Context

Guidance

Since the previous version of this guideline was published, new evidence that could affect recommendations was identified through NICE's surveillance process. Full details are set out in the surveillance review decisions from 2019 and 2021.

Menopause is the point at which menstrual cycles stop. Menopause usually happens in women, and in some non-binary and trans people, when they are aged 45 to 55, but can happen earlier, for example, because of surgery or medical treatment. The time period when symptoms first start and there are changes to the menstrual cycle is called perimenopause. Its duration varies, but it typically lasts a few years, and leads to menopause. Based on evidence, 3% to 8% of people experiencing menopause are estimated to have early menopause (perimenopause starting between 40 and 44 years), and 1% are estimated to have premature ovarian insufficiency (perimenopause starting before 40 years).

Menopause can affect people in a variety of ways. Most experience some symptoms, although not everyone seeks treatment. Some people have symptoms that may significantly impact their daily life, and they need treatment, for example, hormone replacement therapy (sometimes called HRT or menopause hormone therapy). Menopause symptoms may last for a long time, with a median duration of 7 years. Common symptoms associated with menopause are vasomotor symptoms (hot flushes and night sweats) and vaginal dryness.

In 2019, the Medicines and Healthcare products Regulatory Agency (MHRA) published a drug safety update on hormone replacement therapy based on the Collaborative Group on Hormonal Factors in Breast Cancer's 2019 meta-analysis of type and timing of menopausal hormone therapy and breast cancer risk, and this guideline takes this update into account.