Pathological complications of menopause. IPE-95/03 (Public report)

Sez A, Conde J, Ruiz F, Cuadrado C, Saiz J, Sancho J
Record ID 31996008344
Authors' objectives:

According to the recent Royal Decree (Real Decreto) which establishes the basic public coverage of health care, pathological complications of menopause must be specifically covered. The issue raised by the Ministry of Health is to establish the content of this definition and the necessity to find a specific build-up, procedures and guide lines.

Authors' results and conclusions: In Spain each year 240,000 new women present a menopausal condition, with a life expectancy of 30 more years. If the symptoms and disturbances are so important that requires medical care, the menopause is named "pathological", as is the case of premature menopause. Because there is a hormonal deficit, hormonal replacement therapy (HRT) for specific climacteric disturbances had been claimed by some. Long term HRT is advocated to have a prophylactic benefit for two phenomenon that are not specific but coincidental within the menopausal condition: increased cardiovascular mortality and osteoporosis risks. However, the possible HRT benefits in quality of life and life-expectancy is counter-balanced with increased risk for cancer. The pros and cons of the arguments for the adoption to these therapies depends of two different questions. One of them is the variable personal concept of disease and quality of life. The other is the different interpretation of the scientific evidences. There is not available data from a large randomized controlled clinical trial for determining the risks and benefits for long term HRT. The actual evidence is based upon non-experimental studies whose conclusions are based in some assumptions therefore they solve uncertainties and therefore there is controversy and discussion.
Authors' recomendations: Short term HRT (lesser than 5 years) should probably be recommended for women with specific climacteric symptoms and long term therapy for women who have had a hysterectomy or premature menopause. For other women the best course of action is unclear. Bone densitometry as a screening diagnostic procedure to identify women at risk of hip fracture is not recommended on its poor positive predictive power.
Project Status: Completed
URL for project:
Year Published: 1995
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Absorptiometry, Photon
  • Climacteric
  • Coronary Disease
  • Densitometry
  • Estrogen Replacement Therapy
  • Menopause
  • Osteoporosis
  • Premenopause
Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias
Contact Address: Jose Luis de Sancho Martin, Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;
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Copyright: Agencia de Evaluacion de Tecnologias Sanitarias
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