Menopause, HRT and Natural Treatments 

A Comprehensive Guide to Hormonal Health 

Your Choice and What’s Best for You 

Following years of hesitancy from both patients and healthcare professionals, fuelled by widespread negative publicity and concern over earlier studies, NICE (National Institute for Health and Care Excellence) revised its guidance in November 2015 to affirm that HRT is a safe and appropriate option for managing menopausal symptoms in most women should they want to take HRT.  There are still only around 14% of women in the UK taking HRT and in some areas it’s as low as 2% according to Balance Menopause. 

In Davina McCall’s 2021 documentary Sex, Myths and the Menopause, brought huge public awareness and led to a shift in national conversation. It is thanks to the celebrities, such as Davina McCall, Halle Berry, Oprah Winfrey, Gillian Anderson, Gwyneth Paltrow and many more who have brought the menopause conversation to the forefront and spoke openly about their own experiences. 

The UK government appointed a Menopause Champion and introduced the HRT prepayment certificate in 2023, reducing cost barriers. HRT Prescription Prepayment Certificate will cost you £19.80 for 12 months, this includes 2 prescribed items.  

For further details on HRT prescriptions and the costs please visit https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-hormone-replacement-therapy-prescription-prepayment-certificate-hrt-ppc 

HRT comes in many forms, such as gel, spray, tablets and patches, under brand names like Oestrogel (gel), Evorel (transdermal or patch), Sandrena (gel), Lenzetto (spray), Estradot (patch) and Progynova (oral tablet). 

Now, let’s get into what’s available, with the advantages and disadvantages.  

In the UK, progesterone, particularly in the context of HRT, comes in various forms and preparations. The choice depends on whether a woman has a womb (uterus), her menopausal stage, and individual preferences or medical needs. Here’s a breakdown of the types of progesterone available in the UK. 

Body-Identical Micronised Progesterone (Natural Progesterone) 

This is the most preferred and widely recommended type of progesterone for HRT in the UK, as it is biochemically identical to the progesterone naturally produced by the ovaries. It’s derived from plant sources (like yam or soy). The most common brand in the UK is Utrogestan (capsules). 

Form & Administration 

Oral Capsules 

This is the primary licensed route in the UK. Utrogestan capsules are swallowed, usually at bedtime, as they can cause drowsiness. 

Vaginal Use (Off-label) 

While primarily licensed for oral use, Utrogestan capsules are very commonly used vaginally off-label as part of HRT. This method delivers the progesterone directly to the womb lining, often resulting in fewer systemic side effects (like mood changes or drowsiness) because less of the hormone is absorbed into the general circulation. It’s also sometimes used this way in fertility treatments. 

Vaginal Pessaries 

Other body-identical progesterone pessaries, like Cyclogest or Lutigest, are primarily licensed for fertility treatments but are sometimes used off-label for HRT, if Utrogestan isn’t suitable, particularly for vaginal administration. These can help to elevate some (not all) menopause symptoms. If vaginal dryness is not the main issue, then other treatments may be recommended by your doctor. 

These vaginal pessaries are low dose oestrogen and used to treat vaginal dryness and irritation. It can help to rejuvenate the vaginal lining and support healthier soft tissue in the vagina. There are many different pessaries available, such as vaginal oestrogen, gel, ring. For more information, check out the NHS at https://www.nhs.uk/search/results?q=vaginal%20oestrogen 

The Approach, when used with oestrogen 

Sequential/Cyclical 

For perimenopausal women (still having periods, or their last period was less than 12 months ago), progesterone is taken for 10-14 days of each 28-day cycle, leading to a monthly withdrawal bleed. Typically, 200mg Utrogestan is taken for 10-14 days. 

Continuous Combined 

For postmenopausal women (no periods for at least 12 months, or over a certain age like 54/55), progesterone is taken every day without a break. Typically, 100mg Utrogestan is taken daily. 

Benefits 

Generally considered to have a more favourable side effect profile and a lower or neutral impact on breast cancer risk (especially in the first 5 years of use) compared to some synthetic progestogens. This can also have a calming effect and aid sleep. 

Synthetic Progestogens (Progestins) 

These are synthetic compounds that mimic some, but not all, of the actions of natural progesterone. Their chemical structure differs slightly from body-identical progesterone, which can lead to different metabolic effects and side effects in some women. 

Oral Tablets (separate from oestrogen) 

These are taken cyclically or continuously, depending on the approach. 

