Extracts from "Clinical Evidence": Menopausal symptoms

doi:10.1136/bmj.321.7275.1516

BMJ 2000;321:1516-1519 ( 16 December )

Clinical review

Extracts from "Clinical Evidence"

Menopausal symptoms

Janice Rymer, senior lecturer and consultant in obstetrics and gynaecology, ^a Edward P Morris, senior registrar and honorary lecturer. ^b

^a Guy's, King's, and St Thomas's Medical School, London, ^b HRT Research Unit, Guy's Hospital, London SE1 9RT

Correspondence to: E P Morris eddie.morris{at}virgin.net

Definition: Menopause begins one year after the last menstrualperiod. Symptoms often begin in the perimenopausalyears.
Incidence/prevalence: In the United Kingdom the mean age for themenopause is 50 years 9 months. The median onset of the perimenopauseis between 45.5 and 47.5 years. One Scottish survey (of 6096 womenaged 45 to 54 years) found that 84% had experienced at least oneof the classic menopausal symptoms, with 45% finding one or moresymptoms a problem.1

Interventions

: Beneficial:
Oestrogens
Tibolone

: Likely to be beneficial:
Progestogens
Clonidine

: Unknown effectiveness:
Phyto-oestrogens
Testosterone
Antidepressants

Aetiology/risk factors: Urogenital symptoms of menopause are causedby decreased oestrogen concentrations, but the cause of vasomotorsymptoms and psychological effects is complex and remainsunclear.
Prognosis: Menopause is a physiological event. Its timingmay be genetically determined. Although endocrine changes arepermanent, menopausal symptoms such as hot flushes, which areexperienced by about 70% of women, usually resolve with time.2However, some symptoms, such as genital atrophy, may remain thesame orworsen.
Aims: To reduce or prevent menopausal symptoms,and to improve quality of life with minimum adverseeffects.
Outcomes: Frequency and severity of vasomotor, urogenital,and psychological symptoms; quality oflife.
Methods: Clinical Evidence search and appraisal December1999. We included only randomised controlled trials (RCTs) andsystematic reviews that met Clinical Evidence qualitycriteria.

© BMJ 2000

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