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NICE supports HRT


Menopause Therapy: 'Don't Suffer Silently,' Says NICE
The National Institute for Health and Care Excellence (NICE) has issued its first-ever guidance on menopause , which emphasizes that help and information are available to women suffering from symptoms and that a range of treatment options, such as hormone-replacement therapy (HRT) as well as nondrug treatments, can be discussed with their doctors.

NICE notes that menopause is a gradual process that occurs on average, at age 51 in UK women, and it estimates that 80% of women going through perimenopause/menopause suffer from common symptoms such as hot flashes and night sweats. Other debilitating symptoms include mood changes, sleep disturbances, joint and muscle pain, and headaches.

Together these symptoms, which last 4 years on average but can affect 10% of women for up to 12 years, "can severely affect a woman's life. Yet the effects of menopause are often not fully understood. As a result, women do not always get the help they need from their general practitioner [GP], nurse, practice, or hospital specialist to manage their symptoms effectively," NICE notes.

The guidelines have had a lot of media coverage, in particular with regard to the issue of whether or not women should take HRT. Since the results of the Women's Health Initiative studies more than 10 years ago, which showed no cardiovascular benefit but showed an increase in breast-cancer risk, there has been a big decline in the number of women taking HRT for menopausal symptoms in the United Kingdom.

The NICE guidelines recommend that doctors:

Offer women HRT for hot flushes and night sweats after discussing risks and benefits.

Consider HRT to ease low mood that occurs as a result of menopause and consider cognitive behavioral therapy to alleviate low mood or anxiety.

Explain that oestrogen-only HRT has little or no increase in the risk of breast cancer, while HRT with estrogen and progestogen can be associated with an increase in the risk of breast cancer, but any increased risk reduces after stopping HRT. Specifically, it says there will be 17 more cases of breast cancer per 1000 menopausal women in current HRT users over 7.5 years (compared with no HRT).

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. Also ensure that women with cardiovascular risk factors are not automatically excluded from taking HRT.

Refer women to a menopause specialist if there's no improvement after trying treatments.