Hormone replacement therapy (HRT) can relieve almost all symptoms of menopause. (Getty Images)
Menopause awareness campaigners have warned that new guidelines from the National Institute for Health and Care Excellence (Nice) around care for women going through menopause will harm womens health rather than help them.
It comes after the new draft guidelines for GPs were published last month. Nice has said that doctors should offer cognitive behavioural therapy (CBT) alongside or as an alternative to hormone replacement therapy (HRT) in women struggling with symptoms of menopause.
HRT can alleviate symptoms of menopause - like hot flashes, night sweats, vaginal dryness, sleep issues and mood swings - as it replaces oestrogen, progesterone or both. These hormone levels drop naturally as a woman ages, usually between the age of 45 and 55.
Nices new guidelines lays out clearly the risks and benefits of taking HRT, and states that CBT was found to reduce the frequency and severity of hot flushes and night sweats.
It adds: While it is important that people know about the risks associated with HRT, it is also important they are made aware it is unlikely to increase or decrease their overall life expectancy.
In recent years, awareness around menopause has increased dramatically, thanks to campaigners and celebrities like Davina McCall who are speaking up about it.
But the organisations new guidance has not been welcomed by campaign groups and experts, who warned that it uses misogynistic language and would result in doctors becoming more reluctant to prescribe HRT and women more fearful about asking for or accepting it.
In a statement to the Guardian, Justine Roberts, founder and chief executive of Mumsnet, highlighted that women currently struggle to access HRT, adding: By emphasising the negative over the positive, failing to include information about the safest forms of HRT and placing CBT on par with hormone replacement therapy, this guidance will worsen the struggle.
Story continues
Dr Louise Newson, a GP and menopause specialist who also campaigns loudly for better menopause care, told Sky News that the guidelines were a disappointing draft update. We must address the long-term health risks of low hormones, she continued. There is good quality, established evidence about the protective effects of HRT in relation to osteoporosis, heart disease, clinical depression, and colon cancer, and there is emerging evidence around dementia risk also being reduced.
These are ignored in this document and the perceived risks of breast cancer stated in these draft recommendations are not based on good quality evidence.
Dr Newson is referring to a part of the guidelines that reads: While there is some evidence around taking HRT and breast cancer risk in early menopause (ages 40 to 44), there is a lack of evidence about the effects of taking or not taking HRT on overall health outcomes in this age group. Nice called for more research into this area.
To understand the backlash against Nices draft guidelines, we must look back to the start of the 20th century. HRT first became available in the 1940s in the form of an oestrogen pill under the brand name Premarin. It grew in popularity and hit its peak in the 1960s, considered to be revolutionary for women managing their menopause symptoms.
But in the 1990s, HRTs status plummeted after a clinical randomised trial in the US, called Womens Health Initiative (WHI), raised concerns about HRT and suggested that extended use of the drug could increase the risk of breast cancer and heart disease.
According to the British Menopause Society, the UKs regulatory authorities issued an urgent safety restriction on HRT following the publication of the WHI study. This resulted in widespread confusion and uncertainty amongst both doctors and HRT users.
Many doctors stopped prescribing HRT and many women abandoned HRT immediately, with a return of their menopausal symptoms. The number of women taking HRT fell by 66%, which has not changed so that now after more than 10 years, there has been almost a generation of women who have mostly been denied the opportunity of improved quality of life during their menopausal years, the society said in its 2022 factsheet about HRT.
The WHI study, which was published in 2002, tested the cardiovascular effect of hormone therapy in older women (50 to 79 years). The test focused on a form of progesterone and oestrogen that is no longer used by doctors today due to the development of more effective and safer HRT, and did not include a large number of women who recently started menopause.
The study reported a 26% increase in the risk of breast cancer among these older women on this specific type of HRT - but it did not make a distinction between the participants who used HRT and their age. The results received a huge amount of negative media attention.
Dr Ginni Mansberg, author of The M Word, wrote in the Guardian: As a postscript, late analysis of WHI data shows that if you look only at women between the ages of 50 and 59, when most women use it and need it, there are clear benefits of HRT. These women had fewer cancers, fractures and deaths from any cause compared with the women taking placebo.
But the legacy of the WIH study has continued to persist, with many women declining HRT out of the belief that it puts them at a much higher risk of developing breast cancer.
The risks associated with HRT vary depending on what type of HRT is used, your existing risk of developing breast cancer (ie. family history of breast cancer), and lifestyle factors that may increase the risk such as smoking and obesity.
The British Menopause Society said that, while the WHI long-term randomised clinical trials published in 2020 found that women on combined oestrogen and progestogen HRT had an increased risk of breast cancer diagnosis, there was no significant increase in mortality.
It adds that other data has suggested that other forms of HRT are likely to be associated with a lower risk of breast cancer compared to that seen with other progestogens.
Studies have also suggested that HRT can help reduce the risk of cardiovascular disease, and is unlikely to increase the risk of dementia or have a negative effect on cognitive function in women starting HRT under the age of 60.
