- Email: [email protected]
The NICE menopause guidelines
Maturitas 85 (2016) 71–72
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Editorial
The NICE menopause guidelines
The UK NICE menopause guidelines were launched in November 2015 [1]. They aim to improve the treatment of women during the menopause transition. For the readers of ‘Maturitas’ none of the recommendations will come as a surprise, since it is a summary of the current evidence-base of papers on the subjects. Where that evidence is lacking, the agreed ‘best practice’ has been cited. The NICE menopause guidelines have made recommendations on:
• • • • •
Individualised care. Diagnosis of perimenopause and menopause. Information and advice. Managing short-term menopausal symptoms. Long-term benefits and risks of hormone replacement therapy (HRT). • Diagnosing and managing premature ovarian insufficiency.
The whole thrust of the guidelines is to give the woman as much information and explanation as possible for her individualised care, and for her to make an evidence-based patient choice in discussion with her general practitioner (GP). There are sections on a ‘normal’ menopause, specific recommendations for women with premature ovarian insufficiency, and women with vasomotor or other symptoms who are breast cancer patients. For example, NICE recommends that women with breast cancer should have access to a specialist menopause clinic or professional. Often this patient cohort receives treatment for menopause from their oncologist who may not have the appropriate training. This has cost implications for better services. There is also a recommendation that women over 45 years do not need an FSH measurement, since it adds no useful information to the clinical diagnosis of the menopause. Hopefully the cost saving from fewer unhelpful biochemical tests might be put into specialist menopause clinics. There is a patient-friendly version of the guidelines and recommendations for women themselves. There is also a twenty nine-page summary of the recommendations with tables of the benefits/risks of hormonal therapy designed to be the distillation of good practice for family doctors. This short document will also be invaluable for anyone in training grades in gynaecology or women’s health, and for the woman herself to understand these complex statistics of the pros and cons of taking or not taking treatments: worth laminating and kept in the waiting room for patients to read and refer to. http://dx.doi.org/10.1016/j.maturitas.2015.12.016 0378-5122/© 2016 Elsevier Ireland Ltd. All rights reserved.
For the women’s health researchers of Maturitas there is an interesting section of research recommendations made by the committee, such as ‘what is the safety and effectiveness of alternatives to systemic HRT as treatments for menopausal symptoms in women who have had treatment for breast cancer?’ These guidelines are concerned with improving knowledge amongst healthcare professionals. There is a need to improve knowledge about the long-term benefits and risks of HRT. No other treatment has been shown to be as effective as HRT for menopausal symptoms, though the risks and benefits vary amongst women. Healthcare professionals need to be in a position to be able to support women to make an informed decision about individual benefits and risks of HRT. NICE is working with the UK Royal College of Obstetricians and Gynaecologists to ensure that management of menopause, including the benefits and risks of HRT, is covered within the core curriculum. This includes supporting the update and promotion of the advanced training specialist module on menopause and the subspecialty training in reproductive medicine. NICE are also working with the Faculty of Sexual & Reproductive Healthcare (FSRH) to highlight the menopause special skills theory course and the basic and advanced special skills module. Based in England, NICE can only work within its remit: educational journals such as Maturitas have the opportunity to reach health care professionals across the globe. In order to address variation and potential gaps in service provision, local health services may need to review, map and redesign local service provision. The number of women aged over 45 years in the world has been steadily increasing and will continue to rise. The associated increase in the number of women going through menopause is expected to result in more new referrals to secondary care of both women needing short-term symptom control and those with associated long-term health issues. There is currently a lack of specialist services and their availability varies nationally, and internationally across countries. Throughout this guideline there are recommendations to refer certain women to a healthcare professional with expertise in menopause. Currently, there may not be enough services to refer these women to. Further resources are available from NICE that may help to support implementation: uptake data about guideline recommendations and quality standard measures.
Contributor SH is the sole author of the editorial.
72
Editorial / Maturitas 85 (2016) 71–72
Conflict of interest SH is a member of the NICE Menopause guideline group.
Reference [1] Menopause: diagnosis and management. NICE guidelines [NG23]. Published date: November 2015 https://www.nice.org.uk/guidance/ng23/resources/ menopause-diagnosis-and-management-1837330217413 (accessed 12.12.15).
Funding None was sought or secured to write this editorial. Provenance and peer review Commissioned; not externally peer reviewed.
