What NICE NG23 actually says
NG23 is cited constantly and misquoted often, usually in one direction: attributing things to it that it does not say. It is a NICE guideline covering diagnosis and management of menopause for the NHS in England, published free, and readable in about twenty minutes.
The single most useful correction: NG23 contains no recommendation about symptom diaries, scores or questionnaires. They are not in the recommendations. Every page telling you "NICE recommends tracking your symptoms" is wrong — including, in the past, pages written by people who meant well.
The source that does support writing symptoms down is The Menopause Society, which advises making a list of symptoms with their frequency and timing before a consultation. Both are worth citing. Conflating them is not.
What it covers
Diagnosis. NG23's position is that in women over 45 with typical symptoms, menopause can be diagnosed on symptoms without laboratory tests. This is the recommendation most worth knowing before an appointment, because it is misunderstood in both directions — some people arrive expecting a blood test to settle the question, and some are told they need one when the guideline says otherwise for their age group. The guideline separately addresses circumstances where testing may be appropriate, particularly for younger women.
Management options, including hormonal and non-hormonal approaches, and information to support a discussion of benefits and risks.
Review cadence, including a review after starting or changing treatment and annual review thereafter.
Premature ovarian insufficiency, which is handled differently from typical menopause — a genuinely important distinction and a reason not to assume general guidance applies to a younger person.
Information and support, including what women should be told to make an informed decision.
The three things people say it says, that it does not
1. "NICE recommends keeping a symptom diary." It does not. This is the most common misattribution in this space and it appears on app marketing pages, blog posts and — occasionally — material that ought to know better. If you want to cite support for tracking, cite The Menopause Society.
2. "NICE says you should be scored on a validated scale." It does not. Symptom scales are research instruments. NG23 makes no recommendation about them, and the two best-known — the Greene Climacteric Scale and the Menopause Rating Scale — are licensed and not freely usable in a commercial product. What the scales are.
3. "NICE says you should be offered HRT." The guideline is about supporting an informed discussion of options, benefits and risks. Framing it as a mandate misrepresents both the guideline and the decision.
Why this matters more than a citation nitpick
Two reasons, and neither is pedantry.
It changes what you can say in an appointment. Arriving with "NICE says you should give me X" based on a misquote is a bad position to be in, because a clinician who knows the guideline knows it does not say that. Arriving with "my understanding is that diagnosis over 45 is usually clinical rather than by blood test — is that right for me?" is a question that goes somewhere.
It is a test of the source you are reading. A page that misattributes something checkable to a freely available guideline is a page that has not read its sources. That is worth knowing before you trust what else it tells you, particularly in a category where the frameworks are contested and the products are selling something.
What to read instead of summaries
Read NG23 itself. It is free at nice.org.uk, the recommendations section is the part that matters, and twenty minutes there beats any number of summaries, this one included.
For US readers, NG23 is guidance for the NHS in England. It is a high-quality evidence synthesis and widely read internationally, but it is not the governing guidance elsewhere. The Menopause Society's positions are the more relevant reference in the US.
How this site handles it
Every claim links to its source, and where a widely repeated claim is wrong it is corrected rather than quietly omitted. That applies to claims that would suit us: HormoneLog would be easier to market if NICE recommended symptom tracking. It does not, so we do not say it does.
The same standard applies to the systematic review most cited about menopause apps, which is frequently attributed to the wrong authors and credited with a statistic it does not contain.
Information, not medical advice. This page describes what a published guideline covers. It is not a substitute for reading NG23 yourself or for a consultation with a clinician. HormoneLog is not affiliated with, endorsed by, or licensed by NICE or The Menopause Society.
Questions and answers
Does NICE recommend keeping a menopause symptom diary?
No. NICE guideline NG23 covers diagnosis and management of menopause and contains no recommendation about symptom diaries, scores or questionnaires. Pages claiming NICE recommends symptom tracking are wrong. The Menopause Society is the source that advises making a list of symptoms with frequency and timing.
Does NICE say you need a blood test to diagnose menopause?
NG23's position is that in women over 45 with typical symptoms, diagnosis can be made on symptoms without laboratory tests. The guideline addresses when tests may be appropriate, particularly for younger women. Read the recommendations directly rather than relying on any summary.
How often does NICE say HRT should be reviewed?
NG23 sets out a review cadence including a review after starting or changing treatment and annual review thereafter. Check the current guideline text for the exact wording, as NICE updates its guidance.
Does NICE NG23 apply outside the UK?
NG23 is guidance for the NHS in England. It is widely read elsewhere and is a high-quality evidence synthesis, but it is not the governing guidance in other health systems. In the US, The Menopause Society's positions are the more relevant reference.
Where can I read NICE NG23 myself?
It is published free at nice.org.uk/guidance/ng23. Reading the recommendations section directly takes about twenty minutes and is the single most useful thing anyone writing or reading about this can do.
HormoneLog. “What NICE NG23 actually says.” Baker Ventures LLC, September 6, 2026. https://hormonelog.bakerventuresstudio.com/guides/what-nice-ng23-actually-says/