What are the UK National Institute for Health and Care Excellence (NICE) guidelines on menopausal hormone replacement therapy (HRT)?

Updated: Sep 24, 2019
  • Author: Nicole K Banks, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Answer

The UK National Institute for Health and Care Excellence (NICE) issued guidelines on menopause that recommend that doctors [24, 25] :

  • Offer women hormone-replacement therapy (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 estrogen-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.

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