Research on the menopause in the 1990s
Report of WHO Scientific Group
An expert assessment of what is known about the menopause, its immediate and long-term effects on health, and the possibilities for their treatment and prevention. Noting the many methodological problems surrounding research on the menopause, the report makes a special effort to separate those areas where firm conclusions can be reached from those where questions remain and further research is needed. Particular attention is given to the risks and benefits of hormone therapy.
The report has twelve sections. Methodological problems are addressed in the first, which considers the strengths and weaknesses of various investigative approaches and explains why certain designs are more likely to yield reliable results. Subsequent sections review the demography of the menopause and summarize what is known about the endocrinology of the normal menopause. A section on symptoms and their treatment underscores the importance of distinguishing between symptoms that result from loss of ovarian function and symptoms that arise from the ageing process or from the socio-environmental stress of the mid-life years.
The most extensive sections attempt to resolve some of the controversy surrounding the use of hormone therapy to reduce the risks of osteoporotic fractures and cardiovascular diseases while also answering the question of whether hormone therapy increases the risk of breast cancer, endometrial cancer, and other gynaecological cancers. Information ranges from advice on calcium and vitamin D supplementation for the prevention of osteoporosis, to estimates of the increase in relative risk of breast cancer among women using estrogens alone for different lengths of time.
The report concludes with a balanced discussion of strategies for managing the health consequences of the menopause, emphasizing the need for a clear distinction between short-term therapeutic and long-term preventive goals, since the risks and benefits of the two types of therapy are very different.