Ongoing/Future Research on Menopause

To gather more data to help women make a well-informed decision regarding hormone therapy, researchers at the National Institutes of Health (NIH) launched the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) in 1989. With 127 women enrolled at each of seven medical centers, PEPI will address the short-term safety and efficacy of various methods of HRT. The study will compare women who take estrogen by itself to those who take it with different types of progestin. It will also examine the effects of both cyclical and continuous progestin on cardiovascular risk factors, blood clotting factors, metabolism, uterine changes, bone mass, and general quality of life.

Several new studies are looking at normal body changes as women move from pre- to postmenopause. Up to now, the lack of such data has been one problem in assessing the value of HRT. Without knowing what "normal" is, scientists have difficulty judging the effect of a particular treatment. Another problem with past studies is the "healthy user effect." In many trials preceding PEPI, the HRT users studied had freely chosen to begin treatment, with advice from their doctors. In general, most physicians discourage women with a preexisting illness or long family history of breast cancer from taking HRT. This factor could skew study results to appear that nonusers became ill or died more frequently simply because they failed to take estrogen. Only by randomly assigning study participants to the treatment can this bias be overcome. Until more random trials are completed, the jury is still out on HRT.

Another NIH study is the Women's Health Initiative, a multicenter trial involving 70,000 postmenopausal women ages 50 to 79. The study will assess the long-term benefits and risk of hormone therapy as it relates to cardiovascular disease, osteoporosis, and breast and uterine cancer. It will also help determine the effects of calcium supplementation, dietary changes, and exercise on women in this age group. Some of the specific questions to be addressed by the Women's Health Initiative include:

• How long is estrogen effective for each system of the body (skeletal, cardiovascular, nervous, endocrine)?
• What is the best dose and route of administration of estrogen and progestin to prevent side effects yet maintain efficacy?
• How long is estrogen safe to take?
• Does estrogen act the same way in older women as in younger women?
• Are there effective alternatives to HRT?

Clearly, no one has all the answers about menopause. Medical research is beginning to give us more accurate information, but some myths and negative attitudes persist. Women are challenging old stereotypes, learning about what's happening in their bodies, and taking responsibility for their health. The important thing to remember as you go through menopause is to be good to yourself. Take time to pursue your hobbies, be they gardening, painting or socializing with friends. Have a positive attitude toward life. Sharing concerns with friends, a spouse, relatives or a support group can help. Don't fight your body--allow the changes that are happening to become a part of you, a part that is natural and that you accept.

Many women feel that their physicians do not listen to their concerns. Nor do they give them enough information to make an educated decision about hormone therapy.