Evidence-based medicine and the management of 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.