Women with menopause should be offered hormone replacement therapy (HRT) as the ‘preferred, recommended’ approach, UK’s health watchdog has said.
The new guidance by the National Institute for Health and Care Excellence (NICE) comes after draft guidance in 2023 suggested cognitive behavioural therapy (CBT) as an alternative to HRT, which was termed ‘disappointing’ and ‘controversial’ by healthcare professionals.
Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines at NICE said: ‘We have revised the guideline to be really clear that CBT is an adjunct, it’s an add-on therapy, and it can help people manage the symptom, in addition to HRT, or some women may choose not to take HRT, or they may not be able to take HRT, and therefore that’s where CBT can be useful.
‘But we are very keen to emphasize that HRT is our recommended first-line therapy for vasomotor symptoms (hot flushes and night sweats) and for symptoms of menopause.’
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As women approach the menopause, their periods permanently stop. This leads to fluctuations in the hormone oestrogen, which can cause problematic symptoms such as hot flushes, vaginal dryness, muscle aches, recurrent urinary tract infections and difficulty sleeping.
HRT replaces the hormones oestrogen or progestogen, or both. It is administered using gels, creams, pessaries, tablets, patches or sprays and is sometimes prescribed during perimenopause, as the hormones start to fluctuate before menstruation stops.
In November last year, NICE draft guidelines suggested that talking therapy or CBT could replace HRT. However, after feedback and analysis of benefits and risks of HRT, the new guideline recommends offering talking therapy to women over 40 alongside HRT or, if the patient's individual circumstances call for it.
Dr Marie Anne Ledingham, consultant clinical adviser to NICE, said that an independent panel assessed available scientific evidence to come up with guidance on HRT. Even though there are risks, they found that the drugs do no affect life expectancy. ‘The risks are very low in the population, and HRT can provide huge benefits at a very difficult point in many women's lives,’ said Dr Ledingham.
While HRT prescriptions have increased by 22% in the UK in 2023/2024, Professor Benger called for improved support for women from ethnic minority backgrounds and from poorer areas who may be unaware of or unable to access treatments.
‘Women need to feel confident that they will be offered advice and options that meet their needs, and that they will be supported to make the choices that are right for them,’ he said.