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July 31, 2002


Menopause Is A Normal Stage of Life; HRT Is Not Recommended to Prevent Heart Disease in Women, Says NIH International Expert Panel Headed by Emory Cardiologist

Most women today live long enough to become menopausal, and because they do, menopause should not be treated as a disease, but rather a normal physiologic event in a woman's life that offers physicians the opportunity to assess a woman's health and her need for health promotion and disease prevention measures, according to Nanette K. Wenger, M.D., professor of medicine in the Division of Cardiology at the Emory University School of Medicine, and chief of cardiology at Grady Memorial Hospital in Atlanta.

Dr. Wenger is chairperson of the NIH Expert Panel and senior editor of the monograph, entitled Women's Health and Menopause: A Comprehensive Approach. The co-editors are Dr. Claude Lenfant, director of National Heart, Lung, and Blood Institute; Dr. Vivian Pinn, NIH Office of Research on Women's Health; and Dr. Rodolfo Paoletti of the Giovanni Lorenzini Medical Science Foundation of Milan, Italy. The group's final position paper has been posted this week on the NIH Web site at:

"The unique contribution of this monograph is that it is evidence-based," Dr. Wenger said. "For each of the recommendations cited, the level of evidence is provided and specific citations to the literature are offered. This provides the clinician with a spectrum of evidence to enable a multi-disciplinary approach to the enhancement of menopausal health."

In the area of coronary heart disease, the position paper indicates that there is no definitive evidence-based rationale to recommend hormone replacement therapy for the prevention of coronary heart disease, and that coronary heart disease prevention should rely on identifying and treating the classic risk factors. With regards to stroke, the position paper asserts that hormone replacement therapy has not been consistently linked to stroke protection, and in the first clinical trial in women with prior stroke, there was no reduction in risk for a recurrent stroke resulting in death, and a likely increased risk for more severe strokes in the first few months after initiation of therapy.

The paper also points to evidence that hormone replacement therapy increases the risk of venous thromboembolism (blood clots).

The paper also addresses the issue of osteoporosis, making the bones fragile and susceptible to fractures.

"The question of choosing among estrogen preparations and other medications, including raloxifene, bisfosphonates, and calcitonin, remains challenging for the individual patient," says Dr. Wenger.

"There is no one-size-fits-all solution. The patient and her physician should consider for the issues of prevention versus treatment, the need for bone-specific versus broad-spectrum effect, what sort of tradeoffs are acceptable to the patient, her individual tolerance for the various drugs available to us, and cost," Dr. Wenger said.

The position paper is a cooperative venture between the National Heart, Lung and Blood Institute, the NIH Office of Research on Women's Health, and the Giovanni Lorenzini Medical Science Foundation of Milan. The paper represents the culmination of seven years of cooperation between the three organizations in a public/private partnership in the development and co-sponsorship of four international conferences on Women's Health and Menopause since the mid-1990s. All four conferences have addressed not only cardiovascular disease, but other health problems such as cancer, osteoporosis, and Alzheimer's disease, as well as the impact of hormone replacement therapy.

The topics addressed in the monograph include menopause and aging, symptoms and the menopause; sociocultural issues; physiological role of estrogen and estrogen receptors and pharmacologic modulation of estrogen receptor activity; sexuality; cardiovascular and pulmonary disease osteoporosis and oral bone loss; risks and therapy; gynecologic and urologic aspects; menopausal therapies and cancer; neurological function; mental health; and eye.

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