New official guidance on treating menopause will harm women’s health, experts, MPs and campaigners have warned.
Last month, new draft guidelines to GPs from the National Institute for Health and Care Excellence (Nice) said that women experiencing hot flushes, night sweats, depression and sleep problems could be offered cognitive behavioural therapy (CBT) “alongside or as an alternative to” hormone replacement therapy (HRT) to help reduce their menopause symptoms.
But critics have castigated the guidance, saying it belittled symptoms through misogynistic language, and women’s health would suffer as a result of failing to emphasise the benefits of HRT on bone and cardiovascular health as opposed to CBT.
In its response to the guidance, Mumsnet said Nice’s recommendations – shared exclusively with the Guardian – used “patronising” and “offensive” language and would be “detrimental” to women’s health.
Justine Roberts, the founder and chief executive of Mumsnet, said: “Women already struggle to access the HRT they are entitled to. We hear daily from women in perimenopause and menopause who are battling against a toxic combination of entrenched misogyny, misinformation and lack of knowledge among GPs.
“Too often they are fobbed off or told they simply need to put up with severe physical and mental symptoms – often with life-changing effects.
“By emphasising the negative over the positive, failing to include information about the safest forms of HRT and placing CBT on a par with hormone replacement therapy, this guidance will worsen that struggle. It will make doctors more reluctant to prescribe HRT and women more fearful about asking for or accepting it.”
The menopause expert and campaigner Kate Muir, the author of Everything You Need to Know About the Menopause (But Were Too Afraid to Ask), accused Nice of scaremongering. “This draft Nice guidance skews the science to fan flames of fear and attempts to push women away from the choice of increasingly safe forms of HRT,” she said.
Dr Nina Wilson, a GP in Sussex and founder of the One Woman Health women’s clinic, said advocating CBT could increase the stigma around menopause. “By recommending psychological therapy, people may see this as a signal to women and society that symptoms are ‘all their heads’,” she said.
“If a man with erectile dysfunction experiences stress and anxiety due to performance worries, CBT could help with that, but it wouldn’t open up the blood vessels – the underlying issue – like Viagra would. It’s similar with HRT. The CBT can minimise the stress response but the underlying cause – the drop in oestrogen – is only addressed with HRT.”
Nice’s guidelines were also “very light” on the benefits of HRT, which was the “single most effective treatment for all menopausal symptoms”, she said, especially as it also helped maintain bone strength and may reduce cardiovascular risk long-term – “real threats to women’s health as they age”.
Carolyn Harris, the MP for Swansea East and the chair of the all-party parliamentary group on menopause, said the new guidance was “antiquated”, “naive” and “ill thought-out”.
”Talking can make you feel better, but it’s not going to take away the aches in your joints and it’s not going to change how you live your life,” she said. “Whatever a woman feels is what she needs to support her through the menopause should be readily and immediately available, and that’s not true currently [of HRT or CBT].
“Nice really needs to go back to the drawing board and come up with a whole new set of criteria around what the menopause is.”
Caroline Nokes, the chair of the Commons’ women and equalities committee, said while there was “no one size fits all” solution to the menopause, “we cannot have a situation where the negatives around HRT are being emphasised over the very real positives”.
“We know the worst symptoms of menopause can be alleviated by replacing the lost oestrogen, and that is what HRT does,” she said. “For those who cannot take HRT there may be real benefit in CBT, but that must not exacerbate the fears some medical professionals have about prescribing HRT. And there is still a real challenge with the supply of some HRT, like Estradot.”
A Nice spokesperson said: “The draft guidance makes clear that it is important that healthcare practitioners take a personalised approach when discussing treatment options, tailored to individual circumstances. The impact of menopause symptoms on quality of life can vary hugely.
“New evidence shows that cognitive behavioural therapy can help reduce menopause symptoms including hot flushes and night sweats, depressive symptoms and problems sleeping.
“The draft guidance makes it clear that CBT could be considered alongside or as an alternative to hormone replacement therapy (HRT) and sets out the risks and benefits of different treatment options so people can work with their healthcare practitioner to agree what works best for their particular needs.”
