Menopausal women should be warned that hormone replacement therapy (HRT) may increase their risk of breast, ovarian and uterine cancer, new NHS guidance says.
The drugs, which relieve hot and night sweats, offer “huge benefits”, health bosses say, but disadvantages must be highlighted so patients can make an informed decision.
The new guidance includes special recommendations for counseling women over 45, when health risks from hormones are thought to increase further.
Overall, the guideline states that HRT is “the recommended and preferred approach” for treating some symptoms of menopause.
However, it is “unlikely to change life expectancy” and “personalized discussions” with a GP should inform whether a patient takes it or not.
It comes after England’s health watchdog, the Care Quality Commission (CQC), launched an investigation into a celebrity-backed private menopause clinic over allegations it was prescribing patients with very high doses. of HRT.
More than a dozen patients at Newson Health, run by TV menopause guru Dr Louise Newson, told the BBC they had suffered health problems due to the drugs.
Some developed a thickening of the lining of the uterus, a possible precursor to cancer.
Hormone replacement therapy offers “huge benefits for women” and should be the first line of treatment for menopausal symptoms, a health watchdog says today (file image)
The British Menopause Society (BMS) removed Dr Newson from its register of menopause specialists last year as a result of the organisation’s concerns about her practices.
In a new statement, Dr Newson described the latest update to the National Institute for Health and Care Excellence (NICE) guidelines as “disappointing”.
He added that “the word risk is used three times more than the word benefit.”
Dr Newson said: “The guidelines do not differentiate between older synthetic HRT and the natural body-identical hormones that are now more commonly prescribed…these newer forms offer more benefits than risks.”
“The real risk comes from not taking HRT at all, and there is good quality evidence showing that low levels of hormones increase the risk of heart disease, osteoporosis, type 2 diabetes and dementia.”
In an apparent departure from draft guidelines published last year, NICE said cognitive behavioral therapy (CBT) should only be considered in addition to HRT, unless women are unable or unwilling to take the drug.
Last year’s draft guidelines said CBT could be used “in conjunction with or as an alternative to” HRT to help reduce menopausal symptoms. But this proposal was harshly criticized.
The change comes after extensive consultation with healthcare providers, patients and research organisations, which its independent committee said it had taken “very seriously”.
Dr Newson said: “The guidelines do not differentiate between older synthetic HRT and the natural body-identical hormones that are now more commonly prescribed…these newer forms offer more benefits than risks.”
NICE chief Professor Jonathan Benger said: ‘HRT is our recommended first-line treatment for vasomotor symptoms – hot flashes and night sweats.
‘We recommend that it be offered to women, provided it meets their needs and after informed debate.
In addition to the revised guidelines, the regulator has developed a “discussion aid” for GPs and patients.
This includes data on how HRT may slightly increase the risk of some health conditions.
A review of the evidence found that there were no links with an increase in heart disease, stroke or dementia when HRT was started at the typical time of menopause, between ages 45 and 55.
The new NICE guidance also addressed the use of cognitive behavioral therapy, a type of psychotherapy that has also been shown to help reduce some menopause symptoms.
Professor Benger said: “We have revised the guidelines to make it really clear that CBT is an adjunct, it is a complementary therapy and it can help people manage symptoms… in addition to HRT, or some women may choose not to. do it”. take HRT, or they may not be able to take HRT and therefore that is where CBT can be helpful.
“But we want to emphasize that HRT is our recommended first-line therapy for vasomotor symptoms and menopausal symptoms.”
Marie Anne Ledingham, clinical adviser at NICE, said: “While there are some increased risks associated with hormone replacement therapy for menopausal symptoms, there are obviously a huge number of benefits for women.”
“The updated guidance advises healthcare professionals to tailor information on the benefits and risks of HRT for these individual symptoms based on the person’s age, their individual circumstances and any additional potential risk factors.”
