Sign Out: My days as a policy wonk

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Recently, I was privileged to spend several days on a National Institutes of Health consensus panel evaluating current evidence on menopause symptomatology.

I was one of the presenters to the Advisory Panel, which had only two ob/gyns on it. The Advisory Panel was composed of physicians from all areas of medicine as well as laypeople. The panel was sequestered during 2 days of presentations, subsequent discussions, and then worked into the wee hours drafting the statement. The panel's charge: Evaluate the state of knowledge about symptoms of menopause, identify gaps in knowledge, and suggest priorities for future research. As a presenter to the panel, I addressed key questions about the hormonal changes associated with menopause, symptoms that could be attributed to the menopausal transition, and medical evidence for effectiveness of treatment for menopause-related symptoms.

As a non-panel member, I found it somewhat awkward not to be able to communicate with my colleagues outside of the formal presentations and Q&A sessions. But the conference planners felt it necessary to discourage fraternization so as to maintain an "unbiased" review of the data. They also chose panelists for their ability to evaluate medical evidence and required that they have no history of receiving pharmaceutical company support in areas relevant to our deliberations.

As someone active in research on the menopausal transition, I was heartened by the panel's encouragement of treatment for symptoms of menopause and its call for more research. On the other hand, I felt that they could have gone further in endorsing more research in more controversial areas-such as sleep and depression-and their association with menopause. Women frequently bring these complaints to their ob/gyns yet we still have no practice guidelines with which to address them.

Many of the panel's recommendations were informed by the Women's Health Initiative, which remains the largest and most carefully performed study of its kind in postmenopausal women. While the panel was well justified in drawing conclusions from that study, it's still very difficult for individual ob/gyns to extrapolate the results of one trial to one patient. Many more questions remain about the menopause and we have many more opportunities for research. Among the questions raised by the panel for which we still need answers:

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