Menopause doesn’t come with a manual. When you’re faced with symptoms that disrupt your sleep, mood or daily life, knowing your options can make a real difference. You may have heard of HRT, but that’s just one piece of the puzzle. This blog gently walks through a full range of evidence-backed treatment options so you can understand what’s available and start finding what feels right for you.
1. Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy replaces the oestrogen your body stops producing during menopause. For many women, it is the most effective way to manage symptoms such as hot flushes, night sweats, low mood, and joint pain. It can also help protect against osteoporosis and, when started within 10 years of menopause, may reduce the risk of heart disease[1].
Types of HRT include:
- Combined HRT (oestrogen and progestogen) for women with a womb
- Oestrogen-only HRT for those who have had a hysterectomy
- Various delivery methods such as tablets, patches, gels, sprays, or implants
Transdermal HRT (patches, gels or sprays) may carry a lower risk of blood clots compared to oral HRT[2].
Cyclical vs Continuous Combined HRT
- Cyclical (sequential) combined HRT is typically offered to women who are still having periods. It involves taking oestrogen daily and progestogen for part of the month, mimicking the natural menstrual cycle and often resulting in monthly withdrawal bleeds.
- Continuous combined HRT is usually recommended for postmenopausal women (those who have not had a period for at least 12 months). It involves taking both hormones daily, with the goal of eliminating bleeding altogether.
The best option depends on your age, stage of menopause, medical history, symptoms, and personal preferences. A menopause-informed clinician can help tailor the approach[3].
2. Non-hormonal prescription treatments
If HRT isn’t suitable or preferred, several non-hormonal prescription treatments are available to help manage symptoms:
- SSRIs and SNRIs – Certain antidepressants such as venlafaxine and fluoxetine can reduce hot flushes by 20–60%, and support mood and sleep[4].
- Clonidine – A medication originally used for high blood pressure that may help reduce hot flushes in some women.
- Gabapentin – Typically used to treat nerve pain or seizures, but can also relieve hot flushes, especially night sweats.
- Fezolinetant – A newer non-hormonal drug that targets neurokinin-3 receptors in the brain’s temperature control centre. It is an option for those who cannot or prefer not to take hormones[5].
3. Lifestyle and behavioural strategies
Sometimes, small changes in daily life can make a meaningful difference in how you feel.
- Exercise – Regular physical activity improves mood, metabolism, sleep and bone health. Aim for at least 150 minutes of moderate aerobic activity and two sessions of strength training per week[6].
- Sleep and stress – Prioritising sleep hygiene, relaxation techniques and structured routines can help reduce anxiety and emotional symptoms.
- Cognitive Behavioural Therapy (CBT) – CBT tailored for menopause can ease hot flushes, support sleep and improve emotional wellbeing[7].
- Healthy routines – Reducing alcohol, quitting smoking, and maintaining social connection can all support your physical and mental wellbeing[8].
4. Nutrition and supplements
What you eat can influence how your body responds to hormonal changes.
- Calcium and Vitamin D – These are essential for bone health and reducing fracture risk. Adults should aim for 700–1200mg of calcium daily and 10mcg (400 IU) of vitamin D, or more if deficient[9].
- Phytoestrogens – Naturally found in soy, flaxseed and legumes, these plant compounds may mimic oestrogen slightly. Evidence is mixed, but they may help with mild symptoms in some women[10].
- Supplements – Many over-the-counter products are marketed for menopause. Always consult your clinician before starting any supplement, as some can interact with medications or cause side effects[11].
5. Complementary and alternative therapies
While some women find relief with alternative therapies, scientific evidence is generally limited.
- Herbal remedies (e.g. black cohosh, red clover): Some women report symptom relief, but research is inconsistent. Black cohosh in particular carries some risks.
- Potential risks and interactions include:
- Liver toxicity – Rare cases of liver damage have been reported. It should be avoided by those with liver disease or abnormal liver function[12].
- Oestrogen-sensitive cancers – It is not recommended for those with a history of breast, ovarian or endometrial cancer[13].
- Medication interactions – May interact with blood pressure medicines, tamoxifen, statins, paracetamol, and antifungal agents[14].
