NICE is set to update its menopause guidance to consider new evidence on hormone replacement therapy (HRT) cancer risks that could overturn previous recommendations, it has announced.

In setting out its reasons for the review, NICE said that for those who need medical treatment to manage symptoms of the menopause, there is variation in access to treatment and specialist services.

It follows a drug safety update published in 2019 by the Medicines and Healthcare products Regulatory Agency (MHRA) on HRT and breast cancer risk.

The regulator was responding to a study in The Lancet showing a greater magnitude of risk than previously realised, particularly with oestrogen plus daily progestagen.

NICE said some of the conclusions made by the MHRA on the risk of breast cancer differ from those of its 2015 guideline and ‘therefore a review of the evidence is warranted’.

But the review would not include the use of testosterone in the menopause after the committee said there had been no new evidence beyond the current recommendations on its use for altered sexual function.

The evidence review will include cognitive behavioural therapy to manage symptoms associated with the menopause and interventions to manage genitourinary symptoms, NICE said.

It will also look at the effects of HRT on overall health outcomes to decide if new recommendations or an update to existing guidance is needed.

Minister for women’s health Maria Caulfield said: ‘Most women will experience menopausal symptoms – some of these can be quite severe and have a significant impact on their everyday activities.

‘It’s crucial these can be managed effectively to enable women to continue living their lives and this step forward will ensure healthcare professionals continue to have access to the most up to date evidence and recommendations on menopause care.’

She added: ‘Women’s health is a priority for this Government and we will set out our plans in the first ever Government-led Women’s Health Strategy to level up women’s health.’

Professor Lucy Chappell, chief executive officer for the National Institute for Health and Care Research (NIHR), said: ‘We welcome this work by NICE to evaluate new evidence that relates to the management of the menopause, and the opportunity to address gaps in the evidence base through timely research.

‘We know that this topic is of high importance to many women and healthcare professionals and this update should provide high-quality recommendations on best practice, not just on menopausal symptoms but also on wider health outcomes.’

This week, the Government announced that pharmacists can now substitute certain HRT products for alternatives if the original prescription is out of stock, as part of a host of new rules aimed at tackling a shortage of the drugs.

Recent shortages of HRT after a dramatic rise in demand in the last few years have also led to the Government limiting patients to three months’ supply and appointing an ‘HRT tsar’ to tackle supply problems that have been happening since 2018.

From April 2023, women will be able to access HRT on a month-by-month basis via a prepayment certificate – a one-off charge equivalent to two single prescription charges, currently £18.70, for all their HRT prescriptions for a year.

A version of this story was first published on the Pharmacist's sister website, Pulse.