New NICE Guidelines Could Help More Women Benefit from HRT
New guidelines from the National Institute for Health and Care Excellence (NICE) are being published to help more women receive the treatment they need to manage the symptoms of the menopause. The guidance could lead to thousands more women being offered hormone replacement therapy (HRT) in the UK.
An estimated 1.5 million women – around 80% of those experiencing the menopause – have some symptoms, while 20% suffer more severely. Symptoms typically last for around four years but in some cases can last as many as twelve. However, in the last decade, research which has suggested a link between HRT and breast cancer has led to a halving of the numbers of women taking the drugs.
The new guidance aims to tackle these declining numbers. The NICE guideline committee says that too many women are suffering unnecessarily with debilitating menopausal symptoms because they are not being prescribed drugs which could relieve them. They say that women should be able to make up their own minds about whether or not to take HRT after discussing the potential benefits and risks with their doctor.
The guidelines also highlight the importance of doctors assessing the appropriateness of HRT and other treatments based on each woman’s personal circumstances, and of addressing the needs of women who experience premature menopause.
The new recommendations include:
- Diagnosing healthy women aged over 45 years with menopausal symptoms as entering menopause if they experience hot flushes and night sweats
- Diagnosing women with menopause if they have not had a period for at least 12 months and are not using hormonal contraception
- Offering women HRT for hot flushes and night sweats after discussing the risks and benefits with patients
- Considering offering women HRT to ease low mood that arises as a result of the menopause, and considering cognitive behavioural therapy (CBT) to alleviate low mood or anxiety
- Explaining to women 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, which reduces again after stopping HRT
- Not automatically excluding women with cardiovascular risk factors from taking HRT, and explaining that HRT does not increase cardiovascular disease risk when started in women under the age of 60
- Referring women who have had breast cancer and have menopausal symptoms to a specialist to see what treatment is suitable for them
The guidelines also stress that women who have been prescribed menopause treatments but found them ineffective should be referred to a menopause specialist.
“Women should not feel they have to suffer in silence when menopause is affecting their daily lives at work and at home,” says Dr Imogen Shaw, a GP with a special interest in gynaecology who helped develop the guidelines. “The effects of menopause are often misunderstood and underestimated – it can impact on health significantly in both the long term and short term.”
Dr Heather Currie, chair of the British Menopause Society, says: “Our hope is that the guideline will play an important role in raising awareness of all menopausal symptoms, will encourage women to consider lifestyle changes to improve later health, and will clarify uncertainty around both prescribed and non-prescribed treatment options.”