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Guideline of the month – NICE menopause guideline

hrt patch 3x2

The guideline

This is the first time NICE has offered guidelines on the menopause. The document seeks to ensure women ‘get the help they need from their GP to manage their symptoms’.

Key points for GPs

• Offer women HRT as first-line treatment for vasomotor symptoms, after a discussion of the short- and long-term benefits and risks.

• GPs should also offer HRT as an option for psychological symptoms that result from the menopause.

• Women should be told that the risk of venous thromboembolism is greater with oral HRT, compared with the baseline population risk. The risk for HRT in patch form, at standard doses,

is no greater than the population risk.

• Ensure women understand that HRT does not increase risk of cardiovascular disease when it is started in those under 60.

• HRT with oestrogen and progestogen can be associated with an increased risk of breast cancer, but this risk is related to treatment duration and reduces after stopping HRT.

• Do not routinely offer SSRIs, SNRIs or clonidine for vasomotor symptoms.

Practical issues

The implication that GPs have been underusing HRT, combined with coverage of the new guidance in the media, could prompt more women to attend practices seeking to discuss HRT.

Expert comment

Dr Anne Connolly, GPSI in gynaecology in Bradford and chair of the Primary Care Women’s Health Forum, said: ‘I think this guideline is extremely important for women and long overdue. Many women have suffered with significant menopausal symptoms since the adverse publicity caused by the Women’s Health Initiative study in 2002, as they have been unsure about the safety of HRT and their busy GPs have been reluctant to prescribe it. This guideline provides up-to-date evidence and recommendations for women and their primary care clinicians to allow an informed decision to be made.

‘The Primary Care Women’s Health Forum is supportive of this guidance, which we feel will stop many women suffering in silence.’

The guideline

NICE. NG23: Menopause – diagnosis and management. London: NICE; 2015