The menopause and its management using hormone replacement therapy


Symptoms associated with the menopause

As well as a change in their menstrual cycle women may experience a variety of symptoms associated with menopause, including:

  • Vasomotor symptoms (for example, hot flushes and sweats)
  • Musculoskeletal symptoms (for example, joint and muscle pain)
  • Effects on mood (for example, low mood)
  • Urogenital symptoms (for example, vaginal dryness)
  • Sexual difficulties (for example, low sexual desire)

Managing short-term menopausal symptoms

The information below is not intended for women with premature ovarian


Vasomotor symptoms

Offer women Hormone Replacement Therapy (HRT) for vasomotor symptoms after discussing with them the short-term (up to 5 years) and longer-term benefits and risks. Offer a choice of preparations as follows:

  • Oestrogen and progestogen to women with a uterus
  • Oestrogen alone to women without a uterus.

Psychological symptoms

HRT can also help to alleviate low mood that arises as a result of the menopause.

Altered sexual function

Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective.

Urogenital atrophy

Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

Explain to women with urogenital atrophy that:

  • Symptoms often come back when treatment is stopped
  • Adverse effects from vaginal oestrogen are very rare
  • They should report unscheduled vaginal bleeding to their GP

Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

Explain to women who wish to try complementary therapies that the quality, purity and constituents of products may be unknown and the efficacy and safety of unregulated compounded bioidentical hormones are also unknown.

Starting and stopping HRT

Explain to women with a uterus that unscheduled vaginal bleeding is a common side effect of HRT within the first 3 months of treatment, but should be reported at the 3-month review appointment, or promptly if it occurs after the first 3 months of treatment.

Offer women who are stopping HRT a choice of gradually reducing or immediately stopping treatment. Explain to women that:

  • Gradually reducing HRT may limit recurrence of symptoms in the short term
  • Gradually reducing or immediately stopping HRT makes no difference to their symptoms in the longer term

Long-term benefits and risks of HRT

Discuss with women the importance of keeping up to date with nationally recommended health screening.

Explain to women the risks relating to:

  • Venous thromboembolism
  • Cardiovascular disease


NICE. Menopause: diagnosis and management. Nice Guideline NG23. National Institute for Health Care and Excellence 2015 (updated Dec 2019)


This page is intended for UK healthcare professionals only

UK19NNM00001 March 2020