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Menopause

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.

 

Sallie describes how she coped with hot flushes and how she changed her diet.

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Age at interview: 56
Sex: Female
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What did I do about them? Well, just tried to cool down by removing clothing, not too much. Taking a cardigan off or rolling sleeves up, opening windows if I was indoors. And going and standing outside sometimes just to cool down.

I did look at foods that were supposed to help you through menopause, I can’t remember any of them now but I think I just do eat them anyway. Broccoli springs to mind. I don’t even know if that is anything to do with menopause and being good for you. I really don’t know but I think I’ve improved a lot actually over the years but don’t know about it being anything to do with menopause but then maybe it is.

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’).

 

Anne copes with her hot flushes by diet and exercise, and wearing a cotton nightdress

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Age at interview: 58
Sex: Female
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At the moment, my only symptoms are flushes. I do play quite a lot of sport. I play tennis and I think that helps quite a lot. I read a very good book by Miriam Stoppard about the menopause and she was quite keen on emphasising that diet and exercise were very important. So I’d say I have a good diet, balanced diet and I play a lot of sport and I think that’s helped a lot.

Yes, I mean at night I throw off the covers and I wear a cotton nightdress. In fact, they’re [hot flushes] not as bad as they were. I did have to at one point have a sort of flannel by the side of the bed just because I actually was perspiring so much but that’s not happening now. During the day, well maybe if I’m wearing a cardigan I just take it off but they’re actually very quick. I don’t really need to do that now.

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.

 

Rhonda’s exercise routine helps minimise the risk of osteoporosis

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Age at interview: 46
Sex: Female
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I still keep to a low dose of calcium, magnesium and a very healthy diet, lots of veggies and things. I am scanned, I have a scan for osteoporosis every three years and I’ve actually had two so far and I am due another one. And there was a slight decrease on my last scan. From the hospital’s point of view they would have wanted to have treated it but from my doctor’s point of view, she said “You’re border line and keep to load bearing exercise”. Which I do, hence the belly dancing. And also I’ve got a cross trainer and a bike at home which I’m not very good at, every now and then I think I need to do this and I will really kick myself into action and do it. But I do a lot of load bearing exercise before I go to bed at night, just for ten minutes just swinging my legs and my arms and moving my shoulders and moving my hips. Hopefully it’s doing a little bit of good. I do try and walk and we do try and go out on bike rides and keep healthy from that point view as well.

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.

 

Cynthia’s doctor offered her fluoxetine (Prozac) to help her hot flushes but she didn’t want an...

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Age at interview: 54
Sex: Female
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It was clear I was not having an easy ride with the menopause. Mine wasn’t going to take the standard oh well, up to two years. Mine was dragging on so I went back to the doctor. This time I found him a bit more receptive to other suggestions but that was because I sat down in the surgery and burst into tears. And I had read about clonidine being used for hot flushes and so he did agree that I could try that or he offered me Prozac. Now I was a bit surprised. I know that on certain doses some antidepressants are supposed to be able to help the menopause but I don’t really think it’s appropriate to have women going on Prozac when they’re not clinically depressed. I’m not sure there’s been enough research there for them to be so quick.

 

And I said, well, I’d try the clonidine but I wasn’t interested in the Prozac. I tried that low dose rising one tablet a week until I was up to the maximum of six and it did help during the day. From about 7.30 in the morning until about 4.30 I didn’t have any hot flushes. And then from 4.30 in the evening until right through the night I was back to having them on the hour every hour. So I’ve no idea. I think other things must come into play not just oestrogen and progesterone. There must be I don’t know chemicals or hormones that you make in the day or at night. There must be something else in there. Otherwise why would I every late afternoon and evening and night have flushes and then they’d stop in the morning. That was really weird but. So I did stay on that for about five months but it didn’t get any better in the evenings and I just had had enough. So back I went and said, “I’m now desperate. I’ll go on HRT.”

 

Deborah’s moods went ‘haywire’ and she experienced problems reaching orgasm while taking...