- Surgery – It may affect clotting and should be stopped at least two weeks before surgery[15].
- Potential risks and interactions include:
- Acupuncture and reflexology – Some small studies suggest benefits, but results are not conclusive.[16]
- Mindfulness and yoga – These can support mental wellbeing and reduce stress, though they have not been shown to directly reduce hot flushes.
Always check with a qualified healthcare professional before using alternative therapies, especially if you are on medication or managing other health conditions.
6. Vaginal and pelvic health support
Genitourinary symptoms such as vaginal dryness, irritation, or discomfort during sex are common and often underreported.
- Vaginal moisturisers and lubricants – Available over the counter for mild or occasional symptoms.
- Local oestrogen – Delivered via cream, pessary or vaginal ring, this provides targeted relief with minimal absorption into the bloodstream. It can be used long-term and safely even in those not using systemic HRT[18].
- Pelvic floor exercises – These strengthen the muscles supporting the bladder and vagina, improving bladder control and sexual function[19].
7. Integrating and personalising your approach
Most women benefit from a combination of treatments—for example, HRT for hot flushes, CBT for mood and sleep, and vaginal oestrogen for dryness. The best plan is one that reflects your symptoms, values, medical history and lifestyle. A menopause-informed clinician can help you explore your options and make changes as your needs evolve.
¹Women’s Health Concern (2022) HRT Summary Factsheet
. Available at: https://www.womens-health-concern.org
²British Menopause Society (2022) Prescribers’ guide to HRT. Available at: https://thebms.org.uk
³NHS (2024) Treating Menopause Symptoms. Available at: https://www.nhs.uk
⁴NICE (2023) Clinical Knowledge Summary: Menopause. Available at: https://cks.nice.org.uk
⁵NICE (2023) Menopause: diagnosis and management (NG23). Available at: https://www.nice.org.uk/guidance/ng23
⁶Women’s Health Concern (2023) Nutrition in Menopause Factsheet. Available at: https://www.womens-health-concern.org
⁷Hunter, M.S. and Mann, E. (2010) ‘A cognitive behavioural intervention for women who have menopausal symptoms following breast cancer treatment (MENOS 1): a randomised controlled trial’, BJOG, 117(4), pp. 475–482. https://pubmed.ncbi.nlm.nih.gov/22340966/
⁸NHS. How to quit smoking. 2024. Available at: https://www.nhs.uk/live-well/quit-smoking
⁹NHS (2024) Vitamin D and Calcium Guidelines. Available at: https://www.nhs.uk
¹⁰Lethaby, A. et al. (2007) ‘Phytoestrogens for vasomotor menopausal symptoms’, Cochrane Database of Systematic Reviews, Issue 4. https://pubmed.ncbi.nlm.nih.gov/17943751/
¹¹British Menopause Society (2023) Complementary and Alternative Therapies Statement. Available at: https://thebms.org.uk
¹²NICE (2023) Complementary and alternative therapies for menopause. Available at: https://cks.nice.org.uk/topics/menopause
¹³Enbom, Elena T., et al. "Mechanism of hepatotoxicity due to black cohosh (Cimicifuga racemosa): histological, immunohistochemical and electron microscopy analysis of two liver biopsies with clinical correlation." Experimental and molecular pathology 96.3 (2014): 279-283. https://www.sciencedirect.com/science/article/abs/pii/S0014480014000343
¹⁴National Institutes of Health (2022) Black Cohosh Fact Sheet. Available at: https://ods.od.nih.gov
¹⁵Ernst, E. (2006) ‘Black cohosh for menopausal symptoms: a systematic review of efficacy, safety, and mechanisms of action’, Menopause, 13(5), pp. 744–749. https://journals.lww.com/menopausejournal/abstract/2003/10010/a_systematic_review_of_the_safety_of_black_cohosh.10.aspx
¹⁶Natural Medicines Database (2023) Black Cohosh Monograph. Available at: https://naturalmedicines.therapeuticresearch.com
¹⁷British Menopause Society (2023) Local oestrogen therapy guidance. Available at: https://thebms.org.uk
¹⁸Women’s Health Concern (2023) Vaginal Dryness Factsheet. Available at: https://www.womens-health-concern.org
