NICE has outlined plans to update its guidance on managing menopause, including a look at new evidence on the effects of hormone replacement therapy on cancer risk.

In a statement last Friday (May 27), NICE identified areas of evidence that it plans to include in its review, potentially leading to new or updated recommendations for menopause care.

The key issues NICE will consider are: the effectiveness of cognitive behavioural therapy in managing menopausal symptoms; the effectiveness of treatments such as local oestrogen and laser therapy for genitourinary symptoms; and the impact of HRT on overall health outcomes.  

NICE will look separately at a number of health conditions to determine whether HRT influences an individual’s risk of developing them, including breast cancer, ovarian cancer, cardiovascular disease and dementia.  

The new evidence review is needed because a 2019 drug safety update from the MHRA on HRT and breast cancer risk differed from NICE’s own 2015 guidance, the health body said.

Following a meta-review published in the Lancet, the MHRA said that all HRT treatments except vaginal estrogens led to a higher risk of breast cancer than was previously thought.  

The NICE review will not include an assessment of the use of testosterone in menopause, because a scoping exercise did not identify substantive new evidence beyond the current guidelines around using testosterone for altered sexual function.

However, NICE has asked the National Institute for Health and Care Research (NIHR) to fund urgent new research in this area.  

NICE interim chief medical officer Dr Gail Allsopp said: “We recognise the profound impact, ​both physically and psychologically that menopause can have and ​the need for updated guidance. 

“​We are working at pace on this guideline update to ​ensure ​that its impact ​can be realised as soon as possible. 

“We work closely with our stakeholders at the interface of health and care, and after highlighting the gap in the evidence for the use of testosterone, I am delighted that our partners at NIHR have agreed to scope further research into whether testosterone helps to manage menopausal symptoms beyond altered sexual function.” 

Pharmacy minister 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. 

“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.”