Combined HRT Tablets/Patches 

Many HRT products combine oestrogen with a synthetic progestogen in one tablet or patch.  

Tablets are one of the most used forms of HRT, usually taken once a day. Both combined HRT and oestrogen only are available as tablets. The advantage of taking a tablet once a day is the easiest form of treatment. However, the disadvantages are that there is a higher risk of blood clots, according to the NHS, which is higher than using the patches, gel or spray, although the risk is still very small. For more information on this, please visit https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/ 

Patches are also a common way of taking HRT. These work by sticking to the skin on the lower part of your body (below the waist) avoiding areas near the breasts and will gradually release tiny amounts of hormones into your body. You will typically need to change the patch every few days but check as each brand can be different. T

he advantages of patches, if you struggle to take pills, or forget to take your tablets, this may be the better choice. Patches also do not increase the risk of blood clots. The disadvantages may be that you find the patches do not stick very well, may cause redness or a rash. Patches need to be applied to dry, non-moisturised skin. 

Intrauterine System (IUS) / Hormonal Coil 

If you still have a womb and are taking oestrogen tablets, patches, gel or spray, the Mirena Coil may be a suitable way that can give you the progestogen you need. The Mirena Coil is inserted into the womb and gradually releases a form of progestogen (levonorgestrel) into your body. The Mirena Coil is also used for birth control and to treat heavy periods. The advantages of the Mirena Coil are it can stay in place for up to 5 years. This can be a possibility if you don’t like taking medicine or have issues with other forms of progestogen. 

Testosterone 

As with oestrogen and progestogen, menopause also causes the amount of the sex hormone to fall, this does happen gradually. This can make you feel tired, affect your mood, and can affect your sex drive (libido). Another effect it can have, is to our bone health. Testosterone is not currently licensed to treat menopause symptoms, but a specialist doctor may be able to prescribe it for you, it is usually recommended if: 

You are post-menopause 

You have problems with low sex drive 

HRT alone has not helped you 

Research is still underway on whether testosterone may help with other menopausal symptoms. 

Testosterone comes as a gel, and the possible side effects of using this can include acne, unwanted hair growth and weight gain. Testosterone gel can also cause side effects for other people they come into regular contact with. To help avoid this, wash your hands after each application and cover the area with clothing. Speak with your doctor if you feel you would benefit from taking this. 

Tibolone 

This is a prescription medicine, like taking HRT, but also has a testosterone effect. This is taken once a day in tablet form. It helps symptoms such as hot flushes and low mood, although studies suggest it may not be as effective as the combined HRT. This is only suitable if you have not had a period for 12 months or more (post-menopause). 

Sequential combined HRT 

You will usually be recommended to take sequential (cyclical) combined HRT if you have menopause symptoms but still have periods. It comes in tablet form or as a patch. There are a couple of types: 

If you are still having regular periods, you will take oestrogen every day and progestogen alongside it for 10-14 days of your menstrual cycle each month. 

Or 

If you are having irregular periods, this would be 3 monthly HRT which means you take oestrogen every day and take progestogen alongside it for around 10 – 14 days every 3 months. 

Continuous combined HRT 

This is usually recommended if you are post-menopause and you have not had a period for 12 months. Continuous HRT involves taking oestrogen and progestogen every day without a break. 

Benefits for HRT 

Highly effective at protecting the womb lining, often leads to noticeably light or no periods, provides effective contraception, and side effects are often minimised due to localised delivery compared to systemic oral progestogens. A Mirena Coil used for HRT is typically effective for 5 years for endometrial protection. 

Key Considerations 

HRT can be a highly effective treatment for troublesome menopausal symptoms and offers significant benefits, particularly for bone health. However, it’s a personal decision that requires a detailed discussion with your GP to weigh the potential benefits against the individual risks based on your current health situation. 

Key Considerations for Progesterone Choice in the UK 

Presence of a Womb, if a woman still has her womb, a progestogen must be prescribed alongside oestrogen to prevent endometrial hyperplasia and cancer. 

Perimenopausal vs. Postmenopausal, this decides whether a cyclical (monthly bleed) or continuous (aiming for no bleed) regimen is used. 

Side Effect Profile, some women are more sensitive to certain types of progestogens and may experience mood changes, bloating, or sleep disturbances. Switching types (from synthetic to micronised progesterone, or from oral to vaginal micronised progesterone) can often alleviate these issues. 

Contraception Needs 

The Mirena coil offers both endometrial protection for HRT and highly effective contraception. Remember, pregnancy is still possible during perimenopause. 

