Parental internet platform calls UK menopause guidelines “patronizing”

05 Jan 2024 --- Guidelines from the UK National Institute for Health and Care Excellence (NICE), which cover the identification and management of menopause for general practitioners (GP), are criticized as “detrimental to women’s health” by Mumsnet, a parent-child internet discussion forum. 

Justine Roberts, Mumsnet CEO and founder tells Personal Care Insights, “The draft NICE guidance fails to give clear information on the safest forms of hormone replacement therapy (HRT) and emphasizes the risks of HRT over the benefits.” 

We also reached out to NICE and were told, “The draft guidance makes clear that it is important that healthcare practitioners take a personalized approach when discussing treatment options tailored to individual circumstances,” 

Roberts disagrees and fears “it will make doctors more reluctant to prescribe HRT and make it even harder for women to access it. And we’ve heard from thousands of women who are already struggling to access the HRT they are entitled to — from GPs refusing to prescribe HRT to being wrongly prescribed antidepressants.”

Helping or hindering?
According to NICE, the guidelines were made to improve the consistency of support and information provided to people experiencing menopause. It includes updated recommendations on the management of genitourinary symptoms and the effects of HRT on cardiovascular disease and stroke, breast cancer and dementia. 

NICE suggests CBT for menopausal women as a replacement to HRT.“The impact of menopause symptoms on quality of life can vary hugely. The draft recommendations are based on the latest available evidence, and we want it to offer a useful and usable guide to help inform those discussions,” explains the NICE spokesperson. 

It also includes new information on endometrial cancer, ovarian cancer and life expectancy, alongside the effects of either taking or not taking HRT on health outcomes for people experiencing early menopause. 

“The draft guidance… sets out the risks and benefits of different treatment options so people can work with their healthcare practitioner to agree what works best for their particular needs,” highlights the NICE spokesperson.

The institute says that women experiencing hot flushes, night sweats, depression and sleep problems could be offered cognitive behavioral therapy (CBT) “alongside or as an alternative to” HRT.

“While CBT may be beneficial for managing some symptoms of menopause, it doesn’t actually alleviate them, but we know that HRT can lessen physical symptoms such as night sweats, joint pain, and low libido,” asserts Roberts. 

“We also know that in some areas, National Health Service waiting lists for CBT can be extremely long, with some having to wait for up to a year.”

The NICE spokesperson adds: “The recommendations were agreed by an independent committee which included specialist consultants, GPs, menopause nurses and a range of patient experts and stakeholders. We know there are strong views, and we welcome constructive challenge and a broad range of views as part of our consultation on this draft, which is open until 5 January 2024.”

Importance of wording
Mumsnet says NICE's guidelines do not understand the scale of the effect they can have.In many references to recommendations, NICE uses the phrasing “troublesome genitourinary menopause symptoms.” Mumsnet critiques using the word “troublesome” as “patronizing.” 

It continues that the language fails to reflect the life-changing difficulties experienced by women who have left jobs, are unable to cope or suffer severe physical and mental health problems until they are offered HRT. 

“Every day on Mumsnet and Gransnet, we hear from women how badly menopause symptoms can affect their lives, from mental health and work to sex and sleep. The use of the term ‘troublesome’ in the guidance belittles these symptoms, is patronizing and shows a complete failure to grasp the effect they can have on women,” cites Roberts. 

In the forum’s statement to the institute, Mumsnet says it believes that the priorities suggested in the guidance will be “detrimental to the health of women and that the medical advice fails to give doctors (and women) clear information on the safest forms of HRT.”

According to Mumsnet, in a 2021 survey, nearly four in ten women seeking treatment for perimenopause symptoms say their GP told them they’d just have to learn to live with it, while 26% of those who sought help for menopause symptoms say they visited their GP three times or more before being prescribed appropriate medication. 

In a survey in 2022, 28% of those women who told Mumsnet they were considering leaving work said they were enjoying work less because of the menopause, and 11% of respondents who left said it was because of the menopause. 

“Describing the symptoms that prompt these life changes as ‘troublesome’ is deeply offensive and suggests a failure to grasp the scale of the effect they can have on women,” writes Mumsnet in their statement to NICE.

NICE plans to publish its guidance in May, 2024.

By Sabine Waldeck