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Practice Guidelines

Diagnosis and management of menopause: summary of NICE guidance

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5746 (Published 12 November 2015) Cite this as: BMJ 2015;351:h5746
  1. Grammati Sarri, senior research fellow and guideline lead1,
  2. Melanie Davies, clinical director, consultant gynaecologist2,
  3. Mary Ann Lumsden, professor of medical education and gynaecology, honorary consultant gynaecologist3
  4. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, Royal College of Gynaecologists and Obstetricians, London NW1 4RG, UK
  2. 2National Collaborating Centre for Women’s and Children’s Health, Royal College of Gynaecologists and Obstetricians; University College London Hospitals, London, UK
  3. 3Reproductive and Maternal Medicine, University of Glasgow; Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to: G Sarri gsarri{at}rcog.org.uk

What you need to know

  • Menopause is a clinical diagnosis in healthy women over 45 years who have not had a period for at least 12 months and are not using hormonal contraception, or who do not have a uterus and have menopausal symptoms

  • For vasomotor symptoms, offer hormone replacement therapy (HRT) after discussing the short term and longer term benefits and risks (box); prescribe oestrogen and progestogen to women with a uterus, and oestrogen alone to women without a uterus

  • Advise women to report unscheduled vaginal bleeding in the first three months of HRT use (a common side effect) at routine review, but to report such bleeding promptly if it occurs after three months

The average age of menopause in the United Kingdom is 51 years, although 1% of women experience premature ovarian insufficiency (menopause before the age of 40 years). Eight out of 10 women experience perimenopausal symptoms, most commonly hot flushes and night sweats (figure⇓), which typically last about four years.1 Quality of life may be severely affected.2

Perimenopausal symptoms. FSH=follicle stimulating hormone; GNRH=gonadotrophin releasing hormone; LH=luteinising hormone

Services and information available for menopausal women in the UK are variable.3 The use of hormone replacement therapy has been highly controversial.4 5

What’s new in this guidance

  • Twenty five percent of women have severe menopausal symptoms, which can seriously affect a woman’s quality of life. Millions of women worldwide now live 30-40% of their lives after the menopause.

  • HRT is the most effective treatment for the relief of vasomotor symptoms although other options, including non-pharmacological ones, are available.

  • For most symptomatic, menopausal women, the benefits of HRT outweight the risks

  • Any increase in risk of breast cancer, experienced with some HRT preparations, disappears once HRT is stopped

This article summarises the most recent recommendations on the diagnosis and management of menopause from …

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