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In a joint position statement published in Post Reproductive Health, the BMS, RCOG and SfE state that their aim is to provide evidence-based guidance to healthcare practitioners who work with women experiencing the menopause so they have the right information and guidance to make informed decisions about their treatment and care.
The guidelines state that the management of menopause should be individualised to the needs of each woman rather than a 'one size fits all' approach.
Key recommendations
The following recommendations are included in the guidelines:
- When discussing the menopause, it is important to look not only at the role of HRT but also to offer advice regarding lifestyle and diet modifications, such as exercising, optimising weight, stopping smoking and reducing alcohol.
- The decision whether to start HRT, as well as the dose and duration of use, should be based on discussion of the benefits and risk to the individual woman and should take into consideration the overall benefits obtained from using HRT including symptom control and improving quality of life as well as the bone and cardiovascular benefits associated with its use. No arbitary limits should be set on age or duration of HRT use.
- Alternative therapies, such as cognitive behavioural therapy, should be discussed with women who don't wish to start HRT or for whom there is a contraindication to its use.
HRT-specific recommendations
The guidelines make a number of recommendations relating specifically to the use of HRT, including the following:
- Compared with placebo, HRT has been consistently shown to improve menopausal symptoms and remains the most effective treatment that is also associated with significant improvement in quality of life.
- While bisphosphonates are considered as the first-line option for most women with postmenopausal osteoporosis, HRT may be considered as an additional alternative option, particularly in younger women with menopausal symptoms and an increased fracture risk.
- HRT is considered a first-line intervention for the prevention and treatment of osteoporosis in women with premature ovarian insufficiency and early menopause (40-45 years of age). These women should be advised to continue HRT at least until the average age of the menopause.
- Evidence suggests that HRT started before the age of 60 or within 10 years of the menopause may lower cardiovascular and all-cause mortality.
- Current evidence suggests that oestrogen-only HRT is associated with a lower risk of breast cancer than combined HRT. The risk should be considered in the context of the overall benefits and risks associated with HRT; women with early menopause should be advised that HRT is unlikely to increase their risk of breast cancer.
- Transdermal estradiol is considered unlikely to increase the risk of venous thromboembolism and stroke above that in non-users and is associated with a lower risk than oral estradiol. As such, the transdermal route is preferred for women with related risk factors.
The guidelines also state that HRT should not be used without a clear indication and should not be used for the sole purpose of disease prevention, adding that menopause is a life stage rather than a deficiency state.
In a related editorial introducing the position statment, the authors state that it is important women are made aware that help and support is available to them, and it remains essential that women have access to accurate information to be able to seek appropriate advice on how to manage their menopause.
Dr Edward Morris, president of the RCOG and joint author of the editorial, said: "The aim of this statement is to provide clear recommendations for healthcare professionals caring for women and people of all ages who have menopausal symptoms. All women will experience the menopause in different ways and that's why it is important they are provided with tailored care that's right for them."
