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Managing Menopause beyond HRT

Although hormone replacement therapy (HRT) can be beneficial for many women, there are some women who cannot take HRT for medical reasons and others who wish to not take it. In addition, taking HRT is not the only treatment for the menopause and should not be given in isolation without considering other treatments and lifestyle interventions.

Eating a healthy diet

It is really important that women eat a healthy balanced diet. As our bone density reduces during the perimenopause and menopause, it is essential to eat a diet rich in calcium to keep our bones strong and healthy. Reducing the amount of sugar in our diet is beneficial and trying to eat foods with a low glycaemic index (such as brown rice and oats) will reduce sugar swings and can be beneficial to our pancreas which produces insulin.

Eating less processed foods and trying to eat healthy fats such as those in avocado and nuts are important. There is increasing evidence that gut health is very important, not just for our health but also they can have an influence on our mood, emotions and wellbeing. The levels of gut friendly bacteria can reduce after the menopause which can lead to symptoms such as poor digestion and food intolerances occurring.

Some women find that eating spicy foods can exacerbate their symptoms.

Reducing alcohol

Some women find that drinking alcohol can worsen their symptoms, especially hot flushes. Keeping our alcohol intake to a minimum is healthy for so many reasons as drinking more than the current recommendations can increase our future risk of osteoporosis, heart disease and even some types of cancer. Alcohol also contains hidden calories!

Doing regular exercise

Undertaking regular exercise is clearly very important for our cardiovascular and bone health. It can also help reduce anxiety and stress.

Finding an exercise that suits you is important as you are then more likely to do it regularly. Even just walking up stairs instead of using the lift is a step in the right direction. I personally find practising yoga regularly addresses my exercise and also wellbeing in a really positive way. Doing yoga regularly can also help balance other hormones such as melatonin, thyroid hormones and stress hormones.

Having enough sleep

It can be very common for our sleep patterns to change with our changing hormone levels. Avoiding using screens, including telephones, in the bedroom is essential as the blue light emitted from these screens can affect our melatonin (sleep hormone) levels.

Many women find it useful to sleep with a window open so having fresh air circulating in the bedroom. Avoiding caffeinated drinks for a few hours before bedtime can reduce stimulation. Drinking alcohol can actually make the quality of sleep worse so this is another reason to moderate your alcohol intake.

Using meditation as a way of mimicking restful sleep even if you are not fast asleep can be difficult for some women but it is certainly worth trying to master.

Cognitive Behavioural Therapy (CBT)

This can work to improve emotions, such as anxiety and low mood, which can occur as a result of the menopause. There is also some evidence that CBT can be beneficial to reduce the frequency and duration of hot flushes.


There is some evidence that acupuncture can improve menopausal symptoms.

Herbal preparations and supplements

Agnes castus may improve some symptoms such as mood swings, tension and anxiety. Black cohosh and red clover may help improve some symptoms.

There is no good evidence that any of these preparations are beneficial. However, this does not mean they do not work. There has been little research in this area. It is important that if you do take a herbal treatment then it should have a traditional herbal registration (THR) and this logo should be clearly marked on the packaging. There is a fair amount of variety in these products effectively and potency.

These preparations may improve symptoms that they will not reduce future risk of osteoporosis and heart disease which HRT can.

Other prescribed medication

Antidepressants can reduce hot flushes and night sweats in some women. They are often given in low doses for women who cannot take HRT for medical reasons. One of the side-effects is they can reduce libido.

Many women are given antidepressants first line for the low mood associated with the menopause and this goes against current guidance.  There is no evidence that taking antidepressants in this way is beneficial.

Other medications, such as gabapentin, pregabalin and metformin, can be given with some benefit for some women. Clonidine is a medication sometimes given for hot flushes but it is very seldom beneficial.

It is really important that women have individualised treatment regarding their menopause. They certainly should not be taking medications or supplements without speaking to a doctor who has experience in the menopause.

Managing Menopause beyond HRT
Dr Louise Newson

Written by
Dr Louise Newson

Dr Louise Newson is a GP and pioneering Menopause Specialist who is passionate about increasing awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all people.

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