As a treatment, HRT is associated with some slight increased risks. For some women — particularly those with a history of breast cancer, of blood clots, of liver disease or of untreated high blood pressure — HRT can be unsuitable.
Some women may find HRT to not be worth it considering the impact of their menopause symptoms, or may just simply want to explore a natural remedy or supplement for keeping their symptoms in check.
Let’s take a science-based look at the latest evidence for the best HRT alternatives for menopause symptoms.
Hormone replacement therapy and the menopause: why might an alternative be more suitable for me?
Hormone replacement therapy is a treatment that involves replacing oestrogen and progesterone, two female sex hormones that decline in production during the menopause.
Oestrogen and progesterone are usually taken together in a treatment called combined HRT. Some women, such as those with a hysterectomy, will usually be recommended an oestrogen-only course of HRT.
HRT has been scientifically proven to help alleviate the many symptoms women experience during the menopause — hot flushes, mood swings, vaginal dryness, fatigue and sleeping difficulties.
However, the treatment is associated with a number of slight risks that may make some types of HRT unsuitable for women with certain health issues, including those with:
A history of breast, ovarian or womb cancer
A history of blood clots
A history of liver disease
Untreated high blood pressure
Some women don’t find their menopause symptoms to be sufficiently bothersome to warrant HRT and any increased risks that come with it. Other women may simply be interested in pursuing a natural solution or remedy, seeking an alternative source of relief from their menopause symptoms.
Fortunately, there are a number of alternative sources of relief from menopause symptoms that don’t include HRT.
What are the HRT alternatives for menopause treatment?
From lifestyle adjustments and dietary changes to alternative therapies and a number of types of medication, there are still ways to manage menopause symptoms that don’t include HRT.
Let’s explore the evidence for the effectiveness of HRT alternatives.
Healthy lifestyle choices have been shown to help improve many of the classic menopause symptoms.
Mindfulness & breathing
Stress — or, rather, the absence of relaxation — is a major contributor to the aggravation of menopause symptoms, a particular trigger for hot flushes and sleeplessness. Research shows that mindful, deep breathing plays a role in making us feel relaxed, and therefore minimising menopause symptoms like hot flushes.
In one randomised 9-week study, paced breathing was shown to reduce menopause symptoms like hot flushes by inducing relaxation. As well as being simple and convenient, the most helpful ‘dose’ of paced breathing was twice per day.
For many women, excessive amounts of drinking are known to trigger common menopause symptoms. Some women also find that certain types of food are also associated with increased likelihood of experiencing hot flushes — particularly spicy foods.
Hot flushes are probably the quintessential menopause symptom. As well as quitting smoking and practicing mindful breathing, there’s another obvious lifestyle change that can help you to minimise their impact on your life — taking steps to keep cool.
This can include lightweight clothing, particularly at night, when hot flushes become ‘night sweats’, interfering with and wreaking havoc on our sleep. These can be offset by keeping a spray bottle of cool water next to your bed, ensuring your bedroom is well ventilated and by sleeping in loose, lighter-weight clothing.
It won’t come as a surprise to learn that regular physical activity can lift our mood and help us manage our weight, but it can also represent an effective way of combating some of the menopause’s most common and troublesome symptoms: bone density loss, hot flushes and sleeping problems.
Taking up aerobic exercise
There is evidence to suggest that menopausal women who are more active are less likely to experience vasomotor symptoms (hot flushes and night sweats), insomnia, low mood and anxiety.This should not necessarily be ultra high-impact activity, though — research shows that the best results can be from sustained, moderate intensity aerobic exercise, such as jogging, swimming or cycling.
Depression, anxiety, low mood, irritability and bone loss are serious symptoms that many women report as a result of the menopause. There is a growing body of evidence to suggest that low-impact activities like yoga and tai chi can have a real effect on relieving these symptoms.
The menopause process brings with it an increased risk of bone density loss and osteoporosis — research shows that incorporating some regular weight-training and weight-bearing exercises can help to keep you in tip-top musculoskeletal shape.
A varied and nutrient-rich diet is important for people of all ages, but it can become even more essential for menopausal women. For our mental, physical and musculoskeletal health, the benefits are all-encompassing.
A good diet can help women manage the increased risk of weight gain during menopause. We also know that the risk of osteoporosis grows in menopausal women, too — a healthy diet can offset this, as well as giving our mood a lift.
Adherence to common dietary recommendations — such as low fat and sugar and a high consumption of plant-based foods — is connected to a reduction in menopause hot flushes.
Watching your caffeine intake
As a stimulant, caffeine is well known to promote hot flushes in many women. Cutting back on the volume you drink, or eliminating coffee and tea entirely, has been suggested as a way of reducing the frequency, duration and intensity of vasomotor symptoms that menopausal women experience.
