Clinical update

Menopause

Menopause is the permanent cessation of menstruation and loss of reproductive function. In the UK the average age of menopause is 51. Currently around a million women in the UK use treatment to relieve menopausal symptoms, says the National Institute for Health and Care Excellence.

Essential facts

Menopause is the permanent cessation of menstruation and loss of reproductive function. In the UK the average age of menopause is 51. Currently around a million women in the UK use treatment to relieve menopausal symptoms, says the National Institute for Health and Care Excellence. Two large studies – published in 2002 and 2003 – raised concerns about the safety of hormone replacement therapy (HRT) in relation to breast cancer and heart disease, leading to new guidance on prescribing. As a result, the number of women taking HRT fell by 66%, says Women’s Health Concern.

New NICE guidance, published last week, emphasises that for most women, HRT is an effective treatment for menopausal symptoms including hot flushes, night sweats and low mood, and also reduces the risk of osteoporotic fracture. The guideline says oestrogen-only HRT is associated with little or no increase in the incidence of breast cancer; HRT with oestrogen and progestogen may increase the risk, but this falls after stopping treatment.

A study based on a sample of 80 women by researchers at New York University, presented to the American Society for Reproductive Medicine in October, found that women who took HRT for up to 25 years were no more likely to develop breast cancer, heart disease or diabetes than women who did not take the treatment.

Hot flushes are the most common symptom of the menopause. Other symptoms may include night sweats, sleeplessness, vaginal dryness, mood changes, depression, joint and muscle pain, urinary problems and a reduced interest in sex.

Picture credit: SPL

The risk of cardiovascular disease increases following the menopause. As oestrogen levels decline, the risk of osteoporosis also rises.

The RCN advises that all nurses, midwives and health visitors should understand the changes that women face at the time of their menopause and the safety and efficacy of modern therapy. You should also have an awareness of complementary therapies. NICE says healthcare professionals should understand that HRT does not increase cardiovascular disease risk when started in women aged under 60 years, and it does not affect their risk of dying from cardiovascular disease.


Expert comment

Kathy Abernethy, menopause specialist nurse

‘We’ve known for several years that HRT is a lower risk than was thought during the scares more than a decade ago. While the conclusion of this new paper is correct, it is based on a small observational study, which does not meet the gold standard for research. Unfortunately, many nurses find it difficult to get funding for education on the menopause, so all too often they just remember scare stories.

‘It’s an individual choice, but women are missing out because of fear. For most women HRT is a low risk medication. Cervical screening is a perfect opportunity for nurses to discuss both symptoms and HRT, but there is a lack of communication.’


Find out more

Menopause: diagnosis and management (November 2015)

RCN competences: a competence framework for nurses working in the field of the menopause (October 2011)

Menopause: lifestyle and therapeutic approaches – RCN guidance for nurses, midwives and health visitors (October 2014)

British Menopause Society

Menopause Matters

Menopause Exchange

UK Menopause Nurse Group

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