Attitudes towards HRT have begun shifting, with the number of patients being prescribed it in England rising by almost a third in just one year, from 1.8 million in 2022-23 to 2.3 million in 2021-23. In April this year, HRT pre-payment certificates were introduced to make it more affordable and accessible.
But the damage done by the WHI study continues to make women fearful of HRT, with only 14% of menopausal women in the UK taking HRT. According to Balance, Dr Newsons menopause support website, uptake of HRT is as low as 2% in some areas of the UK, and there are concerns that women in the most deprived areas do not have equal access to HRT.
Dr Newson wrote: The fact that more women are accessing the treatment they need to manage their menopause symptoms is fantastic, and illustrates that awareness of menopause is increasing and women are more confident in seeking help. But we want to ensure that all women have equal access, whatever their income or circumstances, and that no woman experiences supply issues with the medication they rely on.
Watch: NHS should offer women therapy for the menopause, new guidance says
Read more about menopause:
- Bio Identical Hormone replacement therapy "alternative medicine" OMT - June 1st, 2010 [June 1st, 2010]
- Healthbeat - Hormone Replacement Therapy - August 5th, 2010 [August 5th, 2010]
- Does Hormone Replacement Therapy increase breast cancer risks? - August 11th, 2010 [August 11th, 2010]
- Hormone replacement therapy increases risk of cancer - October 20th, 2010 [October 20th, 2010]
- Hormone Replacement Therapy Risky For Women - October 20th, 2010 [October 20th, 2010]
- Can Hormone Replacement Therapy Lead To Breast Cancer? - January 31st, 2011 [January 31st, 2011]
- Women Turning To Holistic Hormone Replacement Therapy - February 18th, 2011 [February 18th, 2011]
- Is Hormone Replacement Therapy Dangerous? - March 17th, 2011 [March 17th, 2011]
- Hormone Replacement Therapy Complications - May 8th, 2011 [May 8th, 2011]
- Hormone Replacement Therapy - May 10th, 2011 [May 10th, 2011]
- The New Growth Hormone Replacement Therapy - John Crisler, DO - May 13th, 2011 [May 13th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 2 of 6 - May 20th, 2011 [May 20th, 2011]
- Symptoms of Menopause (Menopause #2) - May 20th, 2011 [May 20th, 2011]
- How to Relieve Menopause Symptoms : Hormonal Replacement Therapy for Menopause - May 20th, 2011 [May 20th, 2011]
- HRT - Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- What is hormone replacement therapy? - May 20th, 2011 [May 20th, 2011]
- Hormone Replacement Therapy and Breast Cancer - May 20th, 2011 [May 20th, 2011]
- Natural Treatments Instead of Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 1 of 6 - May 23rd, 2011 [May 23rd, 2011]
- Hormone Replacement Therapy for post-menopausal women - June 19th, 2011 [June 19th, 2011]
- Joe Rogan talking about hormone replacement therapy 6-14-2011 - June 25th, 2011 [June 25th, 2011]
- Hormone Replacement Therapy and Weight - June 25th, 2011 [June 25th, 2011]
- HRC Hormone Replacement Therapy - June 25th, 2011 [June 25th, 2011]
- Study Hormone Replacement Therapy Increases Breast Cancer Risk - kdka.com - June 25th, 2011 [June 25th, 2011]
- 020 - Neo Hormones - July 1st, 2011 [July 1st, 2011]
- Making Sense of Hormone Replacement Therapy - July 28th, 2011 [July 28th, 2011]
- HRT MTF Transition Report Week 10 - July 29th, 2011 [July 29th, 2011]
- Hormone Replacement - Part 2 - July 30th, 2011 [July 30th, 2011]
- Hormone Replacement - Part 1 - July 30th, 2011 [July 30th, 2011]
- Goldie Lookin Chain - HRT - August 9th, 2011 [August 9th, 2011]
- Natural Hormone Replacement Therapy - September 23rd, 2011 [September 23rd, 2011]
- Testosterone Replacement Therapy (TRT): Optimizing Clinical Outcomes - Michael Aziz, MD - September 24th, 2011 [September 24th, 2011]
- Thyroid Replacement Therapy - Ronald Rothenberg, MD - September 24th, 2011 [September 24th, 2011]
- Dr. Ralph Turner discusses Hormone Replacement Therapy. - September 24th, 2011 [September 24th, 2011]
- 1 year on HRT - September 24th, 2011 [September 24th, 2011]
- The Wiley Protocol - September 24th, 2011 [September 24th, 2011]
- My Journal with Low Testosterone TRT Replacement Therapy - September 24th, 2011 [September 24th, 2011]