Managing alcohol consumption
Excessive consumption of alcohol is linked to weight gain and low mood, which many women begin to struggle with as they enter the menopause — this can be reason enough to moderate your intake.
If alcohol seems to be a hot flush trigger for you, consider taking a look at your intake.
Complementary and alternative therapies
The market for alternative and complementary treatments for menopause symptoms has grown rapidly in recent years.
Whilst there is evidence pointing towards the effectiveness of certain alternative herbal remedies for menopause symptoms, such research is not extensive, with uncertainty about how long any benefits may last.
There is additional uncertainty about optimal dosage for treating menopause symptoms. A 2016 article stresses that there is ‘no reliable proof’ that herbal options can alleviate menopause symptoms, with potential for side effects and interactions if taken with certain drugs.
Although these products are marketed as ‘natural’, there’s also no guarantee about the quality and purity of ingredients. These products are not licensed for menopause symptom treatment.
That said, there is some interesting evidence in favour of complementary and alternative therapies — so let’s take a look.
Cimicifuga racemosa, more commonly known as black cohosh, is probably the longest-established complementary and alternative medicine for managing menopause hot flushes. It has been used for centuries in women’s health.
Black cohosh is understood to work similarly to serotonin, inducing feelings of relaxation and keeping our body temperature in check. Derived from a plant in the buttercup family, black cohosh can be mixed with water or taken as a tablet or pill.
As ever, be sure to have a discussion with your doctor if you’re considering black cohosh.
St John’s wort
When it comes to hot flushes, mood swings and sleeping problems during the menopause, this herbal remedy is one of the favourites. It is derived from the dried leaves and flowers of the wild Hypericum perforatum plant.
It can be mixed into a tea, consumed as a liquid or taken as a pill. Best known as a herbal antidepressant, there is some evidence that St John’s wort can improve menopause symptoms, particularly hot flushes. St John’s wort extract contains phytoestrogens — oestrogen-like plant compounds — that are thought to explain its effectiveness.
A clinical trial of 100 women concluded that St John’s wort was ‘an effective treatment’ for hot flushes and night sweats in menopause-age women, reducing their frequency, severity and duration.
There are calls for more structured research into the effectiveness of this plant for menopause symptoms.
As with many complementary medicines, the quality of purity of products can vary. St John’s wort is also known to interact with the effectiveness of some drugs. Make sure to consult with your doctor before deciding to start any new complementary and alternative medicines for your menopause symptoms.
Evening primrose oil
Primrose oil is another oft-touted herbal complementary and alternative medicine. There is some research attesting to the impact of evening primrose oil on hot flushes, although at present this isn’t as compelling as for other types of complementary treatment, nor is the evidence particularly extensive.
As mentioned, complementary remedies like evening primrose oil are not regulated by a government agency. Therefore, it’s harder to be sure about the quality, safety and purity of ingredients.
Soy products contain plant-based oestrogens called isoflavones. There is some evidence suggesting that isoflavones can reduce the intensity and frequency of hot flushes, with the effect scaling up with strength of product.
There are calls for more standardised research and bigger sample sizes in future studies about isoflavones and menopause symptoms. When taking isoflavones, side effects like stomach and bowel problems are not uncommon. Be sure to consult your doctor before beginning any treatment.
For over five thousand years, humans have used this interesting little herb for its therapeutic benefits. Ginseng is thought to be a natural ‘energiser’, most commonly consumed as part of a herbal tea, although can also be taken as an extract or powder.
However, such evidence on the effectiveness of ginseng for the treatment of menopause symptoms is, as the authors of a scientific review put it, ‘limited’. They called for more rigorous studies in order to draw firm conclusions, highlighting that many of the clinical studies that currently exist have a high level of bias.
We all know about the benefits of vitamin D for our bones, teeth and immune system function. As we age, our ability to absorb this crucial vitamin declines, which has made it particularly important for menopausal women to ensure they’re getting enough.
Although not a complementary medicine as such, there is some evidence pointing towards the importance of vitamin D specifically for menopause symptoms like osteoporosis.
Getting your daily recommended dose of vitamin D can be as simple as taking a short 15–20 minute walk, or supplementing with a vitamin D capsule. You may also want to increase your intake through certain foods.
Foods that are high in vitamin D:
Cod liver oil
Fortified dairy products
Some women have found a solution to their hot flushes and night sweats by turning to acupuncture, perhaps one of the most traditional forms of complementary or alternative medicine.
Although evidence is mixed and some researchers point towards the placebo effect, a number of studies have highlighted this ancient Chinese medicine’s potential to alleviate troublesome menopause symptoms.
As a once-a-day tablet, this is a type of medication that works in a similar way to hormone replacement therapy.
The most common brand name for tibolone is Livial. Tibolone has been clinically shown to reduce common menopause symptoms such as hot flushes, osteoporosis, mood swings and lower sex drive.
