Refer a patient for specialist assessment regarding hormone replacement therapy (HRT) management if they have ongoing symptoms and lifestyle measures, hormonal, non-hormonal, or non-drug treatments are ineffective NICE CKS.
Refer if the patient has persistent, troublesome adverse effects from treatment NICE CKS.
Refer if there is uncertainty about the most suitable treatment option, for example if the woman has co-morbidities and/or contraindications to treatment NICE CKS.
Refer if there is a sudden change in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding, to assess appropriately and arrange an urgent 2-week referral if a gynaecological cancer is suspected NICE CKS.
Refer women with premature ovarian insufficiency or if there is doubt about the diagnosis, to a specialist with expertise in menopause or reproductive medicine NICE NG23.
Refer women with menopause-associated symptoms and a personal history, or high risk, of breast cancer for specialist advice NICE NG23.
Refer women with menopause due to medical or surgical treatment to discuss menopause and fertility with a healthcare professional with expertise in menopause NICE NG23.