Patient Preference 

Some women prefer patches over tablets, or vice versa, or prefer the “fit and forget” nature of a coil. 

Progesterone’s is a general term that refers to a group of steroid hormones that play crucial roles in the female reproductive system and other bodily functions. The most important natural progesterone is progesterone itself, produced primarily by the ovaries (specifically the corpus luteum after ovulation) and by the placenta during pregnancy. 

Key Roles of Progesterone 

Menstrual Cycle Regulation 

After ovulation, progesterone levels rise, preparing the lining of the uterus (endometrium) for a potential pregnancy. If pregnancy doesn’t occur, progesterone levels drop, leading to menstruation. 

Pregnancy Support 

Progesterone is vital for supporting a healthy pregnancy, as it thickens the uterine lining to support implantation of a fertilized egg, helping prevent uterine contractions that could lead to early labour, and prepares the breasts for lactation. 

Hormone Replacement Therapy (HRT) 

 In women taking oestrogen as part of HRT, progesterone (or a synthetic progestogen) is often added to protect the uterine lining from thickening excessively, which can increase the risk of endometrial cancer. 

Contraception 

Synthetic forms of progesterone (called progestins) are widely used in hormonal birth control methods (pills, injections, implants, IUDs) to prevent ovulation, thicken cervical mucus (making it harder for sperm to reach the egg), and thin the uterine lining. 

Treatment of Gynaecological Conditions – Progesterone’s can be used to treat conditions such as:  

Irregular periods 

Abnormal uterine bleeding 

Endometriosis (to reduce pain and growth of endometrial tissue outside the uterus) 

Uterine fibroids 

Amenorrhea (absence of periods) 

Fertility Treatment 

Progesterone supplements are often used in fertility treatments, such as IVF, to support the uterine lining and keep early pregnancy. There are potential benefits, some research suggests progesterone may have a positive impact on:  

Sleep quality 

Mood (by influencing neurotransmitters like GABA)  

Bone health 

Cognitive function (though evidence is mixed)  

Reducing hot flashes and night sweats (menopausal vasomotor symptoms) 

Progesterone vs. Progestogens (Progestins) 

Progesterone 

This is the natural hormone produced by the body. When used as medication, it’s often referred to as “micronised progesterone” (e.g., Utrogestan in the UK) because it’s processed to improve absorption when taken orally. 

Progestogens (also called Progestins) 

These are synthetic compounds that mimic the effects of natural progesterone. They were developed because natural progesterone wasn’t well-absorbed orally initially.  

Forms of Progesterone/Progestogen Administration 

Progesterone and progestogens are available in various forms: 

Oral capsules/pills – taken by mouth. 

Vaginal gels/suppositories -inserted vaginally, often used for fertility support or local HRT. 

Injections: Given as a shot, sometimes for long-acting contraception or fertility. 

Transdermal patches – deliver progestogen through the skin (less common for progestogen-only). 

Intrauterine Systems (IUS/IUDs) – devices inserted into the uterus that slowly release a progestogen (e.g., Mirena). 

Subcutaneous implants – small rods inserted under the skin that release progestogen. 

Side Effects 

Like all medications, progesterone’s can have side effects. These can vary depending on the type, dose, and individual, but commonly include: 

Headache 

Breast tenderness 

Nausea, vomiting, diarrhoea, or constipation 

Mood swings, irritability, or depression 

Dizziness or drowsiness (especially with micronised progesterone, which is why it’s often taken at bedtime) 

Bloating or fluid retention 

Changes in menstrual bleeding patterns (spotting, irregular bleeding, or amenorrhea) 

More serious, but less common, side effects can include blood clots (especially with some oral progestogens in combined HRT), liver problems, or allergic reactions. 

It’s crucial for individuals to discuss their specific health history and any concerns with a healthcare professional to decide the most suitable type and form of progesterone or progestogen for their needs. 

Key Roles and Functions of Oestrogens in the Female Body 

Oestrogens are a group of steroid hormones that are primarily responsible for the development and maintenance of female reproductive tissues and secondary sexual characteristics. While present in both sexes, they are found in much higher levels in women and play a critical role in their health throughout their lives. 

Reproductive System Development 

Puberty 

Oestrogens trigger the development of breasts, widening of the hips, and the growth of pubic and armpit hair. 

