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NICE NG23: Identifying perimenopause and menopause, and offering HRT

Tier 1: Established: peer-reviewed research or government health authority
Publisher: National Institute for Health and Care Excellence (NICE) · Published: September 16, 2026 · Accessed: September 16, 2026

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Claims this source supports

  • Identification of perimenopause and menopause in otherwise healthy people aged 45 or over with menopause-associated symptoms is made without laboratory tests: perimenopause if they have vasomotor symptoms that have recently started and any changes in their menstrual cycle, and menopause if they have not had a period for at least 12 months and are not using hormonal contraception (recommendation 1.3.1).
  • The 12-month rule sits in the section on identifying (dating) perimenopause and menopause; it is a diagnostic threshold for when menopause has been reached, not a rule about when treatment should stop (recommendation 1.3.1).
  • Do not use anti-Mullerian hormone, inhibin A, inhibin B, oestradiol, antral follicle count or ovarian volume to identify perimenopause or menopause in people aged 45 or over (recommendation 1.3.4).
  • Discuss with the person the benefits and risks associated with each potential management option for menopause-associated symptoms (recommendation 1.4.1).
  • Offer HRT to people with vasomotor symptoms associated with menopause (recommendation 1.5.1).
  • Consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms: in addition to HRT, or for people for whom HRT is contraindicated or who prefer not to take HRT (recommendation 1.5.2).
  • Menopause-associated symptoms may include vasomotor symptoms (hot flushes and sweats) and genitourinary symptoms (for example, vaginal dryness), as well as menstrual cycle changes, effects on mood, musculoskeletal symptoms and sexual difficulties (recommendation 1.2.2).
  • Offer vaginal oestrogen to people with genitourinary symptoms associated with menopause, including those already using systemic HRT, and review regularly (recommendation 1.5.5).
  • If a person chooses to take HRT, use the lowest effective dosage (recommendation 1.8.3).