2023 NICE draft guidance for menopause | What does it mean?

What are the key insights in the new NICE draft guidance on menopause?

It may sound surprising, but not too long ago, health professionals operated in a kind of wild west when it came to advising women on managing menopause. Support available was essentially a roll of the dice, dependent on how much a doctor or practice nurse happened to know or could reasonably be expected to know.

The arrival of The National Institute for Health and Care Excellence (NICE) document 'Menopause: diagnosis and management' in November 2015 was a significant game-changer. Designed to direct healthcare professionals and ensure consistency of support and information for patients managing the complexities of menopause, it became the gold-standard document.

Fast forward 8 years, NICE have released updated draft guidance on menopause, marking a crucial milestone in women's health. Long-awaited, this draft presents a comprehensive evidence-based strategy for addressing menopause-related symptoms, having broad implications for our healthcare professionals, policymakers, and, most importantly, all women. For the first time, it includes the needs of the trans, non-binary and intersex community.

What does the new NICE draft guidance for menopause offer?

Holistic Approach to Care:

Emphasizing an all-inclusive approach to menopause management, the guidance acknowledges that symptoms can affect various aspects of a woman's life. Healthcare professionals are encouraged to consider physical, psychological, and social factors when assessing and treating menopausal symptoms.

Individualised Treatment Plans:

It’s a given that there isn’t a one size-fits-all management plan for menopause symptoms. A welcome feature of the guidance is the recommendation for individualised, personal treatment plans to meet highly individualised needs based on individual needs, symptoms preferences and health history.

Talking Therapy:

It’s not a new idea but NICE suggests Cognitive Behaviour Therapy (CBT) can be used “alongside or as an alternative to HRT”.

CBT - whether face-to-face, online, self-help, or group sessions - has been backed by evidence to improve symptoms such as hot flushes, night sweats, depression and sleep issues.

Reaction to this suggestion has been mixed. Some see it as a positive step giving individuals more choices. Others worry that with long waiting lists to access mental health services, women looking for CBT to help with the menopause could face a long wait. Access to HRT could become more difficult if health professionals push individuals along the talking therapies route rather than including HRT as an option from the outset where it is a suitable option.

Hormone Replacement Therapy (HRT):

Delving into the nitty-gritty of Hormone Replacement Therapy (HRT), the guideline includes detailed tables of the evidence on the effects of HRT on cardiovascular disease, stroke, dementia risks, and some cancers. The information can guide healthcare professionals in discussing the potential benefits and risks of HRT with women so decision-making can be shared.

Personalised treatment for vaginal dryness:

Genitourinary symptoms - vaginal discomfort, dryness, and painful sex –recommendations have been made for tailored treatment options: vaginal oestrogen as cream, gel, tablet, pessary, or ring, with the flexibility to adjust the dosage if required. This signifies a significant stride towards more personalised, responsive, and effective management of menopausal symptoms.

Education and Empowerment:

The draft highlights the importance of education and empowerment. It encourages healthcare professionals to provide women with accurate information about menopause, enabling them to make informed decisions about their health. This emphasis on education aims to dispel myths and promote a positive, proactive approach to menopause.

Inclusive support:

Inequalities in access to menopause care due to age, disability, ethnicity, socioeconomic status, and gender identity are addressed. The needs of non-binary and trans people, post-menopausal women, and those from diverse cultural backgrounds are addressed, included, acknowledging that every menopause story is unique and deserves its own chapter.

This update isn’t just about menopause basics; it champions inclusivity, tackling inequalities in access to menopause care by shining a light on age, disability, ethnicity, socioeconomic status, and gender identity. Recognizing the unique stories of non-binary and trans individuals, post-menopausal women and women from diverse cultural backgrounds, the update acknowledges all menopause journeys are different and the differences need to be reflected in practice.

Workplace Support:

Recognizing the impact of menopause on women's work and daily lives, the guidance calls for workplace policies that support women experiencing menopausal symptoms. This includes considerations such as flexible working arrangements, temperature control in work environments, and increased awareness among colleagues.

Will the NICE update unlock better menopause support in the workplace and health settings?

The emphasis on education and workplace support signifies a broader societal shift towards acknowledging and accommodating the realities of menopause. This could contribute to reducing the stigma associated with menopause, fostering a more inclusive and supportive environments for those going through menopause.

This menopause guidance has the potential to revolutionize the perception and management of menopause in healthcare settings. By promoting a holistic and individualised approach, it matches our unique needs with the right option.

Have your say on menopause management! Read the draft, share your thoughts and be part of the menopause conversation. The updated draft guideline is open for public input until January 5, 2024.

Does your workplace have a menopause policy that needs supporting?

Postive Pause work with organisations to deliver tailor-made workplace menopause training according to a business’ requirements. If your organisation is looking to support menopause in the workplace with training for HR teams, line managers and employees get in touch!

Email us with your organisations’ requirements, at: business@positivepause.co.uk