Menstrual Cycle 

They are essential for regulating the menstrual cycle. During the first half of the cycle (follicular phase), oestrogen levels rise, causing the lining of the uterus (endometrium) to thicken in preparation for a fertilized egg. A surge in oestrogen also triggers ovulation. 

Fertility and Pregnancy 

Oestrogen helps prepare the uterus for implantation and plays a crucial role in keeping a healthy pregnancy, particularly in the first stages. 

Vaginal Health 

Oestrogen supports the thickness, elasticity, and lubrication of the vaginal walls. 

Bone Health 

Oestrogen helps to keep bone density by inhibiting the activity of osteoclasts (cells that break down bone). This protective effect is why women are at a higher risk of osteoporosis after menopause when oestrogen levels decline significantly. 

Cardiovascular Health 

Oestrogen has a positive impact on cholesterol levels, increasing “good” HDL cholesterol and decreasing “bad” LDL cholesterol. It also helps to keep blood vessels flexible. This is why women often have a lower risk of heart disease before menopause compared to men of the same age. 

Skin and Hair 

Oestrogen contributes to skin hydration, elasticity, and collagen content, helping to keep skin looking supple. It also influences hair growth and quality. 

Brain Function and Mood 

Oestrogen receptors are found throughout the brain, and oestrogen influences neurotransmitters like serotonin, which plays a role in mood. Fluctuations or declines in oestrogen can contribute to mood swings, brain fog, anxiety, and depression, particularly during perimenopause and menopause. 

Urinary Tract Health 

Oestrogen helps support the health of the tissues in the bladder and urethra, contributing to bladder control. 

Main Types of Natural Oestrogens 

There are three primaries naturally occurring oestrogens in women. 

Oestradiol (E2): This is the most potent and abundant oestrogen during a woman’s reproductive years (from puberty to menopause). It’s primarily produced by the ovaries. 

Oestrone (E1): This is the main oestrogen produced after menopause, primarily by the adrenal glands and fatty tissue. It’s a weaker oestrogen than oestradiol. 

Oestriol (E3): This is the main oestrogen produced during pregnancy, mainly by the placenta. It’s the weakest of the three. 

Oestrogen in Hormone Replacement Therapy (HRT) 

We have spoken about the role of progesterone, so now let’s look at Oestrogen. 

Oestrogen is the primary hormone replaced in HRT to alleviate menopausal symptoms caused by declining natural oestrogen levels.  

Forms of Oestrogen in HRT 

17 beta-oestradiol: This is the most common and preferred type of oestrogen used in modern HRT. It is “body-identical,” meaning it has the same molecular structure as the oestradiol produced by the ovaries. It’s often derived from plant sources (like yams). 

Conjugated Equine Estrogens (CEEs): These are older forms of HRT derived from the urine of pregnant mares (e.g., Premarin). They have a mixture of different oestrogens, some of which are not naturally found in humans. 

Side Effects and Risks of Oestrogen Therapy (especially in HRT): 

Common first side effects that often settle within a few weeks or months as the body adjusts include: 

Breast tenderness or swelling 

Headaches 

Bloating or fluid retention 

Nausea or indigestion 

Leg cramps 

Mood changes (though oestrogen can also improve mood in many women) 

Irregular vaginal bleeding or spotting (especially in the first 3-6 months of combined HRT) 

Vaginal oestrogen 

Low dose oestrogen is also available as a cream, gel, vaginal tablet or pessary ring that is inserted into the vagina. This can help with your menopause symptoms, such as dryness, burning or pain during sex. The advantages of this are it doesn’t carry the usual risk of HRT and does not increase the risk of breast cancer, this can be taken without progestogen, even if you have a womb. The disadvantage is it will not help with menopausal symptoms, such as hot flushes, mood swings or sleep issues. 

Oestrogen Gel 

Is an increasingly popular form of HRT. This is taken by gentle applying to the skin and it will be gradually absorbed into your body. If you have had a hysterectomy, then this must be used alongside a progestogen. The advantages, along with skin patches is that it is an effective way of taking HRT is you find taking tablets difficult. Again, using the gel does not increase your risk of blood clots. The disadvantage it that the gel can take up to 5 or 10 mins to dry on the skin, so you do need to wait for this to happen before you can anything else. 

Sprays 

Oestrogen only HRT comes as a spray you use once a day. It’s used by spraying 1 to 3 sprays onto the inner arm or inner high. If you have not had a hysterectomy, then you must use this spray with a progestogen. Using this spray does not increase your risk of blood clots. The disadvantage of the spray is you can’t get dressed for at least 2 minutes and need to wait for 1 hour before having a shower or bath. 

