones:
The panel: Numerous practitioners offer individual blends of estradiol, progesterone, DHEA, testosterone, etc., based on hormone levels measured in a woman's saliva, but there is little scientific data on benefits or risks of this approach.
North American
Menopause Society: Compounded products have not undergone rigorous clinical trials and must be recognized as experimental therapies.
Black cohosh
The panel: There is little evidence it is an effective treatment for hot flashes and studies are hampered because of variations in active ingredients in both the natural plant and products.
American Botanical
Council: Numerous studies support the safety and effectiveness of black cohosh for treating physical and emotional signs of menopause, including hot flashes, night sweats, mood swings, irritability and insomnia. The American Council of Obstetricians and Gynecologists also says the herb appears effective.
Antidepressants
The panel: Several antidepressants appear to reduce hot flashes, which may be useful particularly for women who are unable to take estrogen, but side effects include loss of libido, headaches, insomnia and nausea.
American Academy of Family Physicians: Studies showing antidepressants effective in treating hot flashes and night sweats were flawed, though study authors still thought the approach had promise.
Isoflavones,
phytoestrogens (soy)
The panel: Studies of soy extracts show some reduction in hot flashes but variations in products make it difficult to do scientific trials. Eating soy foods doesn't appear to be beneficial.
American Academy of Family Physicians: There is some evidence soy significantly reduces hot flashes. In one study, hot flashes were reduced in 45 percent of women who ingested 60 grams of soy protein daily. Asian women, who report far less incidence of hot flashes, consume roughly 60 to 120 grams of isoflavones daily in their diets.
Red clover leaf
The panel: No more effective than placebo in reducing hot flashes.
American Botanical
Council: Two unpublished Australian studies found red clover, which is high in isoflavones, reduced hot flashes by between 32 percent and 45 percent. Other U.S. studies find no effect. The National Center for Complementary and Alternative Medicine is funding at least one study on effectiveness of red clover for treating hot flashes.
Dong quai root
The panel: No evidence it is effective for hot flashes, and it may cause bleeding problems for women who take warfarin.
Traditional Chinese
medicine: Based on thousands of years of experience, when used in conjunction with other herbs, it is an effective remedy for hot flashes and night sweat problems.
Ginseng root
The panel: May improve well-being, mood and sleep but not hot flashes.
American Council of
Obstetricians and
Gynecologists: Ditto.
The National Institutes of Health report online
Visit http://www.nih.gov/news/pr/mar2005/od-23.htm
to view the NIH report. A final report is expected by May.
