Here are the latest guidelines in full from The National Institute for Health and Care Excellence (NICE) at

spontaneous POI guidelines

surgical POI guidelines


Menopausal myths busted by NICE

‘HRT isn’t safe’

There’s been a lot of worry and concern about the prescribing of HRT after a 2002 study that linked the treatment to an increased risk of breast cancer. But it’s been known for a long time that much of that was groundless and the research was inconsistent – the NICE guidelines supports this. If 1,000 women aged 50 were not taking HRT, around 22 would be expected to develop breast cancer over seven years, NICE found, in its review of the evidence. If the same number were put on combined oestrogen and progesterone treatment, there would be around five more cases and the slightly increased risk only lasts as long as women are on the therapy.

‘Menopause always happens post-50’

The average age for women to begin the menopause is 51 – though most women experience it between the ages of 45 and 55. Women should be made more aware that early menopause can occur any time after 40, and that POI can happen at any age before. It’s particularly important for younger women to receive medical help, as a lack of oestrogen can lead to more serious conditions such as osteoporosis.

‘Menopausal women have hot flushes’

One of the most common symptoms of the menopause is hot flushes (and night sweats). But not everyone woman will experience this. Some women may cope very easily, but others can become completely debilitated. Symptoms vary from mood changes to joint pain. Not all menopausal women suffer the classic hot flushes, and NICE encourages people of the need to be aware there are many symptoms.

‘A loss in sex drive is down to hormones’

This is partially true. It is common for women to experience a loss of libido, caused by a lack of oestrogen or testosterone. But it can also be down to vaginal dryness – another symptom of the menopause – which can make sex painful, and will naturally lead to a drop in sexual desire.

‘Menopausal symptoms are all physical’

A number of the symptoms are – such as hot flushes, vaginal dryness and headaches. But women can also experience mood changes, depression and anxiety, or even ‘brain fog’. Some women just can’t think straight. They can’t find the right word and that can be part of the menopause transition. It could be a result of insomnia and being tired.

‘The menopause only lasts a few years’

Actually it can vary. Some women will find their periods stop immediately and they have bypassed any symptoms. Others will experience the perimenopause (initial stage) for up to 10 years. The average duration is around four years. The menopause is said to have ended when a woman has gone 12 months without having a period.

What the experts say

“The new NICE guidelines are a welcome resource for helping health professionals better manage the menopause and their launch has helped raise awareness about menopause. Importantly, the guidelines consider POI separately, highlighting the different issues which need to be considered in women who go through the menopause at a particularly young age.

Previously, many young women have suffered with menopausal symptoms, often for several years, before the diagnosis of POI was made. The new guidelines give clear criteria for diagnosing POI, which should allow women to be diagnosed in a timelier manner and receive appropriate treatment. The guidelines also highlight that when there is any confusion regarding the diagnosis, women should be referred to a specialist with expertise in menopause.

The guidelines provide some clarity regarding the treatment options and benefits of hormone replacement in POI. They state that both the combined oral contraceptive (COC) pill and HRT are options, however HRT may have some benefit over the COC in terms of blood pressure.

POI can have profound effects, both physically and psychologically, and the new guidelines also highlight the importance of a holistic approach to care. This means that for some women with POI, they should be offered referral to other specialists, for example, fertility specialists, counsellors, psychosexual therapists or dieticians, if needed.

Unfortunately, there are many aspects of POI which the guidelines do not address. Other than confirming that HRT should be continued up until at least the average age of menopause, there is little guidance on long-term care. The guidelines do not discuss the need for bone density assessment and the long term monitoring of cardiovascular health. Furthermore, due to a lack of data from clinical trials the guidelines are not able to make recommendations as to which type, route and dose of HRT might be preferred.

Although the guidelines are certainly a positive step towards getting better care for women with POI, there remains many unanswered questions and a need for high quality research in this area.”

Kate Maclaran Daisy Network Trustee