CBT was found to reduce the frequency and severity of hot flushes and night sweats and should be considered alongside or as an alternative to HRT, the draft guidance says.
It was also found to help sleep problems related to menopause, including, how long it takes to fall asleep and how long before waking.
The draft guideline lays out clearly the risks and benefits of taking HRT that can be used to help people when they are discussing with their clinician whether to start HRT. Detailed tables lay out the evidence for effects on cardiovascular disease, stroke and dementia risks as well as cancers of the breast, ovary and womb.
The draft guideline highlights that, while it is important that people know about the risks associated with HRT, it is also important they are made aware it is unlikely to increase or decrease their overall life expectancy.
While there is some evidence around taking HRT and breast cancer risk in early menopause (ages 40 to 44), there is a lack of evidence about the effects of taking or not taking HRT on overall health outcomes in this age group. The committee therefore made a recommendation for more research to address this.
Professor Jonathan Benger, chief medical officer at NICE said: “The impact of menopause symptoms on quality of life can vary hugely. It is important that healthcare practitioners take a personalised approach when discussing treatments, using evidence-based information tailored to individuals’ circumstances.
“Today’s draft guideline recommends more treatment options for managing menopause symptoms as well as enabling a wider understanding of the risks and benefits of HRT so anyone going through menopause can choose the best care to suit them.”
Professor Gillian Baird, menopause guideline committee chair said: “This update includes important evidence-based information to help both women and healthcare practitioners during their discussions about the best treatment to manage their symptoms. This gives women more choice and enables them to make informed decisions for their personal circumstances.”
Minister for the Women’s Health Strategy, Maria Caulfield said: “The menopause is a key pillar of our Women’s Health Strategy – and from our work in this area we have already seen over 400,000 women benefit from cheaper HRT prescriptions and receive better access to specialised care through the roll-out of women’s health hubs.
“NICE’s updated guidance shows why research is so important in women’s health – so we can make sure women are offered the support that is right for them.
“That’s why between April 2022 and July this year we have invested £53 million into programmes to support women’s health, including research on male violence against women and girls.”
The updated draft guideline also includes new recommendations on the management of genitourinary symptoms such as dryness, painful sex and vaginal discomfort or irritation. A choice of vaginal oestrogen such as cream, gel, tablet, pessary or ring should be offered to women, trans men and non-binary people registered female at birth, including those on systemic HRT, and treatment should be continued for as long as it’s needed to relieve symptoms.
The draft updated menopause guideline is live for public consultation from 17 November 2023 to 5 January 2024.
Consultation | Menopause: diagnosis and management | Guidance | NICE
