What are the recommended first-line treatments for managing menopausal symptoms in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Offer hormone replacement therapy (HRT) to people with vasomotor symptoms associated with menopause .

For women with a uterus, combined HRT should be offered, and for those who have had a total hysterectomy, oestrogen-only HRT should be offered .

Consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms, either in addition to HRT or when HRT is contraindicated or not preferred .

Do not routinely offer SSRIs, SNRIs, or clonidine as first-line treatment for vasomotor symptoms alone .

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