Hormone replacement therapy (HRT) should be the first treatment offered to women with menopausal symptoms, a health watchdog has said in strengthened guidelines.

The National Institute for Health and Care Excellence (Nice) has stated that “HRT is the preferred and recommended approach” to managing symptoms such as hot flashes, insomnia and low mood , and should be offered by general practitioners in discussion with patients about the risks and benefits. .

This follows draft guidelines from Nice last November suggesting that cognitive behavioral therapy (CBT) – a talking therapy designed to help people manage their problems by changing the way they think and behave – could be offered as an alternative or alongside HRT.

This proved controversial and Nice rewrote the guidelines to emphasize that HRT should be first-line treatment, with CBT an option for women in addition to HRT, for people who cannot take HRT or for those who don’t want to take it.

Nice also emphasized in the updated guideline that HRT does not affect overall life expectancy and will not shorten or extend women’s lives.

Professor Jonathan Benger, chief medical officer and interim director of the Nice Guidance Centre, told a briefing that the body had “worked hard to ensure that the place of CBT” was clear and “some A number of changes have been made to emphasize this. .

He added: “HRT is our recommended first-line treatment for vasomotor symptoms (hot flashes and night sweats), and we recommend that it be offered to women, provided it meets their needs and after a informed discussion.

“We have revised the guidelines to make it very clear that CBT is an adjunctive treatment, a complementary therapy and can help people manage symptoms… in addition to HRT, or some women may choose not to take HRT, or they may I can’t take HRT, and so that’s where CBT can help.

“But we would like to emphasize that HRT is our recommended first-line treatment for vasomotor symptoms and for menopausal symptoms.”

Professor Berger stressed that “what we are not saying is that these are not real symptoms that women are experiencing – these are real troubling symptoms and HRT can be very effective.

“The goal of CBT is to help people manage these symptoms more effectively, so they are less bothersome, but these symptoms are real and they exist.”

Marie Anne Ledingham, a consultant clinical advisor in Nice, said the original draft wording on CBT had proved “controversial” and much time had been spent “re-examining the wording and placement of CBT within the lines guidelines and its ranking compared to other recommendations.

Announcing the draft guidelines last November, Nice said it recommended “more treatment choices for menopausal symptoms” and that CBT “should be considered alongside or as an alternative to HRT”.

The draft guidelines say doctors should “consider CBT” for sleep difficulties, depression and menopause-related sleep problems.

The new updated guidelines now state that CBT may be suitable as a complementary treatment to HRT, or for those who are unwilling or unable to take HRT.

Also on Thursday, Nice published a “discussion aid” for GPs and patients, including data on how HRT may slightly increase the risk of certain diseases such as breast cancer and blood clots, while reducing the risk of osteoporosis.

Professor Berger said the discussion support “will help clinicians offer personalized advice to women who are considering starting HRT.

“Women need to feel confident that they will be offered advice and options that meet their needs, and that they will be supported to make the choices that are right for them. »

Ms Ledingham said: “Menopause care should be individualized and those seeking treatment for menopause symptoms have the right to make informed decisions about their care.

“The experience of menopause differs greatly from woman to woman, but for those seeking treatment for hot flashes and night sweats, this updated guideline offers new options and new evidence on the THS who will support their choices.”