Hormone replacement therapy (HRT) - Alternatives to HRT

If you are unable to or decide not to undertake hormone replacement therapy (HRT), alternative approaches and treatments are available that may help control your menopausal symptoms.

Lifestyle changes

Making changes to your lifestyle may help ease your menopausal symptoms. For example, you should:

• Take regular exercise – regular activity has been shown to reduce symptoms of hot flushes and improve sleep; it is also a good way of boosting your mood if you feel anxious, irritable or depressed.
• Stay cool at night – wearing loose clothes and sleeping in a cool, well-ventilated room may help relieve hot flushes and night sweats. Read more about treating sleep problems. 
• Cut down on caffeine, alcohol and spicy food – as they have all been known to trigger hot flushes.
• Try to reduce your stress levels – to improve mood swings, make sure you get plenty of rest, as well as getting regular exercise. Activities such as yoga and tai chi can help you relax.
• Give up smoking – if you smoke, giving up will help reduce hot flushes and your risk of developing serious health conditions, such as heart disease, stroke and cancer.

Tibolone

Tibolone is a man-made (synthetic) hormone that can be used in post-menopausal women who have a womb. It contains a combination of oestrogen and progestogen, so you only need to take one tablet.

If you are unable to take HRT for medical reasons – for example, if you have a history of breast cancer or heart disease – you will probably not be able to take tibolone.

Tiboline is not suitable if you are experiencing symptoms of the menopause before it actually starts (known as the peri-menopause) or within a year of your last period.

Antidepressants

Although antidepressant medications aren't licensed for treating hot flushes, there are several that may be effective, including:

• venlafaxine hydrochloride
• citalopram

Potential side effects of these antidepressants include nausea, dizziness, dry mouth, anxiety and sleeping problems.

Certain antidepressants have also been associated with a loss of libido (sex drive).

Any side effects will usually improve over time, but you should visit your GP if they don't.

You may need to have regular blood tests or blood pressure checks when taking antidepressants, particularly if you also take the anti-clotting medicine warfarin or have high blood pressure (hypertension).

Clonidine

Clonidine is a medicine originally designed to treat high blood pressure, but research shows it may reduce hot flushes and night sweats in some menopausal women.

Clonidine can cause unpleasant side effects, including dry mouth, drowsiness, depression, constipation and fluid retention.

You will need to take it for a trial period of two to four weeks, to test its effectiveness. If your symptoms don't improve during this time, or if you experience any side effects, the treatment should be stopped and you should go back to your GP.

Complementary therapies

Some products are sold in health shops for treating menopausal symptoms. These herbal remedies include evening primrose oil, black cohosh, angelica and ginseng.

These products are often marketed as "natural", but this does not necessarily mean they are safe to use. There are concerns about the quality of "natural products", and some may interact with other treatments and cause harmful side effects. There is also very little evidence to show that these remedies actually work.

Some women have reported that relaxation therapies – such as yoga, aromatherapy (PDF, 451kb) and reflexology (PDF, 272kb) – reduce their menopausal symptoms, but there's no scientific evidence to show that they're completely effective.

Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.