- 12 years of HRT: My Transition in photos - September 24th, 2011 [September 24th, 2011]
- Dr. Steven Jepson talks about Bio-identical Hormone Replacment Therapy - September 25th, 2011 [September 25th, 2011]
- Estradiol Valerate Injection HRT (Part 3)of(3) - September 25th, 2011 [September 25th, 2011]
- Study: Post-Menopausal Hormone Therapy Increases Cancer Risk - September 25th, 2011 [September 25th, 2011]
- Bio-identical Hormone Replacement (anti-aging) Therapy - Westchase, Tampa, Florida - September 25th, 2011 [September 25th, 2011]
- natural hormone replacement - September 28th, 2011 [September 28th, 2011]
- 6 Month Hormone Effects (before and after) - September 28th, 2011 [September 28th, 2011]
- Jeff Life, MD - Cenegenics, Hormone Replacement Therapy - September 29th, 2011 [September 29th, 2011]
- Huge - September 30th, 2011 [September 30th, 2011]
- Transsexual hormones,Intramuscular injection, Progynon Depot,Estradiol - October 2nd, 2011 [October 2nd, 2011]
- Dr Whiting on Menopause and the Dangers of HRT - October 12th, 2011 [October 12th, 2011]
- Ahuviya Harel (ADF-Fuensalida) to Start Hormone Replacement Therapy - October 13th, 2011 [October 13th, 2011]
- Clomid Defined - Video - October 14th, 2011 [October 14th, 2011]
- Thyroid Hormone Replacement Therapy - Dr. Denis Rebic - Video - October 14th, 2011 [October 14th, 2011]
- Hormone Replacement Therapy - Video - October 14th, 2011 [October 14th, 2011]
- Dr. Pamela Smith - Bio-Identical Hormone Replacement - Video - October 15th, 2011 [October 15th, 2011]
- Jasper Carrott - Traffic - October 22nd, 2011 [October 22nd, 2011]
- VIDEO: Breast Cancer, Hormone Replacement Therapy Connection - Video - October 24th, 2011 [October 24th, 2011]
- Menopause and Hormone Replacement Therapy with Dr. Sulak - Video - October 24th, 2011 [October 24th, 2011]
- Menopause - October 24th, 2011 [October 24th, 2011]
- bio identical hormone replacement therapy raleigh durcham chaepl hill north carolina - Video - October 24th, 2011 [October 24th, 2011]
- Endocrine Related Hair Loss, Can Hormone Replacement Therapy Help Treat This? Friedman - Video - October 24th, 2011 [October 24th, 2011]
- Dr. Navarro Discusses Bio Identical Hormone Replacement Therapy - Video - October 24th, 2011 [October 24th, 2011]
- Hormone Replacement Therapy by the Book - Eldred Taylor, MD - Video - October 24th, 2011 [October 24th, 2011]
- Sangeeta Pati, MD, FACOG, discusses Hormone Replacement - Video - October 24th, 2011 [October 24th, 2011]
- Active Center's Dr. Gross Discusses Bio-Identical Hormone Replacement Therapy on NEWS 12 NJ - Video - October 28th, 2011 [October 28th, 2011]
- DALLAS ANTI-AGING MEDICINE BIO-IDENTICAL HORMONE THERAPY - Video - October 29th, 2011 [October 29th, 2011]
- Hormone Replacement Therapy and Menopause in Women - Video - November 8th, 2011 [November 8th, 2011]
- Amberen - Natural HRT Alternative Commercial - Video - November 9th, 2011 [November 9th, 2011]
- The Dangers of HRT - Video - November 11th, 2011 [November 11th, 2011]
- The Benefits and Risks of Male Hormone Replacement Therapy - Video - November 16th, 2011 [November 16th, 2011]
- Natural Menopause Treatment - Herbal HRT Alternative - Video - November 23rd, 2011 [November 23rd, 2011]
- Dr. Ian Thorneycroft - Hormone Replacement Therapy - Video - November 24th, 2011 [November 24th, 2011]
- Sarah,MTF Transgender 3months HRT - Video - November 24th, 2011 [November 24th, 2011]
- 26. ftm 1 month on t - Video - November 24th, 2011 [November 24th, 2011]
- Dr. Quint Jardine - Hormone Replacement Therapy with Pellets - Video - November 24th, 2011 [November 24th, 2011]
- 6 Month Changes MTF HRT - Video - November 24th, 2011 [November 24th, 2011]
- Medical Mondays: Will hormone replacement therapy increase my risk of breast cancer? - Video - December 6th, 2011 [December 6th, 2011]
- HRT EXPERIENCES NOT ALL GOOD - Video - December 8th, 2011 [December 8th, 2011]
- Sarah, MTF transgender 9 months HRT - Video - December 9th, 2011 [December 9th, 2011]
- Full: Effect of Testosterone Replacement Therapy on Prostate Tissue in Men with Late-Onset Hypogonadism (Dramatic Health) - Video - December 10th, 2011 [December 10th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 3 of 6 - Video - December 11th, 2011 [December 11th, 2011]
- 1 Year HRT MTF Transition - Video - December 12th, 2011 [December 12th, 2011]