Background

The first National Institute for Health and Care Excellence (NICE) Guideline on Menopause: Diagnosis and Management was published in November 2015.1 It was eagerly awaited by clinicians around the UK as a source of accurate information following years of sensationalist headlines and confusion around hormone replacement therapy (HRT), and will be a particularly important resource for primary care where most symptomatic women present and where most HRT prescribing takes place.

Individualisation and information

The document starts by advocating an individualised approach at all stages of the diagnosis, investigation and management of menopause, a life transition which varies widely between women. As many as 80% of women going through menopause experience symptoms, typically lasting for around 4 years after their last period, but in about 10% of cases symptoms can last for up to 12 years. The average age for menopause, currently 51 years in the UK, varies between ethnic groups, with Indian, Hispanic and African women having an earlier menopause and Japanese women tending to have a later menopause compared to Caucasian women.2 Premature menopause, also known as premature ovarian insufficiency, affects 1 in 100 women aged under 40 years.3

The importance of information for women and their family members or carers is emphasised, and this should include an explanation of the stages of the menopause, common symptoms and diagnosis, and the need for contraception when necessary along with treatment options. The benefits and risk of treatments should be explained in the context of the individual woman's personal risk factors, ideas, concerns and expectations. The consultation ideally will also discuss lifestyle changes and interventions that could improve general health and well-being. In some women menopausal symptoms may severely affect a woman's health and quality of life.

Avoid routine use of an FSH level to diagnose menopause

A key change is the recommendation against biochemical confirmation of menopause via follicle-stimulating hormone (FSH) testing to diagnosis …