Clinical Review Extracts from “Clinical Evidence”

Menopausal symptoms

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7275.1516 (Published 16 December 2000) Cite this as: BMJ 2000;321:1516
  1. Janice Rymer, senior lecturer and consultant in obstetrics and gynaecologya,
  2. Edward P Morris, senior registrar and honorary lecturer (eddie.morris{at}virgin.net)b
  1. a Guy's, King's, and St Thomas's Medical School, London,
  2. b HRT Research Unit, Guy's Hospital, London SE1 9RT
  1. Correspondence to: E P Morris

    Background

    Definition: Menopause begins one year after the last menstrual period. Symptoms often begin in the perimenopausal years.

    Incidence/prevalence: In the United Kingdom the mean age for the menopause is 50 years 9 months. The median onset of the perimenopause is between 45.5 and 47.5 years. One Scottish survey (of 6096 women aged 45 to 54 years) found that 84% had experienced at least one of the classic menopausal symptoms, with 45% finding one or more symptoms 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 caused by decreased oestrogen concentrations, but the cause of vasomotor symptoms and psychological effects is complex and remains unclear.

    Prognosis: Menopause is a physiological event. Its timing may be genetically determined. Although endocrine changes are permanent, menopausal symptoms such as hot flushes, which are experienced by about 70% of women, usually resolve with time.2 However, some symptoms, such as genital atrophy, may remain the same or worsen.

    Aims: To reduce or prevent menopausal symptoms, and to improve quality of life with minimum adverse effects.

    Outcomes: Frequency and severity of vasomotor, urogenital, and psychological symptoms; quality of life.

    Methods: Clinical Evidence search and appraisal December 1999. We included only randomised controlled trials (RCTs) and systematic reviews that met Clinical Evidence quality criteria.

    Footnotes

    • Competing interests JR has been sponsored to attend conferences by Organon, Solvay Healthcare Ltd, Wyeth, Novo Nordisk, and Janssen-Cilag and has received research funding from Organon and consultancy fees from Organon, Wyeth, and Janssen-Cilag. EPM has been sponsored to attend conferences and has received speaker's fees from Eli Lilly, Organon, and AstraZeneca.


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