Menopause campaigners have called for NICE guidelines on the menopause to include more ‘balanced’ wording around the benefits of hormone replacement therapy (HRT), as well as for more consideration and detail to be given to the use of testosterone.

In a consultation response published yesterday, campaign group Menopause Mandate also said that the guidelines contained ‘far too much emphasis’ on the use of cognitive behavioural therapy (CBT).

In the first update to its guidance on the topic since 2015, NICE added new information on individualised risks of HRT that GPs should discuss with patients and recommended that CBT should be offered as a treatment option for menopause symptoms, as reported by our sister title Pulse.

The draft guidance was published in November and has been open to consultation since then. Following the consultation, which closes today, new guidance is expected to be published in May this year.

GP and NHS menopause specialist Dr Clare Spencer, who contributed to the response, said that while ‘for most women HRT is the most effective treatment for menopause symptoms’, the current draft of the guidelines ‘place considerably more emphasis on the risks [of HRT] rather than the benefits’.

‘It is critical that the final version has a balanced overview of both,’ she added.

And she said that while CBT ‘clearly has a role to play’, the guidelines needed to be ‘more consistent in clarifying the subset of menopause symptoms it can help manage’.

Menopause Mandate said that the ‘vast majority’ of responses it received from within its community regarding the guidelines focused on its emphasis on CBT as an alternative to HRT.

‘While the majority have acknowledged that there’s definitely a space for CBT, it is not enough to manage severe hormonal symptoms of menopause,’ the group said in its official response to the NICE consultation.

The group also said that it would welcome a formal recommendation for off license prescribing and monitoring of testosterone therapy, for which it said there was high demand.

And it suggested that referrals for the therapy to specialist menopause clinics generated significant cost to the NHS, while guidance for GPs on prescribing testosterone for women with low libido could bring ‘significant financial savings’.

Commenting on Menopause Mandate’s response, Dr Spencer also said that the guidelines ‘do not detail the full spectrum of symptoms’, and that ‘the language used does not adequately reflect the breadth and depth of their impact on quality of life’.

In particular, the group said that the use of the words ‘troublesome’ and ‘bothersome’ were patronising and should be replaced with wording such as ‘mild, moderate and severe’ symptoms.

Menopause Mandate chair Mariella Frostrup commented: ‘This guideline is going to be referred to by GPs and other key health care practitioners, whether newly qualified or veteran.

‘It is imperative that the information is absolutely correct, that it contains up-to-date and comprehensive research and scientific data, and that it reflects women's needs when it comes to management of the menopause transition in its entirety.

‘It is our very strong feeling that the draft guideline is seriously lacking in a myriad of ways and as though decades of research are being largely ignored.’

A spokesperson for NICE told The Pharmacist that it welcomed constructive challenge and a broad range of views as part of the consultation on the draft guidelines, acknowledging that there were strong views around the topic.

‘The draft guidance makes clear that it is important that healthcare practitioners take a personalised approach when discussing treatment options, tailored to individual circumstances. The impact of menopause symptoms on quality of life can vary hugely. The draft recommendations are based on the latest available evidence, and we want it to offer a useful and useable guide to help inform those discussions. The recommendations were agreed by an independent committee which included specialist consultants, GPs, menopause nurses and a range of patient experts and stakeholders,’ the spokesperson said.

And they added that new evidence shows that cognitive behavioural therapy ‘can help reduce menopause symptoms including hot flushes and night sweats, depressive symptoms and problems sleeping.’

‘The draft guidance makes it clear that CBT could be considered alongside or as an alternative to HRT and sets out the risks and benefits of different treatment options so people can work with their healthcare practitioner to agree what works best for their particular needs,’ they said.