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Alternatives to HRT

Not all women need or want to take HRT. Most of the symptoms do settle eventually but it is very variable how long they last. The average is about 7 years. If not taking HRT, any vaginal, vulval or urinary symptoms do need to be treated with long-term local oestrogen or they will only get worse with time.

There is now a big market for products aimed at menopausal women but please don’t spend lots of money on these. Most women who eat a healthy and varied diet including all the food groups will not need lots of supplements. Those with restricted diets may need some supplementation eg iron and B12 for vegans.

We should all be having a daily vitamin D supplement (800 to 1000 i.u. daily dose), especially from October to March as the sun in the UK is not strong enough during these months to help our bodies make vitamin D. We need to be taking enough calcium in our diet – you can check your intake via an online calcium calculator.

Lifestyle changes can improve perimenopausal and menopausal symptoms whether you are on HRT or not – see separate box.

We do also have non-hormonal options that can be prescribed in low doses to help with hot flushes and night sweats. These include venlafaxine, escitalopram, gabapentin, pregabalin, oxybutynin and clonidine. A new drug called fezolinetant (Veozah) is going to be assessed by NICE mid-2024 but is not available on the NHS at present.

Tips for managing hot flushes and night sweats:

  • avoid triggers such as alcohol, caffeine, spicy foods and smoking
  • drink cool rather than hot fluids and keep well-hydrated
  • wear cool, loose fitting layers of clothing
  • avoid sudden changes of temperature eg. hot baths or hot rooms
  • you can use fans, clothing designed to absorb moisture, cooling bedlinen and other items such as pillows
  • consider a separate, lower tog duvet just for you
  • keep the bedroom cool with an open window if possible
  • allow plenty of time for tasks to avoid extra stress

Cognitive behavioural therapy has been shown to help with hot flushes and night sweats as well as the sleep issues caused by the menopause. I recommend the book ‘Living Well through the Menopause’ by Myra Hunter and Melanie Smith  which is an evidence-based self-help guide using a CBT approach. Some areas now offer group CBT for these symptoms.


Date published: 20th April, 2022
Date last updated: 18th January, 2024