The new NICE Guidelines

[PollyPerky]

I thought it might be helpful to pick out the main points because some posts here do show that the message hasn't got through, to GPs or women in peri or post meno.

1 Blood tests are not recommended for women over 45 as they are unreliable (under 45 yes as that would be a premature menopause.)

2 Anti depressants are not recommended for low mood and anxiety unless there is also a diagnosis of depression. ADs are also not recommended for hot flushes and sweats unless HRT in contraindicated.

3 There is no time limit on the use of HRT. It should be prescribed for each woman according to her medical history, symptoms and wishes. (no 5 year 'rule ' any more)

4 Complementary treatments (herbs etc) can be tried but women need to be aware these are not regulated or quality controlled, and there is little evidence they work (and those which do may have serious side effects like a prescribed drug.)

5 Transdermal oestrogen should be used in a woman where there is any risk of stroke or if the woman is obese.

6 Migraine is not a reason to avoid HRT. Neither is high BP. But both should be treated anyway.

7 HRT can be started after 60 but it should be transdermal.

8 HRT started within 10 years of the final period has a better safety profile and also protects against heart disease if used early.

9 Lifestyle measures such as weight loss, exercise, healthy eating and stress reduction should be part of the management of menopause along with HRT or other meds if necessary.

[tass1960]

This is great Polly - thanks for taking the time to summarise the guidelines - am going to print it out and take it with me to the doc (along with my BP profile and all the rest of the shit) am determined to get started on HRT ...

[FrameyMcFrame]

Thnaks will print this out.

[ArgyMargy]

Jeez that's depressing reading! Menopause is not a disease - why the emphasis/insistence on using drugs? Oh and a little footnote about looking after yourself. What a load of bollocks.

[PollyPerky]

Here we go again...:)

If you're managing fine and aren't interested in anything to help, fine- don't read it!

The aim of the Nice guidelines is to inform women and GPs about treatment of the menopause, in the context of latest research. I can't see anything in NICE's guidelines where they insist on women using HRT or anything else.

Menopause is not a disease, correct. Menopause can and does lead to diseases though because women are living for 30+ years without oestrogen compared to a life expectancy of 45 roughly 150 years ago.

The biggest killers of women are a) heart disease and b) osteoporosis. HRT does protect against both of these, (and yes, lifestyle measures are essential too) but no one is forcing anyone to use it.

[SageYourResoluteOracle]

Thank you Polly - it's so useful to have someone here who really knows their stuff not to mention take the time to update us. And it helps me feel less alone.

Argy- you're right- menopause isn't a disease but, for many, it's an affliction that seeps into almost every minute of every day. I am 38. I've been in peri menopause since my twenties. I have hot flushes and night sweats even when I'm on HRT. Without it though I'd be risking heart disease, osteoporosis, early onset dementia ...

I'd had no children when I was diagnosed and it almost ended my marriage and destroyed me. I can't bear minimising. Yes- it may not be a problem for you but it bloody well is for me and many others.

Your intense vitriol may be helped by some calming sage or red clover (tilts head). HTH.

[iseenodust]

Can I ask about HRT v family history of breast cancer? Mum had DCIS (surgery & radiotherapy) and is 10 years clear now age 70. Grandmother died of breast cancer in her early 60s but lived 12 years from initial diagnosis (40 years ago) so assume not an aggressive form. Where would I find some decent quality information?

[PollyPerky]

Sage thanks for your comments. I'm just passing on what I've found out myself- been seeing a gynae consultant for around 8 years and had plenty of opportunity to talk through my own concerns over HRT in that time.

Iseen Can only tell you what my consultant says but make your own enquiries- if you google or search google scholar( or indeed search the NICE guidelines I believe there are links to using HRT in women who have had breast cancer) you should find out something. or you could find a consultant yourself to discuss this with.

My dr says that 2 first degree relatives with BC 'under the age of 45' is a reason to be wary. Sadly, all women's risk of BC is 1:8 so it's quite possible that many women will have someone in their family with it. You could ask for genetic testing (prob not available on NHS ) . If you decide to use HRT there are some types that are considered less risky re. BC and you could always get more regular mammograms if you are worried.

[iseenodust]

Thanks not worried. I reckon we're all going to get something at some point & I recently had clear mammogram. Google scholar a good idea. I want to have a reasonable understanding before going to GP as seems so many find GP not up to date or maybe resistant to prescribe due to NHS cost pressures. Appreciate your sharing best practice.

[PollyPerky]

It's hard, I know. I have a mammogram every 2 years rather than 3 (pay for it) which I have mixed feeling about, but prob best be on the safe(r) side. I also use micronised progesterone which some research shows as having a 'neutral' effect on breast tissue, compared with synthetic progestogens. Read up on this it's mainstream but many GPs don't prescribe it cos they aren't aware of it. Cost ought not to be an issue- HRT is actually very cheap (see the actual RRP on Menopause Matters website under HRT preps).

[CuttedUpPear]

Has anyone found a way to deal with the interminable tiredness?
I'm on patches and am thankful for them but not coping with the exhaustion very well.

[PollyPerky]

Is it worth thinking about the dose you are taking? Sometimes if the oestrogen is too low, we can feel tired. The other thing is, are you using a conti patch or sequential? Are you more tired when you are on the progestogen part of the cycle? If so, maybe changing to another type would help.