Menopausal women could be offered behavioural therapy to ease symptoms

There should also be better understanding of the risks and benefits of hormone replacement therapy, a health care watchdog has said.

Women should be offered talking therapy on the NHS to combat the symptoms of menopause, according to new guidance.

They should also have a better understanding of the risks and benefits of hormone replacement therapy (HRT), the National Institute for Health and Care Excellence (Nice) said.

The spending watchdog recommended the use of cognitive behavioural therapy (CBT) – commonly used to help mental health issues – for some menopausal symptoms, and suggested it should be offered alongside or instead of HRT.

The move is expected to provide a wider choice of treatment, as well as allowing women to make more informed decisions about their care.

It is important that healthcare practitioners take a personalised approach when discussing treatments, using evidence-based information tailored to individuals’ circumstances

Professor Jonathan Benger, Nice

Menopause is when a woman stops having periods and is a natural part of ageing.

It usually happens between the ages of 45 and 55, with symptoms including changes to the menstrual cycle, mood swings, hot flushes and trouble sleeping, which can last for months or years and can change with time.

HRT replaces the hormones the body produces less of – oestrogen, progestogen or both – and can be administered using gels, creams, pessaries, tablets or sprays.

The risk of developing serious side effects on HRT are “very low” according to NHS England, although tablets can increase the risk of blood clots or stroke.

HRT can also lead to a small increase in the risk of breast cancer, as well as slightly increasing the risk of dementia if started at the age of 65.

Nice said there is evidence CBT can reduce the severity and frequency of hot flushes and night sweats, as well as sleeping problems.

The guidance says clinicians should offer patients face-to-face sessions, group sessions or online therapy, as well as advising on how they could self-help.

Professor Jonathan Benger, chief medical officer at Nice, added: “The impact of menopause symptoms on quality of life can vary hugely.

This gives women more choice and enables them to make informed decisions for their personal circumstances

Professor Gillian Baird

“It is important that healthcare practitioners take a personalised approach when discussing treatments, using evidence-based information tailored to individuals’ circumstances.”

The update is due to evidence around HRT becoming clearer since the last guidance on menopause was published in 2015, Nice said.

Its committee also noted that using CBT could benefit the NHS as people would be able to manage their own symptoms and would not require other ongoing treatments.

Professor Gillian Baird, menopause guideline committee chairwoman, added: “This update includes important evidence-based information to help both women and healthcare practitioners during their discussions about the best treatment to manage their symptoms.

“This gives women more choice and enables them to make informed decisions for their personal circumstances.”

However, GP and menopause specialist Dr Louise Newson said the document “is a disappointing draft update”.

“CBT may have a place when taking a holistic approach to managing the perimenopause, but it won’t improve every menopause symptom and won’t treat the underlying hormone deficiency,” she added.

“HRT is first line treatment to improve symptoms, which is clearly documented here.

“In addition to the numerous and often distressing symptoms, we must address the long-term health risks of low hormones.

CBT may have a place when taking a holistic approach to managing the perimenopause, but it won’t improve every menopause symptom and won’t treat the underlying hormone deficiency

Dr Louise Newson

“There is good quality, established evidence about the protective effects of HRT in relation to osteoporosis, heart disease, clinical depression and colon cancer, and there is emerging evidence around dementia risk also being reduced. These are ignored in this document, and the perceived risks of breast cancer stated in these draft recommendations are not based on good quality evidence.”

Dr Newson said women “deserve to be fully informed and involved at every step of their healthcare consultation” to make “an informed decision on the right treatment or combination of treatments for them”.

“While we have seen a rise in recent years in access to evidence-based treatments like HRT, a postcode lottery still exists, particularly for those from lower socio-economic backgrounds,” she added.

“The menopause is sorely under-researched and under-funded, and this must change. In the meantime, women deserve to have a choice, and those who want to take HRT should be able to have it prescribed, and frustratingly it is often more common for women to be prescribed antidepressants than HRT.”

Nice’s guidance comes after the Government published the Women’s Health Strategy, a 10-year plan to better understand women-specific issues and conditions.

Maria Caulfield, minister for the Women’s Health Strategy, said menopause is a “key pillar” of the blueprint.

“Nice’s updated guidance shows why research is so important in women’s health – so we can make sure women are offered the support that is right for them,” she added.

The draft guidance is open to public consultation until January 5 2024.