Hormone replacement therapy (HRT) does not shorten or extend the life expectancy of those who take it to ease menopausal symptoms, health assessment body NICE says in updated guidance.

Its conclusion comes after a detailed analysis of data on the links between HRT and conditions such as heart disease, stroke, some cancers and dementia.

The guide includes a new discussion aid to help GPs give patients the most useful information about medicines and what they do.

And he says talk therapy could be offered alongside HRT to help women cope with symptoms.

HRT replaces the hormones estrogen or progestin, or both, when a woman’s period stops – normally between the ages of 45 and 55.

It is administered using gels, creams, pastes, tablets or sprays.

In its updated menopause guidance, NICE (National Institute for Health and Care Excellence) says that healthcare professionals should take a woman’s personal situation into account and provide all the information necessary to help her make the best treatment choice .

The guideline points out that although there are some increased risks associated with taking HRT, it is unlikely to extend or shorten overall life expectancy.

Easy-to-read illustrations of the likelihood of developing certain health conditions are presented. They are intended to help GPs have informed conversations with patients.

Dr Marie Anne Ledingham, consultant clinical advisor at NICE, explained that an independent panel assessed the available scientific evidence to come up with the information.

She said the risk of coronary heart disease, stroke, and ovarian and endometrial cancer was not higher among women age 45 and older taking combined HRT compared with those who never took it.

And HRT actually reduced the risk of osteoporosis-related fractures, which are more likely to develop after menopause.

But the risk of breast cancer for women has increased slightly, affecting:

• 59 out of 1,000 women who never take HRT
• 79 in 1,000 who take combined HRT for five years from age 50
• 92 out of 1,000 who took combined HRT for 10 years

The risk of dementia was also slightly higher if women started taking HRT after age 65. In younger patients there was no increased risk of developing dementia.

“The risks are very low in the population and HRT can offer huge benefits at a very difficult time in many women’s lives,” said Dr Ledingham.

The guidance is clear that HRT is the treatment option for menopausal hot flashes and night sweats.

Talk therapy known as CBT (cognitive behavioral therapy) is to be offered to women over 40 alongside HRT or, if the patient’s individual circumstances require it, instead of it.

This is a change from the draft guidelines, published at the end of 2023, which RISE controversy suggesting that talk therapy could replace HRT as a treatment.

The level of feedback received by NICE on this point has resulted in a longer than usual delay in issuing final guidance.

HRT prescriptions have increased considerably in recent years in the UK.

Professor Jonathan Benger, chief medical officer at NICE, said awareness of the impact menopausal symptoms can have on women has increased in recent years.

But he said more could be done to improve support for women from ethnic minority backgrounds and poorer areas “who are often unaware of or unable to access treatments that could help them”.

“Women need to feel confident that they will be given advice and options that meet their needs and that they will be supported to make the choices that are right for them,” Professor Benger said.