SPS resources

SPS has two webinars on Supporting pharmacists with HRT decision making and Primary care discussions: HRT use in clinical practice.

The Prescribing available HRT products tool provides updated information from the Department of Health and Social Care on availability of specific HRT formulations.

If relevant information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, we suggest you seek further advice from the SPS Medicines Advice service.

National guidance

The following resources will assist in understanding the considerations when managing HRT medicines.

NICE guidance

The National Institute for Health and Care Excellence (NICE) have published guidance on the diagnosis and management of menopause, including in women who have premature ovarian insufficiency.

NICE have also produced a Clinical Knowledge Summaries (CKS) on the menopause which covers the diagnosis and management of early menopause, perimenopause, and menopause in women.

Primary resource suggestions

We recommend the following resources for information about specific HRT medicines prescribed during the menopause.

The manufacturers information should always be followed unless a healthcare professional with expertise in menopause advises otherwise. Prescribing or administering a medication outside the manufacturers information may render the medicine being used off-label.

SmPCs

Summary of Product Characteristics (SmPCs) give the UK licensed status of HRT use in the menopause and can be accessed at the electronic Medicines Compendium (emc) or via the MHRA. Manufacturers may not be able to give clinical advice.

It is useful to check the SmPCs for the following information:

• dosing and administration – sometimes higher than licensed doses may be prescribed
• contraindications
• precautions
• adverse effects

British National Formulary

The online BNF has a useful overview on sex hormones and HRT, including the associated risks, considerations in patients undergoing surgery and reasons to stop HRT.

MIMS

MIMS (subscription only) has developed a HRT table which tabulates hormone doses and costs of HRT preparations.

Expert guidance

The following recommended organisations provide more specific guidance on menopause and HRT prescribing.

Local formulary or guidelines

Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant local guidelines or documents on their website.

Chelsea and Westminster hospital NHS Foundation Trust has developed guidance for HRT prescribing in primary care which is useful for clinical practice points and troubleshooting.

British Menopause Society

The British Menopause Society (BMS) has developed a range of resources for healthcare professionals which provide guidance on HRT prescribing and other treatment options and clarify some of the myths and misconceptions of menopause. The following resources are most relevant for prescribing HRT in clinical practice:

HRT prescribing resources

• HRT Guide
• HRT – Practical prescribing
• HRT preparations and equivalent alternatives
• Progestogens and endometrial protection
• Management of unscheduled bleeding on HRT
• Testosterone replacement in menopause
• Prescribable alternatives to HRT
• Non-hormonal-based treatments for menopausal symptoms
• Consensus statement on bioidentical HRT
• Consensus statement on HRT in menopausal women

Prescribing HRT in different medical conditions or patient groups

• Breast cancer and breast cancer risk fact sheet
• Coronary heart disease
• Early breast cancer – management of estrogen deficiency symptoms
• Endometriosis 
• HIV
• Menopause in ethnic minority women
• Menopause: Nutrition and weight gain
• Migraine
• Myocardial infarction
• Osteoporosis
• Premature ovarian insufficiency
• Surgical menopause
• Urogenital atrophy

Patient.Info

Patient.Info is a free online resource that provides healthcare professionals with useful information on HRT such as initial consultations, follow-up assessments and topical vaginal HRT.

Other specialist resources

The following recommended organisations provide broader information on menopause and HRT prescribing.

The Primary Care Women’s Health Forum

The Primary Care Women’s Health Forum’s Guidance on management and prescribing HRT for GPs includes a useful flow chart to use as a guide in choosing appropriate treatment.

Menopause Matters

Menopause matters has produced an interactive flow chart which aims to facilitate treatment decisions including non-HRT options and complementary therapies.

They also have guidance on the principles of HRT, the management of side effects, poor symptom control, when to refer and when to follow up.

Royal Osteoporosis Society

The Royal Osteoporosis Society provides information on bone health in the menopause and the use of HRT as a treatment option for osteoporosis.

Faculty of Sexual and Reproductive Healthcare

The Faculty of Sexual and Reproductive Healthcare (FSRH) has produced a guideline on contraception for women aged over 40 years. This outlines the transition to the menopause, suitable methods of contraception, when it should be stopped and whether HRT can be used alongside or in place of contraception.

Training materials

Learn more about the menopause and prescribing HRT with the following recommended resources.

Centre for Pharmacy Postgraduate Education

The Centre for Pharmacy Postgraduate Education (CPPE) menopause gateway portal hosts a range of learning resources for pharmacy professionals and signposts to advanced learning and further reading.

British Menopause Society

The BMS has developed a free resources toolkit that address the key questions in menopause care. The toolkit includes videos, consensus statements, infographics, tools for clinicians and fact sheets for women.

The BMS are also due to launch an online menopause education course for healthcare professionals, which will require a subscription.

International Menopause Society

The International Menopause Society has developed IMPART, an online menopause education initiative for healthcare professionals working in, or with a special interest in, midlife women’s health.

NHS England Menopause awareness elearning

The Menopause awareness elearning aims to raise awareness of the menopause and to support colleagues in the workplace.

Resources for patients

The NHS Menopause pages provides a good overview of symptoms, lifestyle advice and treatment options.

Women’s Health Concern, the patient arm of the BMS, contains a wealth of factsheets in various languages, a Menopause Wellness Hub, a series of short videos and an email advisory service for patients.

Rock My Menopause, the public-facing campaign of the Primary Care Women’s Health Forum, provides factsheets and information on specific topics around menopause and perimenopause.

The Self Care Forum menopause factsheet helps patients to understand and manage their perimenopause and menopause and when to seek further help.

The Daisy Network is a charity that provides information on premature ovarian insufficiency.

The Greene Climacteric scale is a tool for healthcare professionals to score menopause symptoms and helps with the diagnosis and monitoring of symptom control if HRT is initiated. Various apps are available to allow patients to self monitor their menopause symptoms.

The BMS Understanding the risks of breast cancer infographic compares lifestyle risk factors vs HRT.

The NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) covers an unlimited number of certain HRT medicines for 12 months.

Further reading

The Lancet has published a four-paper series on the menopause outlining optimising health after early menopause; promoting good mental health over the menopause transition; and managing menopause after cancer.