Letters NICE guidelines on the menopause

Authors’ reply to Sarri and colleagues

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2259 (Published 11 May 2016) Cite this as: BMJ 2016;353:i2259
  1. Martha Hickey, professor of obstetrics and gynaecology1,
  2. Emily Banks, professor of epidemiology and public health2
  1. 1Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Victoria, Australia
  2. 2National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
  1. hickeym{at}unimelb.edu.au

The current combined evidence from conventional and from network meta-analyses of randomised controlled trial (RCT) data is that menopausal hormone therapy (MHT) is effective for the relief of vasomotor symptoms.1 2 We noted this in our editorial and agree with the National Institute for Health and Care Excellence (NICE) guidelines on this matter,3 so we are unsure why Sarri and colleagues considered this a point of contention.4

We also agree that women differ in their priorities and information needs, and that it is important to provide summary evidence on the risks and benefits of MHT according to each outcome separately. However, an overall assessment of whether MHT is likely to be harmful or beneficial for health in terms of serious potentially life threatening conditions is also important information for many women and their healthcare professionals. We remain concerned that the NICE guidelines do not present women and healthcare professionals with appropriate and useful summary estimates on the risks of MHT for serious disease. In particular:

  1. It is inappropriate to restrict RCT data to those from women aged 50-59 years at trial entry. We did not misunderstand Sarri and colleagues on this point. It is a statistical principle that, where effects in study subgroups such as age do …

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