NICE has published its updated menopause guideline for public consultation.
The draft guideline lays out clearly the risks and benefits of taking HRT that can be used to help people when they are discussing whether to start HRT with their clinician.
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 has made a recommendation for more research to address this.
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.
It also includes new evidence which shows that cognitive behavioural therapy (CBT) can help reduce menopause symptoms including hot flushes and night sweats, depressive symptoms and problems sleeping. 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.
