British Menopause Society publishes response to updated NICE guidance

The British Menopause Society (BMS) has published its response to updated menopause guidance issued by the National Institute for Health and Care Excellence (NICE), following a review and formal consultation process of guidance first published in 2015.

The organisation acknowledged several of the recommendations contained within the new guidance but has also identified some limitations for healthcare professionals to consider when advising patients.

In particular, BMS welcomed the continued recommendation to offer HRT, tailored to the individual, for the management of menopausal symptoms and the emphasis on the need to consider the impact of increased dosages of estrogen, and progestogen intake, on the risk of endometrial cancer.

With the recently well-publicised growth in providers offering menopause treatment, BMS also welcomed the call for healthcare professionals offering such expertise to be recognised by professional bodies including the BMS, the Faculty of Sexual and Reproductive Healthcare and the Royal College of Obstetricians and Gynaecologists.

The organisation also noted the treatment options available for genitourinary symptoms of menopause (vaginal dryness, discomfort or irritation and discomfort or pain during urination or sex) highlighted in the new guidance, including for women with a history of breast cancer.

Recognising the importance of providing women with a range of options, including non-hormonal interventions, BMS has also acknowledged the need for menopause-specific CBT to be more widely available, either as an alternative or addition to other treatment.

Robust clinical evidence continues to be of critical importance to the provision of safe and effective care for people experiencing menopause symptoms. BMS has therefore echoed the need for ongoing research into this area of women’s health.

Professor Janice Rymer, Chair of the BMS, said: “As the specialist authority on menopause established in 1989 to educate, inform and guide healthcare professionals, we welcome the provision of independently reviewed, up-to-date and accurate information on the menopause, together with a balanced review of the benefits and risks associated with HRT and other treatments.

“However, it is also important to recognise that there are limitations in the guidance published today so that these may be taken into consideration by clinicians when helping people experiencing the menopause to make informed choices tailored to their needs and clinical histories.”

The limitations identified in the guidance by BMS included the absence of a recommendation on the impact of early menopause on long term health and the role of HRT in protecting it.

BMS has also questioned the robustness of an analysis providing data on the risk of breast cancer from taking HRT in early menopause.

BMS also highlighted the exclusion of important studies relating to the risk of developing coronary heart disease from HRT and relevant French data on the lower risk of breast cancer from specific types of progesterone.

Professor Rymer added: “Awareness of these limitations is very important because GPs and other healthcare professionals need to factor them into the advice they pass on to patients when considering the right treatment or combination of treatments.”