Discussion aid to support clinical conversations about HRT published alongside updated guidance
NICE’s updated guideline on menopause, published today, emphasises the importance of an individualised approach and shared decision-making.
The guideline aims to support healthcare professionals by providing them with information they need to support evidence-based decisions about treatment choices, as well as information and support about menopause.
The guideline recognises that the experience of menopause varies considerably. For those over 40 seeking treatment for common symptoms, such as hot flushes and night sweats (known as vasomotor symptoms) or genitourinary symptoms, such as vaginal dryness, the guideline advises tailoring information about benefits and risks based on age, individual circumstances, and any potential risk factors. NICE emphasises the importance of only prescribing hormone replacement therapy (HRT) within licensed doses.
While HRT is the most effective treatment for vasomotor symptoms, the guideline also recommends that for people over 40 healthcare professionals should consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms associated with menopause in addition to HRT. It can also be considered for people for whom HRT is not advised, or for those who prefer not to take HRT.
While HRT is effective for symptoms, it should not be used for the prevention of cardiovascular disease or dementia.
NICE has today also published a new discussion aid to support shared decision making about HRT, focusing on the key risks and benefits to consider. The guideline clarifies that whilst HRT has some risks, it is unlikely to increase or decrease overall life expectancy.
The guideline also clarifies when cognitive behavioural therapy (CBT) may be of benefit for vasomotor symptoms and may also benefit sleep and mood.
Recognition of the impact that menopause symptoms can have has grown in recent years, but we know that there remains more to be done to improve the consistency and quality of support. Not least for women from minority ethnic backgrounds or from a poorer area, who are often unaware of or unable to access treatments that could help them.
This useful and useable guidance aims to bring together the latest evidence-based recommendations for the management and treatment of menopause symptoms. It stresses the importance of promoting equitable access to effective care by considering factors such as ethnicity and recognising the diverse needs of different community groups.
Alongside the guideline we have produced a discussion aid for GPs to help them offer personalised advice to women considering starting HRT.
Women need to feel confident that when they talk to a GP about their symptoms, they will be offered advice and options that meet their needs and supported to make choices that are right for them.
Those considering treatment for menopausal symptoms should have access to the highest quality evidence to inform their decisions. Menopause care should be individualised. This updated NICE guideline provides new evidence to support informed choices, clarifies the risks and benefits of HRT and the role of CBT for vasomotor symptoms. The guidelines include a new discussion aid to support shared decision making.
The updated guideline also includes new recommendations on the management of genitourinary symptoms such as vaginal dryness, painful sex and vaginal discomfort or irritation. The guideline includes a visual summary so health professionals treating women with and without a history of breast cancer can find the options that best suit them.