Menopause Guidelines – just what we’ve been waiting for! Up to date research and guidance.
NICE have issued the first guidelines on menopause, to stop women suffering in silence (National Institute for Health and Care Excellence). If you haven’t already seen these new guidelines and related information they are a must read.
We are thrilled to have gained permission from NICE to include this information on our site. Many of our readers are unaware of the facts around menopause and treatments such as HRT and we hope this article will give you the knowledge you need to make the right decisions for yourself, with advice from your GP.
No two women are the same and what is right for one may not be right for another. These guidelines will give you the facts to go and discuss with your doctor to enable you to come to the right choice for you. There really is no need to suffer in silence!
Let’s start by letting you know how to spot the signs of menopause:
So What Are The NICE Guidelines All About
The National Institute for Health and Care Excellence (NICE) has published wide-ranging recommendations for the NHS on the support, information and treatments needed to address the often debilitating symptoms that women suffer. The guideline (click here to see the full recommendations for the NHS) covers determining if menopause has started, the drug and non-drug treatment options that help with physical and psychological symptoms, and it provides clarity on the benefits and risks of taking HRT (hormone replacement therapy).
The guideline also focuses on the often overlooked needs of women aged under 40 experiencing premature menopause, and women who have menopause triggered as a result of treatment for hormone-dependent cancer or gynaecological conditions.
Menopause is when a woman stops having menstrual periods as she reaches the end of her natural reproductive life. The decrease in oestrogen levels can cause problems like hot flushes and vaginal dryness, and may lead to long-term conditions including cardiovascular disease (CVD) and osteoporosis (brittle bones).
An estimated 1.5 million women – around 80% of those going through menopause – experience some symptoms, which typically continue for around 4 years after the last period. But for around 10% of women, symptoms can last for up to 12 years. The average age for menopause in the UK is 51 but it can vary widely depending on lifestyle and ethnicity, and premature menopause affects 1 in 100 women under the age of 40.
Christine Carson, Programme Director at NICE’s Centre for Clinical Practice said: “This is the first NICE guideline which covers the diagnosis and management of menopause, which women will experience at some stage during their lives. Menopause symptoms may severely affect a woman’s health and quality of life. Women don’t always get the help they need from their GP, practice nurse or hospital specialist to manage their symptoms but this guideline recommends effective treatments which can help. The message to women is clear – talk about the menopause with your clinician if you need advice on your symptoms – it’s very important to discuss the options to find what might help you.”
Professor Mary Ann Lumsden, chair of the expert group which developed the NICE guideline, professor of gynaecology at the University of Glasgow and honorary consultant gynaecologist at Glasgow Royal Infirmary, said: “The NICE recommendations are based on a thorough assessment of all important literature, and are the gold standard in managing menopause. The guideline covers the treatment of symptoms and also looks again at the place of HRT in treating menopausal women. It emphasises that, for most women, HRT is a very effective treatment for several menopausal symptoms, for example hot flushing and also reduces the risk of osteoporotic fracture. The guideline outlines that menopausal women should be informed that the impact of HRT on the risk of breast cancer varies with the type of HRT used as does the risk of cardiovascular disease. Since risk varies from one woman to another, lifestyle factors that might be important should also be discussed. Every woman who is worried about the effects that menopause is having on her life must be given the chance to find if there’s an option that works for her.”
Dr Imogen Shaw, a GP with special interest in gynaecology and NICE guideline developer said: “For the last decade, some GPs have been worried about prescribing HRT, and women worried about taking it. I hope that this new NICE guideline will empower women to talk to their GP or practice nurse about menopause and provide them with information on the range of options that could help. For health professionals, the guideline should boost their confidence in prescribing HRT, having fully discussed the woman’s individual circumstances with her.”
if there’s no improvement after trying treatments, and a referral considered if a woman has menopausal symptoms but HRT is contraindicated (for example, in women with hormone-sensitive cancer), or the most suitable option is uncertain.
Guideline recommendations include:
- In otherwise healthy women aged over 45 years with menopausal symptoms, diagnose the following without laboratory tests: perimenopause based on vasomotor symptoms (hot flushes and night sweats) and irregular periods; menopause in women who have not had a period for at least 12 months and are not using hormonal contraception; menopause based on symptoms in women without a uterus
- Offer women HRT for hot flushes and night sweats after discussing risks and benefits
- Consider HRT to ease low mood that arises as a result of the menopause, and consider cognitive behavioural therapy (CBT) to alleviate low mood or anxiety
- Explain that oestrogen-only HRT has little or no increase in the risk of breast cancer, whilst HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer, but any increased risk reduces after stopping HRT
- Women with cardiovascular risk factors should not automatically be excluded from taking HRT. Ensure that menopausal women and healthcare professionals involved in their care understand that HRT does not increase cardiovascular disease risk when started in women aged under 60 years, and it does not affect the risk of dying from cardiovascular disease.
Women should be referred to a menopause specialist if there’s no improvement after trying treatments, and a referral considered if a woman has menopausal symptoms but HRT is contraindicated (for example, in women with hormone-sensitive cancer), or the most suitable option is uncertain.
Life Begins At are delighted these guidelines, published in November 2015, have been released and are keen to get as many women reading them and using them as possible. We shouldn’t beat ourselves up because we feel we aren’t coping or are worried about talking to our Doctor’s about HRT and other menopause treatments. Other information can also help – see the Life Begins At self help book review Dr Myra Hunter’s Managing Hot Flushes & Night Sweats. Menopause can be debilitating and can require treatment like any other health problem.
NICE have also released an Information for Patients version of the guideline, which suggests points that women may find helpful to discuss with their doctor or nurse. This is an excellent resource for anyone who has any questions about the Menopause and will help to point you in the right direction to get the answers you need. It is available at http://www.nice.org.uk/guidance/ng23/informationforpublic
We hope this article and the various links prove useful and informative. Please share with any friends or family who may also benefit.
If you have any questions or just want to share your thoughts or own experiences, we would love to hear from you, either comment below or go to the Forum section of our site and post in there. The more we get this subject out in the open the quicker we break the taboo and stop women suffering the menopause in silence.