GPs should be 'more confident' prescribing HRT for menopause, says NICE

HRT is the 'most effective treatment' for managing menopause symptoms and GPs should not be concerned about prescribing it to patients, say NICE experts, but they stress it may not be the most suitable option for all women.

Guidelines released on Thursday, the first from NICE on diagnosing and managing menopause, are aimed at both women and healthcare professionals and look at how best to help patients going through menopause or early-onset menopause.

Experts behind the guidance said GPs should be more confident in offering and prescribing HRT to patients, which offers the most effective method of treating symptoms of oestrogen deficiency.

GPs should stop completely the ‘unnecessary’ use of FSH tests to diagnose menopause in women aged over 45 years, the guidance says, although it should still be used in cases where premature menopause is suspected.

If a woman over 45 has not had a period for at least 12 months, this is ‘adequate information to diagnose menopause’, the guideline says, and ‘considerable savings could be made’ through ending routine use of this and other laboratory and imaging tests.

HRT for menopause

Once diagnosed, GPs should offer women HRT to treat hot flushes, night sweats and low mood that arises as a result of the menopause, the guideline recommends.

Patients should be told that oestrogen-only HRT – prescribed to women without a womb – is associated with little or no increase in breast cancer risk, while HRT with oestrogen and progestogen can be associated with slight increase in incidence of breast cancer, but any risk reduces after stopping HRT.

NICE found that there was no increased risk of death or heart disease among women taking HRT.

But the NICE guideline team emphasised that there is no one-size-fits-all solution to managing menopause, as symptoms can vary from woman to woman, as does their ability to cope with more severe symptoms – and the convenience with which they can do so.

HRT concerns

NICE recommends several other drug or non-drug treatment options to alleviate all or certain symptoms, including lifestyle changes – such as weight loss, cutting down on caffeine, stopping smoking – oestrogen creams or CBT.

‘Some will just want to talk and be reassured that their symptoms are normal,’ said Dr Imogen Shaw, a GPSI in gynaecology who helped devise the guideline. But she added that GPs should regain confidence in offering and prescribing patients HRT.

‘Unfortunately, since certain large US studies came out in 2002/3 leading to concerns over HRT, both GPs and women have rather lost confidence in the treatment, and HRT prescribing has dropped by over a half,’ she said.

‘We hope the guidelines can be seen as best practice for GPs, and empower them to feel more confident in discussing the benefits and risks of HRT with patients and prescribing it again when appropriate, based on the woman’s own individual circumstances.'

Current estimates suggest between 10% and 15% of menopausal women in the UK are on HRT.

RCGP honorary treasurer Dr Helen Stokes-Lampard said: ‘The new NICE guidelines today are welcome as they explore a wide range of treatment options and clarify the evidence base for these. We also support the move away from unnecessary blood tests to diagnose menopause for women aged over 45.

‘Any decision to prescribe HRT needs to come out of a discussion between GPs and individual patients about their unique circumstances.’

Photo: iStock

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