Sandrena is a type of Hormone Replacement Therapy (HRT) that has estradiol, a form of oestrogen that’s identical to the one naturally produced by the body. It comes as a gel in single-dose sachets and is applied to the skin. Sandrena works by topping up these declining oestrogen levels to help relieve menopausal symptoms such as: 

Hot flashes and night sweats 

Vaginal dryness and discomfort 

Low mood and anxiety 

Difficulty sleeping 

Brain fog and difficulty concentrating 

Joint pain and muscle stiffness 

Reduced sex drive 

Beyond symptom relief, Sandrena also helps to support bone health and reduce the risk of osteoporosis, which is a significant concern after menopause. 

Estradot is a widely used form of Hormone Replacement Therapy (HRT) specifically designed for women experiencing symptoms of menopause. It’s an oestrogen-only patch, delivering estradiol, which is a “body-identical” form of oestrogen (meaning it’s chemically identical to oestrogen naturally produced by your ovaries).  

Estradot is a transdermal patch, meaning the estradiol is absorbed directly through the skin into the bloodstream. This method of delivery is often preferred because it bypasses the liver, potentially reducing some risks associated with oral oestrogen (like a slightly increased risk of blood clots and stroke) and can be a gentler option for those with digestive sensitivities. 

Progynova is a brand name for Estradiol, a form of oestrogen, used as a Hormone Replacement Therapy (HRT) in the UK, and taken alongside progesterone, for patients who have had their uterus removed. It’s available as tablets or skin patches. Progynova tablets are typically prescribed for perimenopausal and postmenopausal women to relieve menopausal symptoms like hot flushes, vaginal dryness, and night sweats.

The Natural Approach  

For many women experiencing menopause symptoms, natural options and lifestyle changes can play a significant role in managing discomfort and promoting overall well-being. It’s crucial to remember that what works for one person may not work for another, and efficacy can vary. 

Important Note – Before trying any herbal remedies or supplements, it is highly recommended to speak with your GP or a menopause specialist. “Natural” does not always mean safe or effective, and some remedies can interact with other medications or have their own side effects. 

Here’s a comprehensive look at natural options for menopause, categorised for clarity. 

Lifestyle Modifications (Strongest Evidence & Widely Recommended) 

These are generally the first line of “natural” treatment and have considerable evidence supporting their benefits for various menopause symptoms and long-term health. 

Lifestyle Modifications – Often the First Line of Defence 

Balanced Diet 

Focus on a diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats (e.g., Mediterranean diet). This supports overall health, energy levels, and can help manage weight. A balanced diet consisting of whole foods, fruit, vegetables and whole grains. Limit processed foods, refined sugars and excessive salt. 

Phytoestrogens are plant compounds that can have a weak oestrogen-like effect in the body. These include: 

Phytoestrogens 

Soya products, such as tofu, tempeh, edamame, soy milk, whole grains, fruits and vegetables, but caution is recommended for those with certain hormone-sensitive conditions, like breast cancer.  

The primary reason for the interest in tofu for menopause is its isoflavone content. As oestrogen levels decline during menopause, these plant compounds can bind to oestrogen receptors in the body, potentially mimicking some of the oestrogens functions. This has led to the hypothesis that they might help alleviate symptoms caused by low oestrogen. Some studies have also shown that this can also help hot flashes and night sweats, bone health, cardiovascular health. 

Flaxseeds are rich in lignans (a type of phytoestrogen) and omega-3 fatty acids. These can be added to cereals, yogurts or smoothies. Lignans are the star player, they are plant compounds that can bind to oestrogen receptors in the body. Thier effect is often described as “oestrogen-modulating” or “oestrogen-adaptive”.  Lignans can exert a mild oestrogen like effect, helping to gently stimulate oestrogen receptors and potentially alleviate symptoms related to oestrogen deficiency. Studies have also shown that this can help with hot flashes and night sweats. 

Legumes like lentils, chickpeas, beans and soybeans. This are highly beneficial for women navigating menopause. Their positive impact comes from a combination of their rich nutrient profile and presence of phytoestrogens, particularly isoflavones. 

Whole grains, fruits and vegetables also hold some. Remember, it may take a few months to see the effects, and they don’t work for everyone. 

Calcium and Vitamin D 

Calcium is crucial for bone health, as oestrogen decline increases osteoporosis risk. Include dairy products: 

Dairy products, including milk, yogurt and cheese, fortified plant milks, leafy greens (kale, spinach), canned fish such as sardines.  

