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December 2019: The table cited in recommendation 1.5.11 has been deleted by NICE and replaced with a link to the MHRA summary table of HRT risks and benefits. Other tables have been renumbered accordingly.
Excerpt
In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.
The need for this guideline was recognised by the Department of Health and aims to provide advice for both healthcare professionals and women regarding the menopause and the way symptom relief can be achieved. It not only covers women who go through the menopause in middle age, but also those with premature ovarian insufficiency (POI) and for whom hormones are not appropriate, including women with, or at high risk of, breast cancer. It covers the diagnosis and optimal clinical management of menopause-related symptoms, including hormonal and non-hormonal therapies. Attention is also given to the contentious issue of the impact of hormone replacement therapy (HRT) on chronic disease prevention, although other, established treatments for cardiovascular disease (CVD) and osteoporosis, in particular, are not covered.
Contents
- Introduction
- 1. Guideline summary
- 2. Development of the guideline
- 3. Guideline development methodology
- 4. Individualised care
- 5. Diagnosis of perimenopause and menopause
- 6. Classification systems for the diagnosis of menopause
- 7. Information and advice
- 8. Managing short-term symptoms
- 9. Review and referral
- 10. Starting and stopping hormone replacement therapy (HRT)
- 11. Long-term benefits and risks of hormone replacement therapy (HRT)
- 12. Premature ovarian insufficiency
- 13. References
- 14. Glossary and abbreviations
- Appendices
- Appendix A. Scope
- Appendix B. Stakeholders
- Appendix C. Declarations of interest
- Appendix D. Review protocols
- Appendix E. Search strategies
- Appendix F. Prisma flow charts
- Appendix G. Excluded studies
- Appendix H. Evidence tables
- Appendix I. GRADE profiles
- Appendix J. Forest plots
- Appendix K. Network meta-analysis of interventions in the pharmacological and non-pharmacological treatment of short-term symptoms for women in menopause
- Appendix L. Health economics
- Appendix M. Absolute risk references
Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.
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