‘Don’t expect women to just grit teeth and get on with menopause’

would outweigh benefits. Prof Mary Ann Lumsden, chairman of the Nice guideline group, said: “What we would like is that people who need and would benefit from it have the option of considering it.”

Prof Lumsden said the most important thing was that GPs took an “individual” approach. Those suffering from low moods might be helped by cognitive behavioural therapy, while some physical symptoms could be treated. For others, simply finding out that their symptoms were normal could help them to cope.

Dr Shaw said fears about HRT meant many women endured years of misery. “I don’t think just because the menopause is a natural process women should just have to grit their teeth and get on with it,” she said.

If 1,000 women aged 50 were not taking HRT, around 22 would be expected to develop breast cancer over seven years, Nice found in its review of the evidence. If the same number were put on combined oestrogen and progesterone treatment, there would be around five more cases, Dr Shaw said.

The increased risk lasted as long as women were on the therapy, Nice said, without a longer-term impact.

In 2000, more than 6 million HRT prescriptions were issued in England. Last year, 2.3 million prescriptions were issued, according to the Health and Social Care Information Centre. HRT can be used to treat a number of conditions including osteoporosis. Prescriptions can be for one, three or six months.

Prof Lumsden said the research linking HRT to cancer did not balance the small increased risk with the misery which could be prevented by treatment. “Doctors trying to counsel patients need to look at both sides of the coin,” she said.

There are two main types of HRT; therapy which combines oestrogen and progesterone, which is the most common, and oestrogen-only therapy.

Oestrogen-only HRT does not carry the same increased risk of breast cancer and heart disease. However, it sharply increases the risk of womb cancer, so is only recommended to women who have undergone an hysterectomy.

Samia al Qadhi, Breast Cancer Care chief executive, said: “This new guidance offers much needed clarity on the often debated topic of hormone replacement therapy and breast cancer risk.”

Dr Claire Knight, Cancer Research UK’s health information manager, said the new guidelines reiterated “that there are many factors at play in a woman’s choice to use HRT or not”.