NICE Emphasizes HRT as Primary Menopause Treatment

The health assessment organization NICE has emphasized to general practitioners (GPs) that hormone replacement therapy (HRT) ought to be presented as the initial treatment choice for alleviating menopause symptoms. Within its revised guidelines, talking therapy is outlined as a supplementary form of assistance. Following an in-depth examination of data concerning connections between HRT and conditions like heart disease, stroke, certain cancers, and dementia, NICE determined that HRT has no impact on life expectancy. The guidelines incorporate a novel discussion tool designed to assist GPs in providing patients with the most pertinent information regarding HRT medications and their functions. HRT substitutes the hormones oestrogen or progestogen, or both, when women cease menstruating—typically between the ages of 45 and 55. This treatment is administered via gels, creams, pessaries, tablets, patches, or sprays and is occasionally prescribed during perimenopause, when hormone levels begin to fluctuate prior to the complete cessation of menstruation. In its updated menopause guidelines, NICE (the National Institute of Health and Care Excellence) states that healthcare professionals must consider a woman’s individual circumstances and furnish all necessary information to enable her to make the most appropriate treatment decision. The guidance explicitly states that HRT serves as the preferred treatment option for hot flushes and night sweats resulting from menopause. Talking therapy, specifically CBT (cognitive behavioural therapy), is to be made available to women over 40 either concurrently with HRT or, if a patient’s particular situation necessitates it, as an alternative. This represents a modification from the draft guidelines, released in late 2023, which generated debate by proposing that talking therapy might substitute HRT as a treatment. The volume of feedback NICE received regarding that specific issue resulted in a longer-than-customary delay in the publication of the definitive guidance. The document underscores that despite certain elevated risks associated with HRT use, it is improbable to either extend or reduce overall life expectancy. Readily understandable illustrations depicting the probability of developing specific health conditions are included. These are designed to facilitate informed discussions between GPs and patients. Dr. Marie Anne Ledingham, a consultant clinical adviser to NICE, clarified that an independent panel evaluated the available scientific evidence to formulate this information. She stated that the likelihood of coronary heart disease, stroke, and ovarian and endometrial cancer was not elevated among women aged 45 and above using combined HRT, in contrast to those who had never used it. Furthermore, HRT actually diminished the risk of fractures associated with osteoporosis, a bone condition more prone to developing post-menopause. However, the risk of breast cancer for women did show a slight increase, impacting: The risk of dementia was also marginally elevated if women initiated HRT after the age of 65. Among younger patients, no increased risk of developing dementia was observed. “The risks are very low in the population, and HRT can provide huge benefits at a very difficult point in many women’s lives,” Dr Ledingham stated. HRT prescriptions have seen substantial growth in the UK in recent years. Professor Jonathan Benger, chief medical officer at NICE, noted that understanding of the effect menopause symptoms can have on women has increased in recent years. Nevertheless, he indicated that further efforts could be made to enhance support for women from ethnic minority backgrounds and economically disadvantaged regions “who are often unaware of or unable to access treatments that could help them”. “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,” Prof Benger commented. Copyright 2024 BBC. All rights reserved. The BBC disclaims responsibility for the content of external websites. Details on their external linking policy are available.