Women can lose up to 20% of their bone mass density in the 5-7 years following menopause. reduced oestrogen levels can also decrease the body’s ability to absorb calcium from food and reabsorb it into the bones. This means even if you are consuming enough calcium, your body might not be utilising it effectively. 

Vitamin D 

Vitamin D sources are oily fish (salmon, mackerel), eggs, fortified foods. Many people in the UK need a vitamin D supplement, especially during the autumn and winter months. In the UK, a daily Vitamin D supplement (10 micrograms) is recommended for everyone from October to March, and potentially all year for certain groups. 

Vitamin D is an essential nutrient for women during and after menopause. Its role goes far beyond just bone health, affecting various aspects of well-being that are particularly vulnerable during this life stage due to declining hormone levels.  

Vitamin D’s well-known function is to help the body absorb calcium from the gut, without sufficient Vitamin D, even if you consume enough calcium, your body can’t effectively utilise it, to support strong bones. 

Vitamin D also plays a role in muscle function and strength. Low levels can contribute to muscle weakness, which can be a concern during menopause as muscle mass naturally declines with age. Maintaining muscle strength helps prevent falls, a significant risk for older women with osteoporosis. If you are low in Vitamin D, many women can experience mood changes, anxiety and even depression. This vitamin is believed to influence serotonin production during menopause, known as the happy hormone. This vitamin also helps with cardiovascular health, vaginal and urinary health. 

Vitamin E 

Some women find it helpful for hot flashes, but evidence is mixed. However, it’s important to note that research results are mixed, with some studies showing positive effects and others finding limited or no benefit compared to a placebo. The evidence is not as strong or consistent as for some other menopausal treatments (like hormone replacement therapy or certain medications).

During menopause, declining oestrogen levels can lead to changes in skin, including increased dryness, loss of elasticity and thinning. Vitamin E helps protect skin cells from oxidative stress and free radical damage, which can contribute to signs of aging. Vitamin E also helps with skin hydration and resilience. Vitamin E intake might play a role in slowing down bone loss, though studies are needed in this specific context.

One of the known benefits of vitamin E for menopausal symptoms if helping with hot flashes and night sweats, it can help with the severity and frequency of these. While some studies show promise, more recent large-scale trials on vitamin E supplements for heart disease prevention have had mixed results, showing the importance of getting it from whole foods. 

We can find Vitamin in the following foods: 

Vegetable oils 

Soybean oil 

Olive oil,

Wheat germ oil 

Safflower oil and corn oil 

Nuts, such as almonds, pinenuts, hazelnuts, peanuts and pecans 

Green leafy veg, like spinach, kale and broccoli 

Avocado 

Fruits, such as kiwi and mango 

Seafood, including trout and salmon 

Omega-3 Fatty Acids 

This can be found in fatty fish, such as salmon, mackerel, sardines, herring, trout, anchovies and tuna, as well as flaxseed, chia seeds, and walnuts. Our bodies can’t produce polyunsaturated fat, so we must obtain them through our diet. during menopause, these health fats become particularly important due to their wide-ranging benefits that can help mitigate many of the challenges associated with declining oestrogen levels.

Omega 3 fatty acids can support women during menopause in helping with hot flashes, night sweats, it can also help with mood and mental well-being. As we know omega 3 is also important for bone health, skin, hair and vaginal dryness. An intake of fatty acids can help with general lubrication. 

Identify & Limit Triggers 

Many women find that certain foods or drinks can trigger hot flushes and night sweats, keep a food journal so you know what to avoid. Common culprits often include:  

Spicy foods 

Caffeine (reduce if you are a heavy coffee drinker) 

Alcohol 

Hot drinks 

Hydration 

Remember to drink plenty of water throughout the day. The general recommendation from the NHS and other health organisation in the UK is to aim for 6 to 8 cups or glasses of fluid a day.  

Water is the best and cheapest choice, lower fat milk (e.g., semi-skimmed, 1% fat, or skimmed). Sugar free drinks, squashes or cordial (no added sugar). Fruit juices and smoothies (limit to 150ml) a day due to higher sugar content.  

It’s so important to remember that around 20-30% of your daily fluid intake comes from the foods you eat, especially fruits and vegetables.  

It’s rare for healthy adults to drink too much water, but consuming excessive amounts (far beyond the recommended 2-2.5 litres a day) can dilute important electrolytes in the body. If you have concerns about your hydration or specific health conditions, it’s always best to consult with your doctor or a dietitian. 

