Menopause
Also known as: hormone replacement therapy · HRT · menopausal hormone therapy
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The 2022 Hormone Therapy Position Statement of The North American Menopause Society
The Menopause Society (formerly The North American Menopause Society) · 2022 · 2022 position statement
The Menopause Society's position statement on menopausal hormone therapy, synthesising evidence on benefits and risks and how these vary with age at initiation and time since menopause. It is the principal US society document on hormone therapy for menopause and has been endorsed by numerous other medical organisations. Metadata record only.
Menopause: identification and management
National Institute for Health and Care Excellence (NICE) · 2015 · NICE guideline NG23 (updated November 2024; amended April 2026)
The UK national guideline on identifying and managing menopause, including premature ovarian insufficiency. It addresses individualised care, symptom management options including hormonal and non-hormonal approaches, and the effects of hormone replacement therapy on specific health outcomes. Metadata record only.
- Originally published 12 November 2015; a substantial update was issued in November 2024 and the guideline was last amended 15 April 2026. source
- Covers women, trans men and non-binary people registered female at birth who have or will experience menopause-associated symptoms. source
- Includes a distinct section on diagnosis and management of premature ovarian insufficiency in people under 40. source
US vs EU key differences
- The US statement organises hormone therapy around a timing window, judging the benefit-risk ratio favourable for women under 60 or within 10 years of menopause onset and less favourable beyond that; NICE instead frames HRT by symptom indication, stating coronary heart disease risk does not increase with combined HRT while advising that HRT not be offered for cardiovascular prevention. source
- Document scope differs: the US document is a hormone-therapy position statement only, whereas NICE NG23 also covers diagnosis, advising that menopause be identified from symptoms alone in women aged 45 and over, with FSH testing reserved for ages 40-45 or under 40. source
- NICE now recommends cognitive behavioural therapy as an option for vasomotor symptoms, either alongside or instead of HRT and particularly for those who cannot take HRT. source
- Neither guideline sets an arbitrary stop date for hormone therapy: the US statement allows longer durations for documented indications such as persistent vasomotor symptoms with shared decision-making and periodic reassessment. source
What changed recently
- EUNICE guideline NG23 (November 2024 update) → NICE guideline NG23 (updated November 2024; amended April 2026)2026-04-15
The April 2026 amendment reworked the advice on unscheduled vaginal bleeding while on systemic HRT, changing one recommendation and adding a new one so the guidance lines up with NICE's suspected cancer referral guidance. The preceding November 2024 update had added evidence-based recommendations on cognitive behavioural therapy for menopausal symptoms, on genitourinary symptoms, and on the health outcomes associated with HRT.
See the full update feed for changes across every system.