HRT should be the first line of treatment for menopause symptoms
Women with menopause symptoms should be offered hormone replacement therapy (HRT) as a first-line treatment instead of therapy, advises the National Institute for Health and Care Excellence (NICE).
In its final menopause guidelines for medics in England and Wales, released today, experts at NICE state that HRT is the preferred method for easing symptoms such as depression, sleep problems, hot flushes. HRT involves using oestrogen and progesterone to replace your body's own levels around the time of the menopause. It should be offered to women after comprehensive conversations with their GP.
Nice have reneged on controversial guidance released last November, which advised women with menopausal symptoms to seek cognitive behavioural therapy (CBT) 'alongside or as an alternative to' HRT. Suggesting that CBT was an equivalent treatment to HRT was criticised as diminishing women's symptoms and increasing health risks.
They implemented these changes following lengthy consultations with healthcare providers, researching bodies and patients. It now says CBT should only be considered for women on HRT who still have symptoms, or are unable or do not want to take HRT.
Prof Jonathan Benger, chief medical officer and interim director of the centre for guidelines at Nice, said: “We are not suggesting that CBT is an alternative to HRT. It’s not an either/or, and we have worked through the guidelines extensively to really clarify this point.'
'We are very keen to emphasise that HRT is our recommended first-line therapy for vasomotor symptoms [night sweats and hot flushes] and for [other] symptoms of menopause.'
Alongside the changed guidelines, the has developed a 'discussion aid' for GPs and patients, includes data on how HRT can increase the risk of health conditions like breast cancer and blood clots, while decrease osteoporosis risk of. A review found there were no links to increased heart disease, stroke or dementia when HRT was started at the typical time of menopause, between 45 and 55.
How do I access HRT?
If you are experiencing (peri)menopausal symptoms that are causing inconvenience or interference, visit the NHS website for more information and contact your doctor.
You can purchase HRT on an NHS prescription. Each item costs £9.90 as a one-off purchase.
If you are prescribed medication often, you could consider getting an HRT prescription payment certificate (HRT PPCs) from your GP for £19.80 for 12 months.
That will cover all your eligible HRT prescriptions for the year, no matter how many different medicines you need. A full list of HRT medicines covered by HRT PPCs can be found here.
According to the NHS, oestrogen comes as:
skin patches
a gel or spray to put on the skin
implants
tablets
Progesterone comes as:
patches, as part of a combined patch with oestrogen
IUS (intrauterine system, or coil)
tablets
Responding to the guidance, Labour MP Carolyn Harris, a previous shadow minister for women and equalities, said to The Guardian: 'I’m disappointed – it feels like a real step backwards.
'Nice are not listening to women. They fail to give a clear pathway to care and the reliance on CBT is, in my opinion, arrogant.'
Also unhappy was Mumsnet Founder and Chief Executive, Justine Roberts, who said the new guidelines risked the difficulties women had accessing treatment for menopause and perimenopause.
'It ignores the evidence on which medication is the safest, and continues to promote largely unavailable CBT to women who are suffering with the debilitating effects of low hormones. Nice must do more to ensure that women and doctors are equipped with the information they need.'
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