EVALUATING NICE NG23: A CRITICAL POLICY ANALYSIS OF EARLY MENOPAUSE CARE IN THE UNITED KINGDOM

ABSTRACT In the United Kingdom (UK), many women experience early menopause or Premature Ovarian Insufficiency (POI), often before the age of 45. Despite its serious health implications––including infertility, osteoporosis, cardiovascular disease, and psychological distress––early menopause remains underdiagnosed and inadequately supported within mainstream healthcare. This paper presents a critical policy analysis of the National Institute for Health and Care (NICE) guideline NG23 on menopause, using the Walt and Gilson Policy Triangle to examine not only the policy content, but also the contextual, institutional, and procedure factors that shape implementation. Drawing on clinical guidance, health policy reports, and international comparisons, the analysis identifies significant gaps in NG23, particularly in relation to younger women and those from marginalised communities. While the guideline provides robust biomedical recommendations, it lacks enforceable mechanisms for equity, work force training, commissioning, and accountability. The paper proposes targeted reforms to address these shortcomings and argues that meaningful improvement in early menopause care requires a shift from rhetorical policy commitment to actionable, system-level implementation.