Herbal Remedies and Supplements (Mixed Evidence & Caution Advised) 

The effectiveness of these can vary, and research is often limited or inconsistent. Always consult a healthcare professional before taking them due to potential side effects and interactions. 

Black Cohosh

Often used for hot flushes and night sweats. Some studies show benefit, others do not. Not recommended if you have a history of liver disease. 

Red Clover 

Has isoflavones (phytoestrogens). May help with hot flushes but not recommended for women with a history of hormone-sensitive cancers. 

Soy Isoflavones 

As mentioned in diet, available as supplements. May help with hot flushes, but long-term safety of high-dose supplements is less certain. 

Evening Primrose Oil (EPO) 

Traditionally used for breast tenderness and night sweats. Evidence for hot flashes is mixed. 

Angus Castus 

Agnus Castus, also widely known as Chasteberry or Vitex agnus-castus, is a traditional herbal medicinal product. It’s often referred to as the “female herb” due to its long history of use for various women’s health issues. Reduces prolactin levels and indirectly supports progesterone. 

Ginseng 

Several types (e.g., Korean Red Ginseng, Siberian Ginseng) may help with mood, energy, and quality of life, but evidence for hot flushes is weak. Can cause insomnia. 

St John’s Wort 

Primarily used for mild depression and mood disorders. Can also help with hot flushes, particularly for women who can’t take HRT. However, it has significant interactions with many medications (e.g., antidepressants, blood thinners, oral contraceptives), so caution is vital. 

Valerian 

Often used for insomnia and anxiety. Some evidence suggests it may help with sleep disturbances and hot flashes. 

Sage 

Some evidence suggests it may help reduce the frequency and severity of hot flushes and night sweats. 

Maca Root 

Some preliminary research suggests it may help with mood, energy, and sexual function, but more high-quality studies are needed. 

Wild Yam 

This holds diosgenin (naturally occurring steroid), which can be chemically converted to progesterone in a lab, but the body cannot convert it directly. Evidence for its effectiveness in managing menopause symptoms is limited. 

Staying Active 

Now, I’m not a fan of the word ‘exercise’ itself, as it often conjures images of intense gym sessions and heavy workouts, which can be quite intimidating. Instead, let’s talk about movement and staying active, and finding ways to integrate gentle activity into your day that feels good for your body and mind. Gentle movement can help with mood, sleep issue, anxiety, low energy and can even help with hot flashes in some women. 

Weight-bearing activity is essential for supporting bone density (e.g., walking, running, dancing, weightlifting). Strength training helps keep muscle mass, which naturally declines with age and can contribute to weight gain, as the metabolism slows with age. 

Deep Breathing exercises can really help in managing your stress levels, as these can worsen menopause symptoms. This activity can also help when hot flushes occur. Other technics like, meditation, yoga, tai chi and mindfulness can significantly reduce anxiety, improve mood and help with sleep disturbances. 

Counselling or cognitive behavioural therapy (CBT) is a type of talking therapy that is highly effective for managing low mood, anxiety, and sleep problems associated with menopause, and can also help with coping strategies for hot flushes. 

Sleep Hygiene 

Consistent sleep schedule, like going to bed and waking up at similar times, even on weekends. However, this does not work for everyone, and sometimes we need to listen to our own bodies as to what is best. So, if you wake up and still feel tired, then stay in bed and relax, until you feel such time that you are ready to start your day. 

Cool Bedroom, keep the bedroom cool (16-18°C is often ideal), dark, and quiet. Use a fan in necessary, sip cold drinks, when you feel a hot flash is coming on. 

Avoid screens, so limit screen time before bed, preferably as least 1 hour before bed refrain from screen use. Remember blue light that is omitted by screens supresses our melatonin, the hormone that regulates sleep. Incorporate relaxing activities before bed, like taking a warm bath or reading. 

Avoiding caffeine and alcohol, especially in the evenings, drinking these can trigger hot flashes and night sweats for some individuals. 

Smoking is strongly linked to earlier menopause and causing severe hot flushes, and can increase the risk of earlier menopause, as well as affecting your overall health. Quitting smoking can significantly reduce symptoms and improve overall health. 

Supporting a healthy weight can reduce the severity of hot flushes and improves other symptoms. Studies have suggested that being overweight or obese can worsen your hot flashes; in losing weight, this will help not only with your overall health but help to ease your menopause symptoms. 

