National Institute for Health and Clinical Excellence (NICE)
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NICE opens consultation on draft menopause guideline

The National Institute for Health and Care Excellence (NICE) has today (Monday 1 June) opened a public consultation on its draft clinical guideline on the diagnosis and management of menopause.

Menopause is when a woman stops having menstrual periods as she reaches the end of her natural reproductive life. The resulting drop in the level of the sex hormone oestrogen can cause problems like hot flushes and vaginal dryness, and can also lead to long-term conditions including brittle bones (osteoporosis) and cardiovascular disease. The symptoms of menopause may severely affect a woman’s quality of life, requiring medical help from a GP or hospital specialist. Around 80% of women 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 of menopause in the UK is 51 but the age can vary widely – and premature menopause affects 1 in 100 women under the age of 40. The age of menopause varies by ethnicity: studies found that early menopause (between 40 and 45 years of age) affected 3.7% of African–American women, 2.9% of white women, 2.2% of Chinese women and 0.8% of Japanese women. 

The draft guideline covers when blood tests or imaging can help diagnosing menopause, and when treatments like hormone replacement therapy or other therapies should be offered.

Professor Mark Baker, Centre for Clinical Practice Director at NICE, said:“Menopause affects millions of women, and its symptoms can severely upset a woman’s day to day life. The effects of menopause are often misunderstood and underestimated – it can result in problems ranging from hot flushes to brittle bones, joint stiffness and cardiovascular disease.  

“When women seek medical help for their symptoms, there is considerable variation in what is offered to them. So NICE is pleased to be developing the first guideline for the NHS on diagnosing and managing menopause, to help improve the lives of women affected by it.” 

Draft recommendations include which tests can be used to diagnose menopause, and advice on offering holistic, individualised care that takes into account the woman’s symptoms and preferences. The draft guideline also highlights that clinicians should give support and advice to women who are likely to go through menopause as a result of medical or surgical treatment, including women with cancer, at high risk of hormone-dependent cancer or having gynaecological surgery. To help women and clinicians decide on what approaches are right for each individual, drug and non-drug treatment options are covered. This includes draft recommendations based on the benefits and risks of treatment with HRT, with specific information provided for women in various clinical circumstances. For example, it’s often considered that women at risk of hypertension or other cardiovascular conditions should not take HRT, but the draft recommendations propose that they shouldn’t automatically be prevented from taking it.

NICE welcomes comments from stakeholders on the draft recommendations as part of our public consultation.

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