Menopause: identification and management

Research recommendations coming out of this guidance

• Women with breast cancer:- What is the safety and effectiveness of alternatives to systemic HRT as treatments for menopausal symptoms in women who have had treatment for breast cancer?

• For people with a personal history of breast cancer, or at high familial or genetic risk of breast cancer, does vaginal oestrogen for genitourinary symptoms associated with menopause increase the risk of recurrence or incidence of breast cancer?

• Does the person's age at menopause or the time between the person's menopause and their first use of HRT affect the long-term risk of coronary heart disease in people who take or have taken combined HRT?

• Does the person's age at menopause or the time between the person's menopause and their first use of HRT affect the long-term risk of coronary heart disease in people who take or have taken oestrogen-only HRT?

• What is the safety and efficacy of vaginal laser treatment for genitourinary symptoms associated with menopause?

• What is the impact of HRT on health outcomes for trans men and non-binary people registered female at birth (who are not taking gender-affirming hormone therapy at the time of taking HRT or in the follow-up period) in relation to:

  • cardiovascular disease

  • stroke

  • breast, endometrial and ovarian cancer

  • dementia

  • all-cause mortality?

• What is the impact of HRT on health outcomes for people from ethnic minority backgrounds in relation to:

  • cardiovascular disease

  • stroke

  • breast, endometrial and ovarian cancer

  • dementia

  • all-cause mortality?

• Effects of HRT on breast cancer risk:- What is the difference in the risk of breast cancer in menopausal women on HRT with progesterone, progestogen or selective oestrogen receptor modulators?

• Effects of HRT on venous thromboembolism risk:- How does the preparation of HRT affect the risk of venous thromboembolism (VTE)?

• Effects of HRT on dementia risk:- What are the effects of early HRT use on the risk of dementia?

• Premature ovarian insufficiency:- What are the main clinical manifestations of premature ovarian insufficiency and the short- and long-term impact of the most common therapeutic interventions?

• What is the effect of either taking or not taking hormone replacement therapy (HRT) on health outcomes for people experiencing early menopause (aged 40 to 44)? 

• Do different types of progestogen (for example, micronised progesterone) alter the risks of breast cancer or cardiovascular disease?

• Do different modes of administration of combined HRT alter the risks of breast cancer, coronary heart disease or dementia? 

• Do different modes of administration of oestrogen-only HRT alter the risks of breast cancer, coronary heart disease or dementia? 

• What is the safety of vaginal oestrogen use for longer than 12 months?