Hormone Replacement Therapy (HRT) is one of those health topics that stirs up heated views. Now the National Institute for Health and Care Excellence (NICE) has stepped in, with their first guideline on HRT, to help doctors and menopausal women make the decisions that are right for them.
The debate about whether Hormone Replacement Therapy (HRT) is safe to take has been going on for years. In 2002, a major study linked taking HRT to a raised risk of breast cancer. As a result the number of women talking HRT dropped by about 50%.
Earlier this year, a small study on HRT from New York University said that it’s safe for women to take HRT, after all. However, the size of the study brought criticism about how reliable the results could be from some experts.
So what had seemed good news for women who struggle with menopausal symptoms, such as hot flushes, poor sleep, night sweats, forgetfulness, depression and more, was left with a question mark hanging over it.
Read our guide to easing menopause symptoms
Now, with the National Institute for Health and Care Excellence’s (NICE) guideline on the menopause, women who are going through it, and the doctors caring for them have a blueprint to work from.
The guideline gives recommendations to those working in the NHS on how to advise patients who are going through the menopause.
Inevitably, some of these women will have minor symptoms that don’t affect them very much. However, other women will be struggling with debilitating symptoms that affect their health and quality of life.
Currently only one in ten women going through the menopause is prescribed HRT, even though it is an effective treatment for helping with symptoms caused by a drop in the levels of the hormone oestrogen.
This means that about 1.5 million women have some menopausal symptoms that last for around four years after their last period.
However, in about 10% of women the symptoms can last for up to 12 years, which can be a long time to cope with hot flushes, night sweats and poor sleep.
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What are NICE's recommendations for HRT?
NICE’s recommendations should make it clearer and simpler for doctors and women going through the menopause to make decisions about treatment. For instance GPs and other medical staff should:
Give women information that can help them make their own decisions.
For instance, by explaining the different stages of the menopause, and the changes that could affect them
Talk about the different symptoms that come with the menopause.
Such as hot flushes and night sweats, poor sleep, joint and muscle pain and low mood
Explain the risks and the benefits of HRT to women going through the menopause.
For instance, if 1,000 women started taking HRT, aged 50, and took it for 5 years, two more women would develop breast cancer, and one more woman would get ovarian cancer.
To put it another way, your average risk of having breast cancer is 1%, (provided you don’t have any risk factors, such as a family history of breast cancer).
Using HRT for five years, increases the average risk by .6%, to 1.6%. The longer you take HRT, the more you increase your risk of breast cancer. Your risk of breast cancer is likely to return to its previous level five years after stopping HRT.
Oestrogen-only HRT involves little or no increased risk of breast cancer. However, HRT with oestrogen and progestogen may increase your risk of breast cancer. Any increased risk of breast cancer goes down once you stop taking HRT.
More important points from the NICE recommendations
Another important point from the recommendations is that doctors and menopausal women should know that taking HRT does not increase your risk of cardiovascular disease if you start taking it under 60 years old, and it doesn’t affect your risk of dying from cardiovascular disease.
The important message here is to talk to your GP about the best post-menopausal treatment for you, with this new guidance in mind.
Ask what health risks might increase if you take HRT. And ask whether HRT can offer you protection against health problems as well as ending hot flushes, mood swings, night sweats and depression, and generally making you feel better.
The guideline, Menopause: diagnosis and management’ is available at www.nice.org.uk/guidance/NG23.