New menopause guidelines designed to cut through misinformation

Hot Flushes. Night sweats. Vaginal dryness. Painful sex. A frequent need to wee.

Menopause marks the end of a woman's reproductive years and is associated with a range of symptoms that can affect their quality of life.

There's a lot of information and misinformation about the best treatments to help ease the severity of symptoms. 

In a bid to make things easier, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has developed a new set of clinical guidelines. 

The guidelines clarify when to use menopausal hormone therapy (MHT) over other medicines and what options are available for those with a history of breast cancer.

RANZCOG guideline development group chair Catriona Melville said they wanted to "cut through the noise" and provide clear, evidence-based recommendations for clinicians to discuss with their patients.

"If your clinician is not clear about where the evidence lies and what's safe and what isn't safe, and what's recommended and what isn't recommended, then they're not in a position to have that patient-centred discussion about what the available [treatment] options are," she said.

What do the guidelines cover?

The new guidelines provide evidence-based advice for managing the symptoms of menopause, which begins 12 months after a woman's last period. 

The guidelines cover vasomotor symptoms (such as hot flushes and night sweats) and genito-urinary symptoms (such as vaginal dryness and the frequent need to urinate) of menopause in women 40 years and above.

They do not cover the management of bone density, joint pain, libido, depression or anxiety.

Magdalena Simonis, a practising GP and women's health expert from the University of Melbourne, said not all women experienced the same type or severity of symptoms.

While she was not involved in developing the guidelines, she said they reinforced the need for clinicians to treat the whole person in front of them, not just the symptom.  

"We should also be looking at lifestyle and other risk factors around the time of the menopause," Dr Simonis said. 

"This is a really important time to talk about [cholesterol] lipid control, bone density management and lifestyle activities.

"Looking at family history of other cancers, breast screening, cervical screening and having that conversation around chronic conditions."

How do the guidelines work?

The guidelines list a range of possible treatment options for different menopausal symptoms, including menopausal hormone therapy (MHT), acupuncture and hypnosis, ranking available evidence on a scale of very low to high.

The guidelines recommend that women taking MHT have an annual review with their doctor.

But there's not enough evidence that weight loss or physical activity alone will improve hot flushes or night sweats, or that hypnosis will improve sleep. 

Dr Melville, a specialist gynaecologist and sub-specialist in sexual and reproductive health, said the new guidelines would hopefully make it easier for clinicians and patients to understand their options.

For example, women with a history of breast cancer can be offered vaginal oestrogen to ease menopausal symptoms.

Although RANZCOG had previously released statements about managing menopausal symptoms, Dr Melville said these were their first evidence-based guidelines.

How will it improve patient care?

Women should receive the same standardised recommendations no matter who they see or where they live if clinicians across Australia use the same guidelines.

Jean Hailes for Women's Health chief executive Sarah White, who was not involved with the guidelines, said this was important because clinicians wanted to give their patients the very best support, but there was a lot of online misinformation to wade through.

"It really will help the health professional to have these new guidelines sitting in front of them so that they can talk them through and reassure women that they are getting the very best advice," she said.

The guidelines also encourage clinicians to ask women approaching menopause if they experience any "troublesome" symptoms, especially if patients are First Nations, Māori and Pacific Islander women and others who may experience barriers to treatment.

This will make it easier for women to get help, even if they find it hard to ask.

Won't there be new national guidelines soon?

The Australian government has funded separate perimenopause and menopause guidelines expected to be released next year. 

These guidelines, which RANZCOG is contributing to, will be continually updated as new evidence emerges.

Dr Simonis welcomed the spotlight on the health of menopausal women.

She encouraged anyone experiencing troublesome symptoms to book an appointment with their GP and advised women approaching mid-life to schedule a check-up.

"Menopause is not a stage to be afraid of or to dread; it's a natural phase of life,"