NICE guidelines on the menopause

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i191 (Published 18 January 2016) Cite this as: BMJ 2016;352:i191
  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. Correspondence to: M Hickey hickeym{at}unimelb.edu.au

Missing quantitative summary estimates of risks of hormone therapy

The first National Institute for Health and Clinical Excellence guidelines on menopause appropriately highlight how symptoms may impair quality of life and function and persist for many years for some women.1 The guidelines promote individualised care and emphasise the need for adequate clinical services and further research.

While the NICE guidelines emphasise the clear evidence that menopausal hormone therapy (MHT, often referred to as hormone replacement therapy) provides highly effective relief of symptoms, there is less focus on other useful options. Recent high quality evidence shows that selected antidepressants are equivalent to very low dose oestrogen for vasomotor symptoms and sleep,2 3 and gabapentin has a similar efficacy.4 For women who want to self manage, techniques such as yoga and cognitive behavioural therapy may reduce symptoms and also improve quality of life and mood.5 6 Women should not be “suffering in silence” but should be informed about alternatives to MHT, even if these are not as effective, and the risks and benefits of MHT so that they can make an informed choice. …

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