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' recommendations: 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: http://www.isciii.es/aets/

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: 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;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias