What is HRT and why is advice around menopause treatment changing?

Dr Sarah Jarvis tells ITV News why this decision has been made and what it means for women when they speak to their GP about menopause symptoms
Hormone replacement therapy should be the first treatment offered to women with menopause symptoms, a health watchdog has said after a previous draft of its guidelines that emphasised CBT sparked an outcry.
The National Institute for Health and Care Excellence (Nice) said “hormone replacement therapy (HRT) is the preferred, recommended approach” for managing symptoms such as hot flushes, insomnia and low mood, and should be offered by GPs in discussion with patients about the risks and benefits.
What is changing?
Draft guidance from Nice last November suggested cognitive behavioural therapy (CBT) – a talking therapy which is designed to help people manage their problems by changing the way they think and behave – could be offered as an alternative or alongside HRT.
That proved controversial and Nice has now rewritten the guidance to stress that HRT should be the first-line treatment, with CBT an option for women in addition to HRT, for people who cannot take HRT or for those who do not want to take it.
Professor Jonathan Benger, chief medical officer at Nice, said they “worked hard to ensure that the place of CBT” is clear and “a number of changes have been made to emphasise that”.
He added: “We have revised the guideline to be really clear that CBT is an adjunct, it’s an add-on therapy, and it can help people manage the symptoms… in addition to HRT, or some women may choose not to take HRT, or they may not be able to take HRT, and therefore that’s where CBT can be useful.”
“But we are very keen to emphasize that HRT is our recommended first-line therapy for vasomotor symptoms and for symptoms of menopause.”
What is HRT?
According to the NHS, the treatment addresses the loss of hormones people experience when they go through menopause.
When the period stops hormones like estrogen and progesterone are produced in far fewer quantities.
While their primary role is to maintain period cycles, ovulation and pregnancy, they also keep bones strong and contribute to overall health.
HRT therapy offers people hormone supplements to replace the ones the body no longer produces.
The treatment usually lasts up to five years but can in some instances go on for longer.
It can be administered by tablets, patches, gels or sprays all with their own advantages and disadvantages.
It is estimated that there are currently around 13 million perimenopausal or menopausal women in the UK, which is equivalent to around one-third of the entire female population, according to University College London.
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Why has Nice changed its guidelines?
Marie Anne Ledingham, consultant clinical advisor at Nice, said the original draft wording on CBT had proved “controversial” and a lot of time had been spent “reviewing the wording and the placement of CBT within the guideline and how it ranked in relation to the other recommendations.”
Announcing the draft guideline last November, Nice said it was recommending “more treatment choices for menopause symptoms” and CBT “should be considered alongside or as an alternative to HRT”.
The draft guidance said medics should “consider CBT” for difficulties sleeping, depression and sleep problems linked to menopause.
The new updated guidance now says CBT can be suitable as an add-on treatment to HRT, or for those who do not want or cannot take HRT.
Nice has also emphasised in the updated guideline that HRT does not affect overall life expectancy and will not shorten or extend women’s lives.
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