Cooling Strategies for Hot Flushes 

Dress in layers of natural, breathable fabrics (cotton, linen, silk) 

Use fans or air conditioning 

Keep cold drinks handy 

Take cool showers 

Complementary Therapies 

Acupuncture 

A key part of traditional Chinese medicine involves inserting very thin needles into specific points on the body. While its exact mechanisms are still being fully understood by western medicine, it’s widely believed to work by stimulating nerves, muscles and connective tissue, which can lead to the body releasing natural painkillers like endorphins and serotonin and affecting brain chemistry. Some women find it helpful for reducing hot flushes and improving sleep, though scientific evidence is inconsistent. 

Its benefits consist of helping with chronic pain, back and neck pain, osteoarthritis, headaches and migraines. It can also help with chronic joint and muscle pain, anxiety and stress, improved mood, insomnia, nausea, vomiting, fatigue, digestive health, fertility support, menopause symptoms and immune support. 

Hypnosis 

Emerging evidence suggests clinical hypnosis can be effective in reducing the frequency and severity of hot flushes and improving sleep. Hypnosis often referred to as hypnotherapy is a clinical context, is a state of heightened focus, concentration, and suggestibility it’s not about losing control, but rather about a trained professional guiding you into a deeply relaxed state where your mind is more open to positive suggestions that align with your goals. Here are some key benefits: 

Pain management, chronic pain conditions like Fibromyalgia, irritable bowel syndrome, back pain, arthritis, migraines. Hypnosis can help alter the feeling of pain, reduce its intensity, and improve coping mechanisms. Hypnosis is also a widely used tool for managing anxiety, stress, phobias, insomnia. Hypnosis can be a valuable aid in changing undesirable habits and behaviours, like smoking cessation, weight management, and menopause symptoms. And finally, hypnosis can help with mental help conditions.  

If you’re curious about hypnotherapy and would like to know more and how this can help you, have a look at Artemiz Hypnotherapy! I had a session with Rachel (the lovely owner), and she really knows her stuff. Highly recommend! Visit https://artemizhypnotherapy.co.uk/ 

Reflexology/Massage 

Can aid relaxation and reduce stress, which may indirectly help with some symptoms. 

Reflexology is a complementary therapy that involves applying pressure to specific points on the feet, hands, or ears. These points are believed to correspond to different organs, glands, and systems in the body. While it’s not a direct medical treatment for menopause, many women find it an extremely helpful therapy for managing a range of menopausal symptoms by promoting relaxation, balancing body systems and reducing stress.

By calming the nervous system, as menopause can be a stressful time, often leading to increased anxiety, irritability and mood swings, reflexology can help by stimulating reflex points linked to the nervous system. 

Massage therapy can be a wonderful supportive and beneficial complementary therapy for women navigating the various symptoms of menopause. While it does not directly alter hormone levels, it works on the body and mind to alleviate many of the uncomfortable physical and emotional aspects of this transition.

Massages can help to lower cortisol, for its ability to induce deep relaxation. It can also help to boost the “Happy” hormones like endorphins, serotonin and dopamine. A massage can improve sleep quality, reduce night sweets and hot flashes and can ease tension and pain in muscles, improve circulation, flexibility, mobility, headaches and migraines. 

I can also highly recommend Total Body and Mind, where I had a very relaxing massage by Karen the owner. I came away with my back feeling amazing, something I had not felt for years! For further details on massages and reflexology please visit https://totalbodyandmind.co.uk/  

Cognitive Therapies 

Cognitive Behavioural Therapy (CBT) is a talking therapy that can help manage mood swings, anxiety, depression, and sleep problems associated with menopause by changing thought patterns and coping strategies.  Visit https://menopausestudio.co.uk/free-resource-list/understanding-cbt-benefit/

The “best” natural relief is often a combination of lifestyle changes tailored to your individual symptoms. Dietary adjustments play a significant role in overall well-being. When considering herbal remedies or supplements, prioritise safety and consult your doctor to ensure they are safe for you and won’t interact negatively with other conditions or medications. 

It’s important to approach “natural” options with a critical eye, prioritising lifestyle changes with compelling evidence. For persistent or severe symptoms, consulting a healthcare professional is crucial to discuss all available options, including HRT, which studies show, is still one of the most effective treatments for most menopausal symptoms.  Take a look at the Menopause Studio website, where there is lots information on everything menopause – https://menopausestudio.co.uk/