A 'holistic and individualised approach' should be taken when assessing and advising women going through the menopause, new practice standards recommend. 

This could include 'lifestyle advice and dietary modification', such as 'optimising weight, stopping smoking, exercising, healthy diet, and reducing alcohol consumption', the Menopause Practice Standards published last week say. 

The standards have been drawn up by six key healthcare organisations - the British Menopause Society (BMS), the Royal Pharmaceutical Society (RPS), Faculty of Pharmaceutical Medicine, Faculty of Sexual and Reproductive Health (FSRH), Royal College of Obstetricians and Gynaecologists (RCOG), and Society for Endocrinology. 

They come amid growing concerns that women are suffering menopausal symptoms without being diagnosed or seeking treatment.

The purpose of the 11 standards is to 'help guide and support health professionals delivering menopause care' by providing 'evidence-based recommendations and guidance on best menopause practice in line with current national and international guidelines and recommendations', the BMS explained.

The standards recommend that, in women aged 45 and over who are presenting with menopausal symptoms, 'the diagnosis of perimenopause or menopause should be considered based on their symptoms alone, without confirmatory blood tests unless uncertainty about the diagnosis'.

They also recommend that 'women aged 45 years and over who seek help for managing their menopausal symptoms should be offered treatment after information and support to make an informed decision about their management options'.

The approach should also include advice on risk factors for cardiovascular disease, and advice on bone health and osteoporosis, as well as cancer risk reduction, in addition to management options including hormone replacement therapy (HRT) or non-hormonal and alternative therapies, the guidance says.

The new standards say 'duration of treatment should be individualised', with 'no arbitrary limits' placed on the dose of HRT, duration of usage or age of women taking treatment. 

'This decision should be made on an individualised basis after discussing the benefits and risks with each patient and should be considered in the context of the overall benefits obtained from using HRT', the guidelines suggest. 

Haitham Hamoda, BMS chairman, said: 'The importance of applying a holistic and individualised approach in the care of women going through the menopause transition was recognised in the NICE guidance in 2015, as well as other national and international guidance documents. 

'It is essential that women are made aware that help and support is available to them and are provided with access to accurate information.' 

Women in early menopause (women aged 40-45 years) 'should be advised to take hormone replacement at least until the natural age of the menopause,' the new standards say, recommending that women having treatment for menopausal symptoms 'ideally have a review three months after starting treatment,' and 'should continue to be reviewed at least annually after that'. 

In menopausal women with low sexual desire, 'testosterone supplementation can be considered' if 'HRT with adequate oestrogen intake has not been effective,' the guidance suggests. 

Referral to - or seeking advice from - a specialist menopause service should be considered where 'menopause specialist input' is required, the standards recommend. For example, for women who may experience difficulty obtaining satisfactory symptom control despite adjustments of their HRT intake. 

The guidance says: 'Women presenting with menopausal symptoms should be made aware of resources available for guidance and should be encouraged to seek help for managing their menopausal symptoms. All women should be able to access accurate advice on how they can optimise their menopause transition and the years beyond.' 

Dr Edward Morris, RCOG president, said: 'All women will experience the menopause in different ways and that’s why it’s important they are provided with tailored care that’s right for them. 

'The menopause is a major life event that can affect women in different ways. An individualised approach in assessing women going through the menopause is essential and it’s important that women are made aware of the help and support available to them, and that they feel able to consult their GP for trusted advice.' 

The FSRH said: 'The 11 standards provide a consistent approach to clinical care and, as a result, will help women access evidence-based advice to optimise their menopause transition.' 

Concerns over the reliability of do-it-yourself menopause home testing kits have been raised by health experts, with the Royal College of Obstetricians and Gynaecologists clear that 'they are not a good method of detecting menopause or perimenopause'. 

Women in the UK going through the menopause have experienced difficulties in obtaining hormone replacement therapy supplies during the coronavirus pandemic. 

In June, the British Menopause Society, Royal College of Obstetricians and Gynaecologists and the Society for Endocrinology produced a joint position statement to provide guidance to healthcare practitioners who offer care to women experiencing the menopause.