Discussion tool to support clinical conversations about HRT, published alongside updated guidelines

The guideline aims to support healthcare professionals by providing them with the information they need to support evidence-based decisions about treatment choices, as well as information and support about menopause.

The guideline recognizes that the experience of menopause varies considerably. For people over 40 seeking treatment for common symptoms such as hot flashes and night sweats (known as vasomotor symptoms) or symptoms such as vaginal dryness, the guideline recommends tailoring information about the benefits and risks based on age, individual circumstances and any risk factors. . It emphasizes the importance of only prescribing hormone replacement therapy (HRT) within the permitted dosages.

Although HRT is the most effective treatment for vasomotor symptoms, the guideline also recommends that healthcare professionals over 40 should consider menopause-specific cognitive behavioral therapy (CBT) as an option for vasomotor symptoms associated with menopause, in addition to HRT. It may also be considered for people for whom HRT is not advised, or for those who prefer not to use HRT.

Although HRT is effective in treating symptoms, it should not be used for the prevention of cardiovascular disease or dementia.

We have also today published a new discussion tool to support shared decision-making about HRT, focusing on the key risks and benefits to consider. The guidance clarifies that while HRT carries some risks, it is unlikely to increase or decrease overall life expectancy.

The guideline also clarifies when cognitive behavioral therapy (CBT) can be useful for vasomotor symptoms and can also benefit sleep and mood.

Recognition of the impact that menopausal symptoms can have has increased in recent years, but we know that more needs to be done to improve the consistency and quality of support. Not least for women from an ethnic minority background or from a poorer area, who are often unaware of or unable to access treatments that could help them.

This useful and actionable guideline aims to bring together the latest evidence-based recommendations for the treatment and management of menopausal symptoms. It highlights the importance of promoting equal access to effective care by considering factors such as ethnicity and recognizing the diverse needs of different community groups.

In addition to the guideline, we have created a discussion tool for GPs to help them provide personalized advice to women considering starting HRT.

Women should be confident that when they talk to a GP about their symptoms, they will receive advice and options that meet their needs, and be 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. Menopausal care must be individualized. This updated NICE guidance provides new evidence to support informed choices, clarifies the risks and benefits of HRT and the role of CBT in vasomotor symptoms. The guidelines include a new discussion tool to support shared decision-making.

The updated guideline also includes new recommendations for treating urogenital symptoms such as vaginal dryness, painful sex and vaginal discomfort or irritation. The guideline includes a visual summary so that healthcare providers treating women with and without a history of breast cancer can find the options that are best for them.