Menopause updates

NICE guidelines on menopause

Guidelines from the National Institute for Health and Care Excellence (NICE) offer a unique perspective on diagnosis and management of menopause, designed to help women stop suffering in silence. Aimed at health care providers in the UK but also relevant to US ob/gyns, the recommendations focus on ways to determine if menopause has started, what drug and non-drug options might be useful for a patient’s physical and psychological symptoms, and clarifying the risks and benefits of hormone replacement therapy (HRT).The NICE Guideline: Diagnosis and Management of the Menopause contains 10 key messages:

• Management of estrogen deficiency needs to be individualized because women respond differently to the condition and to treatment for it.

• Inappropriate use of testing of FSH for diagnosis of menopause in women older than age 45 should be eliminated. The testing is rarely required and expensive.

• Women need information about menopause in a variety of formats. Key topics for counseling include the stages and consequences of menopause and about use of contraception during perimenopause.

• For management of symptom sof menopause, diet and lifestyle should be considered. HRT should be offered for vasomotor symptoms with full consideration of benefits and risks. Clonidine or antidepressants should not be routinely offered.

• Women with a history of breast cancer should be counseled about all treatment options for menopausal symptoms. Those taking tamoxifen should not be given fluoxetine orparoxetine.

• Vaginal estrogen can be used longterm in patients with urogenital atrophy due to estrogen deficiency. It can also be considered for women who are not candidates for HRT because of medical conditions.

• Follow-up with a health care provider is recommended 90 days after a patient starts HRT and annually thereafter. Referral to a provider with experience in menopause may be necessary for a patient with a complex medical history.

• There should be no arbitrary limits for duration of use of HRT. Healthcare providers should provide support for women who want a trial cessation of HRT to see if they still need it to control their symptoms.

• Benefits and risks of HRT vary from patient to patient and are strongly influenced by baseline risk, which is affected by diet, lifestyle, and past medical and family history.

• Blood tests should be used to confirm premature ovarian insufficiency(POI). For women with POI, HRT or combined oral contraceptives are appropriate at least until they reach the average of menopause.

NICE is an independent body responsible for driving improvement and excellence in the UK health and social care system. The organization develops guidance, standards and information on high-quality health and social care and advises on ways to promote healthy living and prevent ill health.

The NICE guideline on menopause for health care providers is available at http://www.nice.org.uk/guidance/NG23.

NEXT: Post NICE guide for HRT

Post NICE guide for hormone replacement therapy

The safety of hormone replacement therapy (HRT) depends largely on the age of the patient. For most women, the risks are few and the potential benefits are many when HRT is given for clear indications and therapy is initiated within a few years of menopause.