Non-HRT and lifestyle options

Hormone replacement therapy (HRT) can bring welcome relief from menopausal symptoms. However, some women do not wish to consider HRT (see ‘Hormone replacement therapy (HRT)’). Women told us about some of the non-HRT options they have used to manage symptoms, including simple lifestyle choices, prescription medication, and over-the-counter products.

Lifestyle choices
The majority of women we spoke to adopted common sense practical approaches to minimise the effect of menopausal symptoms. By making simple changes to their lifestyle and diet as necessary, women felt they were ‘managing’ their symptoms.

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Alongside eating a well-balanced diet with lots of fruit and vegetables women talked about the importance of avoiding potential hot flush triggers such as coffee, spicy food, smoking and alcohol. Wearing cotton clothing, sleeping in a well ventilated room, and reducing stress also helped (see ‘Hot flushes and night sweats’, ‘Changes in the body and keeping healthy’ and ‘Advice to other women’).

Regular exercise, including weight bearing activities such as walking, jogging or running, not only makes women feel better but helps to reduce the risk of osteoporosis.

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In some cases, however, self-help approaches were not enough to ease symptoms. Those women we talked with who didn't want to take HRT considered various other options to improve their quality of life.

Prescription medications used to treat menopausal symptoms
A number of non-HRT prescription options are available to treat menopausal symptoms. Clonidine, a drug originally designed to lower blood pressure is now licensed to treat hot flushes and may offer relief for a few women. Its side effects include dry mouth, drowsiness and fluid retention. Antidepressants such as fluoxetine, paroxetine, citalopram and venlafaxine are sometimes prescribed ‘off-licence’ for women experiencing severe hot flushes, premenstrual tension, mood swings or anxiety. While these drugs can bring relief from symptoms, it should be remembered that their primary use is for major depressive illness and that they are not currently licensed for the treatment of menopausal symptoms. Side effects may include nausea, dizziness, dry mouth, anxiety, problems sleeping and difficulty reaching orgasm.

Non-prescription and over-the-counter treatments

Vaginal moisturisers and lubricants
The menopause is often accompanied by vaginal dryness, irritation and discomfort which can make intercourse painful (see ‘Libido, vaginal dryness and urinary problems’ and ‘Relationships, sex and contraception’). Various hormone-free lubricants for vaginal dryness can be bought without prescription. They include water-based ones such as KY Jelly and Astroglide; and Sylk, made from an extract of the kiwi fruit vine. The lubricant is usually applied just before intercourse. Used regularly, Replens MD, a long-lasting vaginal moisturiser which lubricates the entire vaginal passage, can relieve the symptoms of vaginal dryness for up to three days at a time. Replens MD,  Sylk, and Hyalofemme can also be prescribed in the NHS.

Rather than take oral HRT, some women choose prescription oestrogen in the form of a tablet, cream, ring or pessary which is inserted into the vagina to help raise local levels of oestrogen. This form of HRT is considered to have fewer risks as it is applied locally without affecting the whole body.

Complementary therapies
Many herbal remedies and over-the-counter products are claimed to ease menopausal symptoms and can be bought without prescription, but they are currently unlicensed and unregulated. They include red clover, black cohosh, and St Johns Wort. Some women we spoke to reported short-term relief from their symptoms, but because evidence of the safety, quality and effectiveness of these complementary therapies is lacking, the NHS does not support their use for the treatment of menopausal symptoms (see ‘Complementary therapies’).

‘Natural’ progesterone creams
Available over-the-counter, via the internet or by private prescription, ‘natural’ progesterone cream is an unlicensed dietary supplement made from plant sources such as yams and soya. It is claimed to help relieve symptoms such as hot flushes and sweats during the menopause, supposedly by increasing levels of progesterone which are depleted during the menopause. It can be applied almost anywhere on the body. One woman described rubbing it ‘under my armpits and down in my groin’ but felt no different after using it for six months. Scientific evidence to support its use is thin.

Alongside common sense lifestyle choices, non-HRT prescription medication and over-the-counter products can offer alternatives for women who do not want to take HRT for menopause symptoms. But women should talk to their doctor and consider possible side effects and risks before deciding to use these treatments.

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Last reviewed July 2018.

Last updated July 2018.


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