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Evidence-based Medicine and the Management of Menopause


Clinical Obstetrics and Gynecology: September 2008 - Volume 51 - Issue 3 - p 534-538
doi: 10.1097/GRF.0b013e3181809376
Evidence-Based Approach to Menopause

Although all clinicians should practice evidence-based medicine to assure the highest quality healthcare for our patients, there have been several misconceptions about what this really is, or what it should be. In some instances, the overreliance on a single randomized clinical trial (RCT), while ignoring a wealth of other literature resulted in erroneous conclusions. In many disease entities, results of RCTs and observational trials have rendered similar conclusions. Several weaknesses of RCTs and observational trials will be reviewed. In the area of menopausal medicine, a more in depth study of RCT data, including an appreciation of the type of population studied, the ages and risk factor status of the women participating, and the hormonal regimen tested, results in findings which are nearly identical to many observational trials. In the final analysis, no single study should be relied on solely to guide clinical practice. Understanding that there is a hierarchy of clinical data, the entire literature should be sought to provide the basis on which medicine is practiced.

Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York

Correspondence: Rogerio Lobo, MD, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, 16th Floor, New York, NY 10032. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.