However, like HRT, can be associated with a slight increased risk of breast cancer, as well as having some occasional side effects during the first few weeks of use. This may make the medicine unsuitable for women who were concerned about the risks associated with HRT.
Strokes: The LIFT study found that there was a 2.2 times increased risk of a stroke in women who took tibolone. Risk increased from the first year of treatment. For combined HRT users, this risk is 1.3 times.
Research currently available does not suggest that there is an increased risk of blood clots or coronary heart disease as a result of taking tibolone. Be sure to discuss the benefits and risks with your GP if you think tibolone (Livial) may be a suitable HRT alternative for your menopause symptoms.
Antidepressant medicines have been shown to have a positive impact on hot flushes and have been recommended as an alternative to HRT. There are two types of antidepressant commonly used for menopause symptoms:
Selective serotonin reuptake inhibitors (SSRIs): These are a class of antidepressant medicine that include paroxetine, fluoxetine, escitalopram and citalopram.
Serotonin and noradrenaline reuptake inhibitors (SNRIs): A similar type of antidepressant medicine to SSRIs, which includes venlafaxine (more commonly known by the brand name, Effexor).
When these medicines first began to be used for depression, it was noted that menopausal women were seeming to have fewer (and less intense) episodes of hot flushes. SSRIs and SNRIs appear to minimise hot flushes in some, but not all menopausal women.
Be aware that there are known to be side effects for taking antidepressants for menopause symptoms:
Decreased sexual responsiveness
Although the link has been demonstrated, it’s worth noting that these antidepressant drugs are not licensed for use for menopause symptoms. If you think antidepressants may help you, be sure to consult with your doctor to discuss the benefits and risks.
Gabapentin is a drug traditionally taken for nerve pain and in order to control epilepsy. Several reports have attested to the benefits of gabapentin for reducing hot flushes. It has gained particular popularity as a non-hormonal alternative to HRT.
Side effects of gabapentin for menopause can include:
Fatigue and drowsiness
As with any treatment, be sure to consult with your doctor if interested in taking any medicine for your menopause symptoms.
Clonidine is popular as a non-hormonal alternative to HRT for menopause symptoms, usually taken orally two or three times a day. Once treatment has begun, it can take several weeks until improvements begin to show.
In one randomised, double-blind trial, women taking clonidine noted an additional 20 percent reduction in hot flashes compared to the placebo group; in another, it was an additional 14 percent. However, both groups noted very troublesome side effects, including sleeping problems, itchiness, dry mouth and nausea.
Side effects of clonidine for menopause symptoms can include:
If you think clonidine might be a suitable medication for your menopause symptoms, or you’re experiencing troublesome side effects, be sure to consult your doctor.
Bioidentical or ‘natural’ hormones
Bioidentical hormone therapy uses hormones identical to those produced by the body to replace those that decline during the menopause.
These bioidentical hormones are made from plant sources and are often touted as a ‘natural’ alternative to hormone replacement therapy, sold as preparations by ‘specialist pharmacies’ in the UK.
Many hormones used in regular HRT are made from natural sources; these have been through rigorous testing and are authorised by regulators. These bioidentical hormone treatments, on the other hand, do not follow a regulatory pathway of evaluation by the MHRA, nor has their effectiveness been properly evaluated in randomised clinical trials.
There is a paucity of large-scale research into the effectiveness of these types of preparations for controlling menopause symptoms, but some trials have pointed to their benefits.
Evidence of the benefits of bioidentical hormones for menopause symptoms:
In a study of 69 women, bioidentical hormone therapy improved quality of life by 52 percent and was ‘effective in reducing menopausal symptoms’ including sleep problems, fatigue, hot flushes, tension and loss of libido.
Bioidentical hormones should not be confused with body-identical hormones, such as those used in HRT. Micronised progesterone is a body-identical type of progestogen used in HRT which has been authorised by regulators (like the MHRA in the UK).
Be sure to have a discussion with your doctor if you’re considering bioidentical hormone therapy for your menopause symptoms.
Alternatives to HRT: see what works for you
HRT can have a transformative effect on the menopause symptoms of many women, but not every woman is suitable for the treatment, or comfortable with taking it.
As well as being fabulous advice for people of any age, research demonstrates the impact that a good diet, mindful breathing and regular exercise can have in diminishing some of the most uncomfortable menopause symptoms.
There is also evidence that some types of antidepressant and alternative medicines can provide relief from menopause symptoms. Always make sure to consult your doctor if you’re thinking of starting a new treatment or medicine for your menopause symptoms.
At Inspired Health, we’re the official UK home for many leading health brands, including Cleanmarine and their leading MenoMin all-in-one supplement, specially formulated for menopausal women.
For more information and insight-led articles on the menopause, head over to The Menopause Blog.