The NHS is considering a shift in menopause treatment, proposing talking therapy, particularly cognitive behavior therapy (CBT), as a potential alternative or supplement to hormone

replacement therapy (HRT) for managing troublesome menopausal symptoms. This draft guidance from the National Institute for Health and Care Excellence (NICE) marks the first significant update in nearly a decade, aiming to provide women with more treatment options.

According to NICE, CBT could assist in alleviating hot flushes, sleep disturbances, and mood changes commonly associated with menopause. The guidance emphasizes empowering women to select the most suitable treatments by weighing the risks and benefits in consultation with their healthcare provider.

While the update sheds light on various HRT formulations and their respective pros and cons, it does not introduce information on testosterone therapy, an aspect some menopausal women seek from private clinics.

The draft suggests using the lowest effective dose of HRT if opted for, while also allowing for the consideration of individual or group talking therapy sessions, whether in-person or online.

HRT, aimed at supplementing declining estrogen levels during menopause, can alleviate symptoms and support bone health but poses potential risks such as increased chances of breast, ovarian, and womb cancers, blood clots, stroke, and dementia, albeit with varying probabilities based on individual health factors.

While acknowledging CBT's potential benefits in addressing sleep-related issues during menopause, critics like GP and menopause specialist Dr. Louise Newson find the draft disappointing. Newson emphasizes that while CBT might offer holistic support, it doesn't address the underlying hormone deficiencies causing menopausal symptoms. She highlights the absence of HRT's potential positive impacts on conditions like heart disease and clinical depression in the document.

In contrast, the British Menopause Society appreciates the inclusion of CBT in the guidance, emphasizing the significance of CBT alongside a clear assessment of HRT's benefits and risks.

The draft guidance is currently open for public consultation until January 5, 2024, seeking broader input before finalization. The discussions around this draft highlight the ongoing debate and diverse perspectives on managing menopause symptoms effectively.