Choice, information and advice

CHOICE, PROVIDING INFORMATION AND ADVICE:

Clinicians should share information about menopause with people who have menopause symptoms or people approaching the age of menopause, as well as their family members or carers as appropriate.

Information shared should include:

• What menopause is, including that it is a normal life transition.
• The stages of menopause and commonly associated symptoms.
• Lifestyle changes and interventions that can support health and wellbeing.
• Information on the risks, benefits and uncertainties of all treatment options including non-hormonal options, non-pharmaceutical options (eg cognitive behavioural therapy) and hormone replacement therapy (HRT).

Some individuals will prefer to seek non-hormonal alternatives to HRT, for example non-hormonal vaginal lubricants or moisturisers. An individualised approach should be taken.

HRT:

• The indication for HRT should be for the treatment of menopausal symptoms and it should not be prescribed for the primary prevention of cardiovascular disease or dementia.
• The only exception to this is in younger women <40 years with premature ovarian insufficiency.
• When discussing HRT, explain the risks and benefits associated with treatments.
• Share information about the effects of HRT on health outcomes. See effects on health outcomes for oestrogen only and combined HRT from the NICE draft 2023 menopause update.
• Tailor information about benefits and risks to the person's age, individual circumstances and risk factors.
• Discuss the duration of treatment at the outset.
• Discuss the likelihood of symptoms returning when HRT is stopped, the possibility of restarting treatment if necessary, and the risks associated with prolonged use.