Updated NICE menopause guidelines published today. While it’s welcome to see HRT as the preferred treatment for the menopause, this is a disappointing update overall. The focus remains primarily on vasomotor symptoms – hot flushes and night sweats – which are, for many women, not the main symptoms of perimenopause and menopause. Most women experience brain symptoms – brain fog, low mood, anxiety, poor concentration, sleep disturbances, memory problems and fatigue – and these are things we know are unlikely to be alleviated in the long term by CBT, as suggested. The guidelines also do not differentiate between older, synthetic HRT and the natural (body identical) hormones now more commonly prescribed – while the word “risk” is mentioned three times as often than the word “benefit”, these newer forms offer more benefit than risks. The true risk comes in NOT taking HRT at all, with good quality evidence showing that low hormones during menopause increases the risk of heart disease, osteoporosis, type 2 diabetes, dementia, neurodegenerative diseases, clincial depression, autoimmune diseases and an earlier death. These diseases reduce in women taking hormones and life expectancy increases. Women deserve to be fully informed and involved at every step of their healthcare consultation to make an informed decision on the right treatment or combination of treatments for them. While we have seen a rise in recent years in access to evidence-based treatments like HRT, a postcode lottery still exists, particularly for those from lower socio-economic backgrounds. Too many women are still struggling to receive HRT, and these guidelines will be confusing for both healthcare professionals and women. Perimenopause and menopause is sorely under-researched and under-funded, and this must change. In the meantime, women deserve to have a choice, and those who want to take HRT should be able to have it prescribed. That HRT is now the frontline treatment is refreshing, but future documents and consultations must go further to ensure women get the treatment they deserve.