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Clinicians urged to 'look again' at HRT as treatment option for menopause symptoms

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The National Institute for Health and Care Excellence has called on health professionals to discuss the benefits and risks of hormone replacement therapy with patients going through the menopause.

NICE highlighted that HRT could be an option for many menopausal women and suggested some were “suffering in silence” because of a reluctance among health professionals to use the treatment in the wake of research linking it to cancer and cardiovascular risk.

The institute has today published its first clinical guideline on diagnosing and managing menopause.

“For most women, HRT is a very effective treatment for several menopausal symptoms”

Ann Lumsden

The guideline covers determining if menopause has started, the drug and non-drug treatment options that help with physical and psychological symptoms, and provides clarity on the benefits and risks of taking hormone replacement therapy.

The guideline also focuses on the needs of women aged under 40 experiencing premature menopause, and women who have menopause triggered as a result of treatment for hormone-dependent cancer or gynaecological conditions.

NICE noted that menopause symptoms, such as hot flushes, typically continued for around four years after the last period. But for around 10% of women, symptoms can last for up to 12 years.

Professor Mary Ann Lumsden, chair of the expert group which developed the NICE guideline, described the document as the “gold standard in managing menopause”.

She said: “It emphasises that, for most women, HRT is a very effective treatment for several menopausal symptoms, for example hot flushing and also reduces the risk of osteoporotic fracture.


Question mark over benefits of HRT for some women after menopause

Hormone therapy tablets

“The guideline outlines that menopausal women should be informed that the impact of HRT on the risk of breast cancer varies with the type of HRT used as does the risk of CVD,” said Professor Lumsden.

She added: “Every woman who is worried about the effects that menopause is having on her life must be given the chance to find if there’s an option that works for her.”

The guideline recommends offering women HRT for hot flushes and night sweats after discussing risks and benefits.

HRT should be considered to ease low mood that arises as a result of the menopause, and cognitive behavioural therapy should also be considered to alleviate low mood or anxiety

NICE said clinicians should explain that oestrogen-only HRT has little or no increase in the incidence of breast cancer, while HRT with oestrogen and progestogen can be associated with an increase in the incidence of breast cancer, but any increased risk reduces after stopping HRT.

In addition, it said women with CVD risk factors should not automatically be excluded from taking HRT.

“I hope that this new NICE guideline will empower women to talk to their GP or practice nurse about menopause”

Imogen Shaw

It said menopausal women and healthcare professionals should understand that HRT does not increase CVD risk when started in women aged under 60 years, and it does not affect the risk of dying from cardiovascular disease.

Women should be referred to a menopause specialist if there is no improvement after trying treatments, and a referral considered if a woman has menopausal symptoms but HRT is contraindicated or the most suitable option is uncertain, said the NICE guidance.

Dr Imogen Shaw, a GP with special interest in gynaecology and NICE guideline developer, said: “I hope that this new NICE guideline will empower women to talk to their GP or practice nurse about menopause.

“For health professionals, the guideline should boost their confidence in prescribing HRT, having fully discussed the woman’s individual circumstances with her,” she said.

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, added: “This guideline is a milestone for both healthcare professionals and women.”

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