What are the current guidelines for the management of menopausal symptoms in primary care?

Offer hormone replacement therapy (HRT) to people with vasomotor symptoms associated with menopause, discussing the possible duration of treatment and reviewing benefits and risks at each review ¹.

Consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms, either alongside HRT, if HRT is contraindicated, or if the person prefers not to take HRT ¹.

Do not routinely offer SSRIs, SNRIs, or clonidine as first-line treatments for vasomotor symptoms alone ¹.

For genitourinary symptoms, offer vaginal oestrogen, explaining that serious adverse effects are very rare, and review regularly; symptoms often return when stopped but treatment can be restarted ¹.

When discussing vaginal oestrogen, involve shared decision-making about the formulation (cream, gel, tablet, pessary, or ring) and advise it can be used alone or with non-hormonal moisturisers or lubricants ¹.

For those contraindicated for vaginal oestrogen or preferring non-hormonal options, consider non-hormonal vaginal moisturisers or lubricants, or vaginal prasterone if other treatments are ineffective or not tolerated ¹.

Consider oral ospemifene for genitourinary symptoms if local treatments are impractical ¹.

Provide information and support tailored to individual needs, including discussing menopause and management options with people and their families or carers ¹.