A quality assessment and systematic review of clinical practice guidelines on hormone replacement therapy for menopause using the AGREE II instrument

Clinical Practice Guidelines (CPGs) have an indispensable role in guiding the selection of treatments for menopause. Variations in guidelines can impact treatments and health outcomes. The aim of this study was to assess CPGs on hormone replacement therapy (HRT) for menopause, systematically reviewing their quality and compiling recommendations for HRT usage. Embase, Scopus, MedLine, Geneva Foundation for Medical Education and Research databases were searched to identify relevant publications. CPGs published in English language, focusing specifically on HRT for menopause were included in the analysis. Four reviewers assessed the quality of the included CPGs using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and compiled congruent as well as contradictory recommendations. Nine guidelines met the inclusion criteria. The National Institute for Health and Care Excellence (NICE), the Endocrine Society and The Association of the Scientific Medical Societies guidelines were deemed to have the highest quality and are recommended without modifications. Out of 300+ extracted recommendations, merely 17 showed consistency, overlapping in at least two CPGs. The recommendations were categorized into three domains: treatment considerations, impact of HRT on non-reproductive organ systems, and the associations of HRT with cancer. The included CPGs exhibited the highest scores in the "Clarity of presentation" and "Scope and purpose" AGREE II domains. This study found variation in recommendations and quality of CPG on HRT for menopause. Notably, only a small fraction of recommendations showed consistency across guidelines, highlighting the variability in HRT management. Efforts to improve the quality of CPGs in this area are essential to optimize patient care and outcomes in menopausal women receiving HRT.