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May 26, 2005

How does menopause affect quality of life?

Researchers halted a national study several years ago when they discovered that hormone replacement therapy for menopausal women could increase their risk of heart disease and breast cancer. Many women put down their prescriptions and looked for answers.

But the answers remain illusive. While other studies have found similarly harmful effects from hormone replacement therapy (HRT), especially long term, no consensus has emerged on how to treat the symptoms of menopause. Some doctors say the benefits of HRT therapy might outweigh the risks for short-term treatment for some women.

“There are more questions than there are answers,” said Rachel Hess, an assistant professor in the School of Medicine. In her new study, “Does Menopause Matter?” (also known as “Do Stage Transitions Result in Detectable Effects?”), Hess is focusing her research on the broader issues of how menopause affects the quality of life. She is studying women’s attitudes towards menopause and aging, their social support systems and their menopausal symptoms.

She spoke about her five-year study, started in January this year, at a May 17 seminar sponsored by the University Center for Research on Health Care, the Veterans Administration Center for Health Equity Research and Promotion and RAND-Pittsburgh.

Menopause occurs when a woman stops menstruating, usually between the ages of 45 and 55. The stages of menopause, ranging from perimenopause (when ovarian hormone production declines) to postmenopause (12 months after a woman’s last menstrual period) are characterized by a decline in the production of the hormones estrogen and progesterone. During menopause women may experience hot flashes, weight gain, fatigue, bladder problems, mood swings and vaginal dryness. Also part of the decline in hormone production is the loss of bone density and the potential for osteoporosis.

“One of the issues we really need to look at is that the best data we have now are based on women in the later stages of menopause,” Hess said. With the scientific literature focusing more on women aged 60 years and older, scientists know much less about women as they enter the beginning of perimenopause (typically occurring in women in their mid-40s). Hess added that these younger women have a much lower risk for heart disease, breast cancer or stroke —whether taking hormones or not — than women in their 60s.

Her study is funded by a $700,000 career development grant from the National Institute of Aging and the National Center for Complementary and Alternative Medicine, both of the National Institutes of Health.

Hess describes her research as a small study contributing information to a significant problem. “I hope we will have a better understanding of the menopausal experience and that this research will contribute to new ways to target new interventions that are safer,” Hess said. This is a critical time to examine these issues, she added, because in 10 years about 50 percent of American women will be menopausal or perimenopausal.

Besides the lack of medical consensus in treating menopause, some women are baffled by the plethora of advertisements for traditional hormone treatment and complementary and alternative medicine (CAM) treatments such as herbal remedies, according to Hess.

For example, she points out that 33 percent of North American women are using CAM treatments, a $21 billion industry offering interventions that have not been examined properly for effectiveness and safety.

Hess wants to learn more about what happens to impact the quality of life for women as they go through menopause. “My hypothesis is that as women enter menopause they report having a decline in the quality of their lives, particularly physical and emotional declines, which reverses during the late post-menopause period (age 60 and older).” So far, Hess has discovered that women who have stronger social networks have reported a higher quality of life while going through menopause. “But we still need to see how these attitudes relate to menopausal symptoms,” she said.

Hess advises women who are experiencing discomfort from menopause to consult their physician for treatment.

—Mary Ann Thomas

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