All about the management of the menopause without HRT

The menopause is a natural phase in a woman’s life that is often accompanied by symptoms that can affect daily living and overall wellbeing. While hormone replacement therapy (HRT) is a common treatment for menopause symptoms, not everyone will choose or opt for it.

This article provides an expert insight into the most effective lifestyle changes, non-hormonal medications, and other strategies for managing the menopause without HRT.

What are the most effective lifestyle changes for menopause symptoms?

Lifestyle changes are essential for managing menopause symptoms naturally.

A balanced diet rich in fruits, vegetables, lean proteins, and whole grains provides your body with essential nutrients and stabilises energy levels. Foods high in calcium and vitamin D are especially important for supporting bone health. Foods high in soy or flaxseed contain phytoestrogens, plant-based compounds can help reduce hot flushes.

Hydration is key, especially for managing hot flushes and dry skin. Reducing triggers like caffeine, alcohol, and spicy foods can help reduce the frequency and intensity of symptoms.

Regular physical activity, particularly aerobic and strength-training exercises, is equally crucial. Exercise improves energy levels, mood, and sleep while also supporting cardiovascular and bone health. Activities like yoga are particularly helpful, as they combine physical activity with relaxation techniques.

Are there any non-hormonal medications available?

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), typically used as antidepressants, have been shown to reduce the frequency and severity of hot flushes. Medications like gabapentin are another option, especially for hot flushes that disrupt sleep.

For vaginal dryness and discomfort during intercourse, over-the-counter vaginal moisturisers and lubricants can provide effective relief. In some cases, non-oestrogen prescription therapies, such as vaginal dehydroepiandrosterone (DHEA), may also be suitable options.

As with any treatment, it’s essential to consult your gynaecologist to determine which medication is most suitable for your symptoms and health profile.

Can cognitive behavioural therapy also help with menopause symptoms?

Cognitive behavioural therapy (CBT) is a structured, evidence-based approach that can help navigate the emotional challenges of menopause symptoms, particularly those related to mood and sleep disturbances. CBT achieves this by identifying and changing negative thought patterns and behaviours that can exacerbate symptoms.

For example, CBT can help you develop techniques to manage stress, anxiety, or irritability, which are common during the menopause. Additionally, CBT techniques can address insomnia by improving sleep hygiene and reducing the worry associated with sleepless nights.

Research has shown that CBT can even help to manage physical symptoms of the menopause, such as hot flushes, by helping to develop coping mechanisms and changing the perception of these symptoms. For this reason, it’s a highly recommended option for women seeking psychological support during the menopause.

What are the best strategies for maintaining bone health without HRT?

Bone health is a major concern during and after the menopause due to the natural decline in oestrogen, which plays a critical role in maintaining bone density. Without adequate care, you can face an increased risk of osteoporosis and fractures.

Nutrition is the foundation of bone health. Calcium and vitamin D are essential for bone strength, and foods such as dairy products, leafy greens, fortified cereals, and oily fish should be included in daily meals.

Exercise is another pillar of bone health. Regular weight-bearing and resistance exercises, such as walking, jogging, and strength training, help stimulate bone growth and slow bone loss. Balance exercises can reduce the risk of falls by improving coordination and stability.

If you are at high risk of osteoporosis, your gynaecologist will recommend non-hormonal medications like bisphosphonates or denosumab to reduce the risk of fractures and support your bone health.

How often should I schedule check-ups during the menopause?

The frequency of these visits will depend on your symptoms and risk factors. Most women will experience menopause symptoms for an average of 4–7 years, though some may have symptoms lasting longer. A yearly visit is typically sufficient unless symptoms are severe or there are concerns about specific health conditions.

During these visits, your gynaecologist will conduct tests to assess bone health, as well as check cholesterol levels and blood pressure to monitor cardiovascular disease risk, which increases after the menopause. Screenings for breast and cervical health may be performed as well.

Having a trusted gynaecologist to guide you through this time can ensure that any health concerns are promptly addressed. Each woman’s experience of the menopause is unique, and finding the right approach may take time. However, with the right support and strategies, it’s possible to navigate the menopause naturally and maintain a healthy, fulfilling life.