RITA RUBIN

BETHESDA, Md:

Considering that every woman confronts menopause if she lives long enough, surprisingly little is known about it.

Clearly, women’s menopause experiences vary widely, but it’s not clear why. Some sail through with nary a hot flash (or flush, depending on where you live), while others have hundreds a week. Hot flashes usually subside after a few years. But for some, they last through old age.

For those with intolerable hot flashes and night sweats, estrogen is the most effective treatment, but doctors aren’t certain about how much to take, how long to take it or how best to get off of it.

Genetics plays a role Genetics, hormones and social factors all probably play a role in whether perimenopausal women have symptoms, said University of Pittsburgh psychologist Karen Matthews.

Few women in India or Japan report having menopause symptoms, noted Nancy Avis, professor of social sciences and health policy at Wake Forest University School of Medicine. In an ongoing study of more than 16,000 middle-aged US women, those of Japanese or Chinese descent have been less likely to report symptoms, but it’s “almost impossible” to explain why, Avis said.

Sorting menopause symptoms from aging symptoms is tricky. For example, incontinence is more common in older women, said University of Iowa endocrinologist Bradley Van Voorhis.

Estrogen’s uncertain role

Most women don’t get depressed during perimenopause, and researchers have not yet identified characteristics that might predict who will, said Peter Schmidt, chief of reproductive endocrine studies at the National Institute of Mental Health. Studies have shown that three to six weeks of estrogen therapy improves the mood of depressed perimenopausal women but not postmenopausal women, Schmidt said.

Although estrogen is the most effective treatment for menopause symptoms, conference speakers cited a lack of information about how to take it.

Women have numerous products to choose from, said Marcia Stefanick, professor of obstetrics and gynecology at the Stanford University School of Medicine. “Many women would like to know which one of these is the best for me,” she said. “Side-by-side comparisons of the many available products haven’t been done.” Part of the problem, Stefanick said, is that Food and Drug Administration guidelines for testing new estrogen-containing therapies exclude symptomatic perimenopausal women.

University of California-San Francisco internist Deborah Grady noted that symptoms often resume when women stop hormone therapy. “It treats symptoms essentially by delaying menopause,” Grady said. “They may have to flush now or flush later if they’re going to go on hormone therapy.” — USA Today