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Age at interview: 48
Sex: Female
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And then with the citalopram treatment that sent my moods just haywire, and I felt frightened because at that point a couple of times I felt myself sitting in what should have been familiar environments like my sitting room, not feeling at home, and like things were out of perspective, and it was very frightening.

And you said the citalopram had an impact on your sex life. Can you talk a little bit more about that.

Yeah I’ll tell you about that because I would really like other women to, well I’d just like to share some of this really because I think on the packet, the information that comes with them, it talks about, I think it did actually mention, well there was something about sex life. But what it did to me was meant that I couldn’t have orgasm, and so it took a bit of, well, I worked this out after so maybe it’s two or three goes at sexual intercourse and I couldn’t come basically, so I went back to the GP and I saw the younger GP and he was fine about it, but it was as though, yes I remember him saying to me, “Well this is unusual”, so I thought well I wonder if it is actually, and I don’t know*.

Fair enough when I was on it, it improved my mood, it did. And if I’d have stayed on it, then I’d have been kind of like happy but you know I didn’t want that.

So I finished the citalopram because of the sexual side effects but there again I didn’t get advice about coming off it gradually so that was just horrible and scary because, I was only on about 20mg or something, but I finished straight away and it was very frightening, I did feel quite paranoid.

[* Note' difficulty reaching orgasm (anorgasmia) can be a side-effect of citalopram]

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.

 

Cheryl found that HRT did not improve vaginal dryness and now uses KY Jelly to ease it

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Age at interview: 54
Sex: Female
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Yes, the dryness and I can’t remember when we first noticed that. It’s probably about the time that I went on HRT I think but then that’s supposed to help I think isn’t it actually. So probably about four, no three years I should say that I’ve noticed that I’m much much drier.

Is that now or is it?

Yes, yes.

What since you gave up HRT?


Yes, I think I’m sure we noticed it while I was on HRT as well. But because it didn’t seem to make a lot of difference that wasn’t a reason to stay on HRT we felt.

And how did you overcome the problem?

Simple, KY Jelly. Yes. Just as simple as that and it’s just a routine now.

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’).

 

Susan was worried about taking HRT so tried a sage infusion to relieve her hot flushes

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Age at interview: 55
Sex: Female
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And I didn’t want to take, I couldn’t and didn’t want to take HRT with my mum’s breast, it was breast cancer in the family. I was concerned about HRT and I was never going to take it. So I was always interested in looking for other remedies so one thing that worked for me was the sage infusion. I forget the name of the product and it doesn’t matter but it’s a little sage infusion, so many drops in water and that alleviated it just for a short period of time for about three months. And then it came back but that actually helped. Menosan I think is the name of it but it’s a little sage infusion and I found that useful. I know that people who have taken the black cohosh it’s not such a good idea because it actually creates high blood pressure and things like that but so the Menosan, a wee bit of evening primrose oil, that type of thing. But at the end of the day, you just feel, I felt it was very much a natural, it is a natural process but it does get you down and there’s something about it that you know you have to embrace it and go with it. I think if you fight against it you probably, if you’re resisting it or thinking, “Gosh, this is.” It’s just going with it and accepting it as a natural part of your womanhood and your stage in life.

‘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.

 

Cynthia bought a progesterone cream over the internet after her doctor refused to prescribe it...

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Age at interview: 54
Sex: Female
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So I moved on and had done some research about natural progesterone cream. So I was following a Doctor Lee’s theories. I don’t know if anybody has mentioned that but it’s about the imbalance between oestrogen and progesterone as opposed to being short of one and a little bit of the other so I think your adrenal glands take over producing oestrogen but you’ve got no progesterone so if you put some progesterone cream on that can help.

So I went back to the GP because I knew there is such a thing as progesterone cream but I think it’s very strong and they use it for infertile women. But I know somebody that gets it and breaks it up, cuts up the capsule, whatever it is and just rubs some on her skin. But my doctor wasn’t having any of that. “No, that’s not what it’s for and you’re not having it and there’s no valid research to show that progesterone cream on its own will help anyway.” So he wouldn’t give me that and away I came empty handed again. So I bought it on the internet. You can get it in Guernsey or Jersey.

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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