Dr Sally Hope Metabolic Bone Unit/Oxfordshire Osteoporosis Service, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK E-mail address: [email protected]
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Editorial
The NICE menopause guidelines
The UK NICE menopause guidelines were launched in November 2015 [1]. They aim to improve the treatment of women during the menopause transition. For the readers of ‘Maturitas’ none of the recommendations will come as a surprise, since it is a summary of the current evidence-base of papers on the subjects. Where that evidence is lacking, the agreed ‘best practice’ has been cited. The NICE menopause guidelines have made recommendations on:
• • • • •
Individualised care. Diagnosis of perimenopause and menopause. Information and advice. Managing short-term menopausal symptoms. Long-term benefits and risks of hormone replacement therapy (HRT). • Diagnosing and managing premature ovarian insufficiency.
The whole thrust of the guidelines is to give the woman as much information and explanation as possible for her individualised care, and for her to make an evidence-based patient choice in discussion with her general practitioner (GP). There are sections on a ‘normal’ menopause, specific recommendations for women with premature ovarian insufficiency, and women with vasomotor or other symptoms who are breast cancer patients. For example, NICE recommends that women with breast cancer should have access to a specialist menopause clinic or professional. Often this patient cohort receives treatment for menopause from their oncologist who may not have the appropriate training. This has cost implications for better services. There is also a recommendation that women over 45 years do not need an FSH measurement, since it adds no useful information to the clinical diagnosis of the menopause. Hopefully the cost saving from fewer unhelpful biochemical tests might be put into specialist menopause clinics. There is a patient-friendly version of the guidelines and recommendations for women themselves. There is also a twenty nine-page summary of the recommendations with tables of the benefits/risks of hormonal therapy designed to be the distillation of good practice for family doctors. This short document will also be invaluable for anyone in training grades in gynaecology or women’s health, and for the woman herself to understand these complex statistics of the pros and cons of taking or not taking treatments: worth laminating and kept in the waiting room for patients to read and refer to. http://dx.doi.org/10.1016/j.maturitas.2015.12.016 0378-5122/© 2016 Elsevier Ireland Ltd. All rights reserved.
For the women’s health researchers of Maturitas there is an interesting section of research recommendations made by the committee, such as ‘what is the safety and effectiveness of alternatives to systemic HRT as treatments for menopausal symptoms in women who have had treatment for breast cancer?’ These guidelines are concerned with improving knowledge amongst healthcare professionals. There is a need to improve knowledge about the long-term benefits and risks of HRT. No other treatment has been shown to be as effective as HRT for menopausal symptoms, though the risks and benefits vary amongst women. Healthcare professionals need to be in a position to be able to support women to make an informed decision about individual benefits and risks of HRT. NICE is working with the UK Royal College of Obstetricians and Gynaecologists to ensure that management of menopause, including the benefits and risks of HRT, is covered within the core curriculum. This includes supporting the update and promotion of the advanced training specialist module on menopause and the subspecialty training in reproductive medicine. NICE are also working with the Faculty of Sexual & Reproductive Healthcare (FSRH) to highlight the menopause special skills theory course and the basic and advanced special skills module. Based in England, NICE can only work within its remit: educational journals such as Maturitas have the opportunity to reach health care professionals across the globe. In order to address variation and potential gaps in service provision, local health services may need to review, map and redesign local service provision. The number of women aged over 45 years in the world has been steadily increasing and will continue to rise. The associated increase in the number of women going through menopause is expected to result in more new referrals to secondary care of both women needing short-term symptom control and those with associated long-term health issues. There is currently a lack of specialist services and their availability varies nationally, and internationally across countries. Throughout this guideline there are recommendations to refer certain women to a healthcare professional with expertise in menopause. Currently, there may not be enough services to refer these women to. Further resources are available from NICE that may help to support implementation: uptake data about guideline recommendations and quality standard measures.
Contributor SH is the sole author of the editorial.
72
Editorial / Maturitas 85 (2016) 71–72
Conflict of interest SH is a member of the NICE Menopause guideline group.
Reference [1] Menopause: diagnosis and management. NICE guidelines [NG23]. Published date: November 2015 https://www.nice.org.uk/guidance/ng23/resources/ menopause-diagnosis-and-management-1837330217413 (accessed 12.12.15).
Funding None was sought or secured to write this editorial. Provenance and peer review Commissioned; not externally peer reviewed.
Dr Sally Hope Metabolic Bone Unit/Oxfordshire Osteoporosis Service, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK E-mail address: [email protected]