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6.4.1 Hormone replacement therapy (HRT) for menopausal symptoms

General Advice

  • See NICE NG23 Menopause: diagnosis and management.
  • See CKS Menopause for practical guidance on best practice.
  • In most women with troublesome symptoms the benefits of HRT outweigh the risks. Offer an individualised choice of HRT preparation and discuss risks and benefits prior to starting (refer to links above). In the absence of risk factors e.g. for VTE/stroke either oral or transdermal products can be prescribed depending on patient preference.
  • Women with a premature menopause (<40 years of age) should be referred to a specialist HRT clinic. HRT is normally recommended until the average age of the natural menopause (52 years of age).
  • Specialist advice on HRT regimen is required for women who have had a subtotal hysterectomy or who have a history of endometriosis.
  • HRT preparations should be brand prescribed to aid product identification.
  • For use of HRT in osteoporosis prophylaxis refer to 6.6.3.
  • Tibolone is a synthetic steroidal compound with oestrogenic, progestogenic and androgenic activity. It is licensed for the treatment of oestrogen deficiency symptoms in postmenopausal women, more than one year after menopause.
  • See HRT Starting Treatment Guide-image below or click here to download  as a PDF.