GynaecologyFree in the app
Menopause & HRT
Diagnosis, POI and HRT safety.
Source: NICE NG23 (2024–2026)Diagnosis
- Over 45 with symptoms: diagnose clinically — no FSH needed
- Menopause = no period for 12 months
- Age 40–45: consider FSH
- POI: under 40, symptoms + raised FSH on 2 samples 4–6 weeks apart
HRT
- Uterus: oestrogen + progestogen; no uterus: oestrogen alone
- Transdermal if VTE risk (incl. BMI >30) — no added VTE risk
- Combined HRT: small breast cancer risk rising with duration
- Vaginal oestrogen for urogenital symptoms
- Unscheduled bleeding: review at 3 months, or promptly if later
Contraindications: breast or oestrogen-dependent cancer, undiagnosed bleeding, untreated hyperplasia, active VTE/arterial disease, active liver disease, pregnancy.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.