The new NICE guideline on diagnosis and management of the menopause cut through the confusion and deliver the message that treatment starts with the individual woman.
Dr Heather Currie
Menopause treatment should be tailored to the individual woman. That’s the number one message of the latest NICE guidelines on diagnosis and management of the menopause – and about time too.
“All women are different and so are their experiences of the menopause and how they respond to treatment. These new guidelines put what is best for each individual woman at the forefront,” says Dr Heather Currie, Chair of the British Menopause Society.
The new guidelines offer women clear, evidence-based information to break through the conflict and confusion about menopause treatments. They reject a one-size-fits-all approach and instead recommend that treatment decisions should take into account a woman’s individual symptoms, past history, family history, diet, lifestyle and individual preferences and concerns.
Doctors should place more emphasis on explaining to women the stages and consequences of the menopause, which extends beyond flushes and sweats to include psychological symptoms, musculo-skeletal, vaginal, bladder and sexual effects, as well as long-term effects on bone and cardiovascular health.
On diagnosis, the guidelines suggest that blood tests to diagnose menopause or perimenopause in women over 45 be abandoned, as the level of hormone tested fluctuates significantly and bears no relationship to severity of symptoms. “Reducing this inappropriate testing will free up time for consultation and reduce treatment delays, as well as saving money,” says Dr Currie.
All treatments types should be discussed and advice given about maintaining general health by stopping smoking, losing weight, reducing alcohol consumption and increasing levels of exercise if appropriate.
On the controversial subject of HRT, the guidelines suggest it should be offered, after consideration of benefits and risks, for symptoms such as flushes and sweats, since it was shown to be the most effective treatment with minimal risks. They suggest that vaginal estrogen should be offered for urogenital symptoms.
For low mood, the guidelines say that doctors should not routinely offer clonidine or antidepressants and that HRT or cognitive behavioural therapy be considered instead.
Dr Currie says: “For the first time, leading experts have examined all of the existing evidence and presented information and advice which will enable women to better understand the consequences of the menopause and make informed choices about treatment.
“Women deserve high-quality information on their choices. While too much information may be confusing for women, who may want their health professional to tell them what’s best, managing the menopause is an area of medicine that is truly individual. We hope this guidance will empower both health professionals and women to work together on deciding the best treatment options for them. “