Women experiencing hot flushes, night sweats, depression and sleep problems could be offered therapy to help reduce their menopause symptoms, under new guidelines.
But menopause champions warned on Thursday that those suffering with symptoms could have long waits for mental health support and stressed that the new draft guidance to GPs from the National Institute for Health and Care Excellence (Nice) must not distract from “ongoing challenges” of getting HRT.
A Nice evidence review found that cognitive behavioural therapy (CBT) can help make night-time sweats less severe and frequent and should be considered “alongside or as an alternative to HRT”.
CBT techniques such as paced breathing and stress management can help with menopause-related sleep problems and depression. The more stressed and anxious a woman is, the worse night sweats, hot flushes and sleep disturbance is likely to be.
The guidance is not mandatory but GPs will be expected to take the new guidance “fully into account”, said Nice.
Caroline Nokes, chair of the Commons’ women and equalities committee, welcomed the new guidance saying there was no “one size fits all” to help women going through the menopause, but said it must not be used to fob off women, some of whom were still facing drug shortages.
A major HRT drug shortage last year resulted in 22 restrictions being put in place, pushing some women to turn to the hidden market or meet up with other women to buy, swap or share medicines.
In April 2022, the then health secretary Sajid Javid appointed Madelaine McTernan as hormone-replacement therapy (HRT) tsar, to help deal with UK supply issues, but she returned to her role overseeing vaccines in August 2022.
Nokes called for the reinstatement of an HRT tsar, saying there were still problems with the drug Estradot.
“I very much welcome any offer of CBT which could help alleviate the worst challenges of the menopause. But it cannot be instead of having a focus on the ongoing challenges with HRT supply,” she said.”
Dr Nighat Arif, a GP specialising in women’s health and ambassador at Wellbeing of Women, a charity, said women seeking CBT to help with the menopause could face long waiting lists.
“Current pressures in the NHS mean that GPs and their patients affected by mental health issues struggle to get access to CBT. Women seeking CBT to deal with menopause symptoms would face very long waits,” she said.
“It’s also important that this does not distract from the need to make sure that women who need HRT can access it.”
For the first time, the draft guidelines also specifically cover trans men and non-binary people registered female at birth. The current guidance, published in 2015, only refers to women experiencing menopausal symptoms.
Nice recommends further research on menopause treatment for those who previously took gender-affirming hormone therapy as there is “a lack of evidence” on its effects, it said.
The guidance also updates the evidence of the risks and benefits of taking HRT since the last guidelines were published in 2015. This includes the small increased chance of getting dementia for those taking HRT after the age of 65, and the impact of age and length of time taking HRT on the increased risk of cardiovascular disease, stroke, breast, ovarian and womb cancers.
But Nice makes clear that despite some increased risks associated with HRT, “it is unlikely to increase or decrease overall life expectancy”.
Jonathan Benger, chief medical officer at Nice, said it is important that GPs take a “personalised approach … tailored to individuals’ circumstances”.
Having more treatment options for managing menopause symptoms and a wider understanding of the risks and benefits of HRT would help ensure that “anyone going through menopause can choose the best care to suit them”, he added.
Maria Caulfield, women’s health strategy minister, said: “We have already seen over 400,000 women benefit from cheaper HRT prescriptions and receive better access to specialised care through the rollout of women’s health hubs.
“Nice’s updated guidance shows why research is so important in women’s health – so we can make sure women are offered the support that is right for them.”
Prof Kamila Hawthorne, chair of the Royal College of GPs, said: “It’s always helpful for GPs to have access to a range of potential treatments and interventions to help women manage menopause.
“HRT has been shown to be safe and effective for some women, but it isn’t suitable for everyone, and it’s good to see Nice exploring other options, that evidence suggests may be of benefit, such as CBT.”
