The National Institute for Health and Care Excellence (NICE) guidelines for Menopause were written in November 2015. This provided structured advice and support to health care professionals to enable them to provide the best advice and treatment for menopausal women.

These guidelines transformed menopause care in the UK. This document helped to remove the stigmas and outdated medical perceptions and practices, replacing it with up-to-date research-based information.

Many healthcare professionals knew very little about menopause and HRT. However, this new menopause guidance was researched based, informative and available for everyone to access not just clinicians.

As a health care professional this was music to my ears. In the early days of providing menopause support I referred to the guide a great deal. Mainly as a source to explain how previous research revealed misleading HRT information. NICE Guidance on Diagnosis and Management of Menopause 2015 gave me a voice to say, this is the research. HRT is effective, much safer than we first thought and should be first line treatment for menopausal women. Of course, not everyone could have or wanted HRT but it allowed us to explain why it was safer and more effective than anyone realised 20 years before.

I provided more teaching within the local community, then worldwide! I wrote and delivered training to healthcare professionals including GP’s, Advanced Nurse Practitioners and Pharmacists. We all began to understand that HRT had huge health benefits. Practices slowly began to change as more healthcare professionals such as myself started the wheel of change we still see today. However I know many women still find it hard seeking quality advice. Women still tell me their health care providers “refuse” to prescribe HRT, giving prescriptions for anti-depressants instead. It’s clear we still have a long way to go.

Nearly 10 years on and this Guidance is up for review and a draft policy is in the early stages of being developed. However, this has caused much controversy. It is a draft guide and therefore will be subject to change but myself and other menopause health care professionals are not happy with some the changes we’ve read so far.

It states, “The draft guideline lays out clearly the risks and benefits of taking HRT that can be used to help people when they are discussing with their clinician whether to start HRT. Detailed tables lay out the evidence for effects on cardiovascular disease, stroke and dementia risks as well as cancers of the breast, ovary and womb. The draft guideline highlights that, while it is important that people know about the risks associated with HRT, it is also important they are made aware it is unlikely to increase or decrease their overall life expectancy. CBT was found to reduce the frequency and severity of hot flushes and night sweats and should be considered alongside or as an alternative to HRT”. NICE November 2023.

There’s an emphasis for Cognitive Behavioural Therapy (CBT) to be offered to reduce menopausal symptoms. But who will be providing this? What will the waiting lists be? How long will it take to see the benefits? And what about the effectiveness and benefits of HRT? All menopause care must be individualised and at Bourne2care we pride ourselves in truly listening to what women say. We also use our clinical judgement based on years of training in health to advise and or prescribe what we feel would be most beneficial. HRT ticks most boxes for most women. Therefore, how can CBT or talking therapies reduce symptoms and long term health conditions such as heart disease or Osteoporosis caused by low levels of female hormones?

My concerns are that women may be offered CBT as first line treatment rather than discussing if HRT would be more suitable. Will we be stepping backwards with menopause care rather than progressing? I always offer women choices including how to access CBT if they can’t have HRT or wish to use alongside HRT. Choice is the key.

Let’s wait to see the outcome and fingers crossed the new NICE menopause guide will be revised to help healthcare professionals care for women during the menopause.

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