Consultation on new NICE menopause guidelines
A first look and the correct link!
Yesterday the draft guidelines for the updated NICE menopause guidelines were released. There’s been quite a bit of discussion and some of the reports in the media are not particularly accurate. The BBC report didn’t even include the correct link. So here it is.
If you scroll down and click ‘draft guidance’ it will open in a pdf. There is also the opportunity to respond to the guidance (click on the consultation tab)
As you look at the document the bits shaded in grey are the bits that haven’t changed — so really much of it is the same.
What’s new is a requirement that doctors discuss the risks and benefits between different types of HRT — oral and transdermal for example.
There’s also a new section on Cognitive Behavioural Therapy for Menopause symptoms — and that’s what’s set the cat among the pigeons — although to be fair it doesn’t say that it should be offered instead of HRT. The evidence for CBT is included in the document. I haven’t combed it fully yet, but there is some evidence that it helps with hot flushes, sleep and mood.
I also noted this phrase in the evidence review “The quality of the evidence was rated from very low to moderate, with most of the evidence of very low and low quality.” You might need to remember that phrase. The suggestion that these services could be offered by CBT providers without any specialist understanding of menopause is also concerning.
I personally found it to be useful alongside HRT for managing anxiety and it is important to recognise that HRT is not a complete solution for many. I also talk to those who’s mental health has been badly affected by the progesterone in HRT or who are struggling with difficult and potentially dangerous bleeding on HRT. And while the slightly elevated breast cancer risk may seem worth it to many of us, there are those for whom that risk may be too high to be worth it.
It’s important that there are options for those people. Perhaps CBT will help some of those people. Overall it’s probably good that it’s available — although important that it’s not offered as a first line treatment rather than HRT.
It’s also not clear what provision might be made to supply a demand for menopause CBT and a time when large numbers of people are on waiting lists for talking therapies.
NICE is also reviewing a drug called Fezolinetant to manage hot flushes which may well turn out to be a lifeline for those people but which isn’t mentioned in the document. It’s already approved in the USA and being used under the brand name Veozah. (Who comes up with these names?!)
I also noted the language ‘chose’ to take HRT throughout the document. It is our choice after all! The potential change I see as being most important is a change of attitude leading to women being trusted to weigh up benefit and risk and to make key decisions about their own health.
