HRT offers ‘enormous benefits to women’ and should be the first line of treatment for menopause symptoms, say experts

Hormone replacement therapy offers ‘enormous benefits to women’ and should be the first line of treatment for menopause symptoms, says a health watchdog today.

Bosses at the National Institute for Health and Care Excellence (Nice) say ‘HRT is the preferred, recommended approach’ for easing symptoms such as hot flushes, insomnia and poor mood.

Taking the medication is ‘unlikely to change life expectancy’ and should be offered to women following personalised discussions with their GP, the Nice bosses say in guidelines published today. 

But in an apparent move away from draft guidelines published last year, it said cognitive behavioural therapy (CBT) should only be considered in addition to HRT, unless women are unable to, or do not want to take, the medication.

The draft guidelines last year said CBT could be used ‘alongside or as an alternative to’ HRT to help reduce their menopause symptoms. But this proposal was heavily criticised.

The change follows extensive consultation with healthcare providers, patients and research organisations, which its independent committee said it had taken ‘very seriously’.

Bosses at the National Institute for Health and Care Excellence (Nice) say ‘HRT is the preferred, recommended approach’ for easing symptoms (file image)

Alongside the revised guidelines, the regulator has developed a ‘discussion aid’ for GPs and patients (stock photo) 

Professor Jonathan Benger, chief medical officer and interim director of the centre for guidelines at Nice, said: ‘HRT is our recommended first-line treatment for vasomotor symptoms (hot flushes and night sweats), and we recommend that that should be offered to women, providing that it meets their needs, and following an informed discussion.

‘We have revised the guidelines to be really clear that CBT is an adjunct, it’s an add-on therapy, and it can help people manage the symptoms… in addition to HRT, or some women may choose not to take HRT, or they may not be able to take HRT, and therefore that’s where CBT can be useful.

‘But we are very keen to emphasise that HRT is our recommended first-line therapy for vasomotor symptoms and for symptoms of menopause.’

Alongside the revised guidelines, the regulator has developed a ‘discussion aid’ for GPs and patients.

This includes data on how HRT can slightly increase the risk of some health conditions such as breast cancer and blood clots, while lowering the risk of osteoporosis. A review of evidence found there were no links to increased heart disease, stroke or dementia when HRT was started at the typical time of menopause, between 45 and 55.

Marie Anne Ledingham, consultant clinical adviser at Nice, said: ‘While there are some increased risks associated with taking HRT for menopause symptoms, there are obviously an enormous number of benefits for women.

‘The updated guidance advises healthcare practitioners to tailor information about the benefits and risks of HRT for these individual symptoms based upon the person’s age, their individual circumstances and any additional potential risk factors.’