Blog 11: Non Hormonal HRT

For many women, menopause marks a significant transition that can bring an array of physical and emotional changes. 

While hormone replacement therapy (HRT) is often a go-to option for managing menopause, it’s not necessarily the best—or only—choice for everyone. Some women may have medical reasons to avoid HRT, or they might simply prefer more natural or non-hormonal strategies.

Fortunately, there are a variety of alternative treatments and lifestyle modifications that can effectively address symptoms such as hot flashes, also known as hot flashes, night sweats, and vaginal discomfort.

When we talk about non-HRT (non–hormone replacement therapy) strategies, we’re essentially covering three broad categories:

1. Prescription medications that aren’t based on replacing oestrogen or progesterone.
2. Medical interventions that may be topical or local, providing targeted relief (e.g., vaginal moisturisers).
3. Lifestyle and complementary therapies that include diet, exercise, and herbal supplements.

It’s crucial to remember that each woman’s menopausal experience is unique. What works well for one individual might not be the right fit for another. Always consult with our GPs at Grand Union before starting, stopping, or combining any treatments.

Topical and Local Options for Vaginal Symptoms

Vaginal Lubricants and Moisturisers

One of the most common menopause-related complaints I encounter in the clinic is vaginal dryness. This can lead to discomfort during intercourse, itching, and even urinary symptoms. Over-the-counter lubricants and moisturisers are straightforward solutions that can make a big difference:

• How They Work: These products help maintain moisture and reduce friction in the vaginal area.
• Who They Help: Suitable for women who experience dryness or mild discomfort but either can’t or prefer not to use hormonal treatments.
• How to Use: Apply as needed, either before sexual activity or on a regular schedule, depending on the product instructions.

A key advantage is that vaginal lubricants can be used alone or in tandem with other treatments like HRT, offering flexible and localised relief without systemic hormonal effects.

Prescription Non-Hormonal Medications

Clonidine

Originally developed for high blood pressure, Clonidine has also been licensed to treat hot flushes and night sweats in menopausal women.

• How It Works: It affects the body’s temperature regulation by acting on certain brain receptors.
• Possible Benefits: It may reduce the frequency and intensity of flushes.
• Side Effects: These can include drowsiness, dizziness, or dry mouth. It’s crucial to discuss with your doctor whether Clonidine fits well with your medical history, especially if you have low blood pressure.

Antidepressants (SSRIs and SNRIs)

Another group of drugs—selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)—can help relieve menopausal symptoms:

• Understanding the Stigma: Some women worry that being offered antidepressants means their concerns aren’t taken seriously. In reality, there’s solid evidence that these medications can reduce hot flushes and ease mood swings or anxiety, even for women without depression.
• Common Examples: Medications like venlafaxine (SNRI) or sertraline (SSRI) might be prescribed at lower doses than typically used for depression.
• Potential Side Effects: These can vary but might include gastrointestinal upset, headache, or mild drowsiness. Side effects often subside after the first few weeks.

Lifestyle Interventions

Exercise for Menopausal Symptoms

Exercise isn’t just about weight management—it plays a critical role in managing menopause:

1. Cardio Workouts (e.g., running, cycling): Helpful for mood, stress relief, and supporting heart health. The endorphin rush can alleviate irritability and low mood.
2. Weight-Bearing Exercises (e.g., brisk walking, tennis): Ideal for bone health, helping prevent osteoporosis.
3. Strength or Resistance Training (e.g., lifting weights, Pilates): Builds and maintains muscle mass, which often declines during menopause.

Cognitive Behavioural Therapy (CBT)

Although CBT is commonly associated with mental health conditions like anxiety and depression, it can also reduce hot flushes and night sweats by helping women manage stress and reinterpret physical sensations in a more constructive way.

Herbal and Plant-Based Options

Isoflavones and Phytoestrogens

Found in soy products and supplements like red clover, phytoestrogens mimic the action of oestrogen in the body but typically have a milder effect:

• Common Uses: Hot flushes, night sweats, and mild mood issues.
• Effectiveness: Research is mixed, but some women report meaningful symptom relief.
• Safety Considerations: Generally safe, though high doses might not be suitable for women with certain hormone-sensitive conditions.

Black Cohosh

A traditional North American herb, black cohosh has long been used for menopausal symptoms:

• Evidence: Clinical studies offer varying results, with some showing improvements in hot flushes and others suggesting minimal benefit.
• Safety: Typically well-tolerated, though it can occasionally cause stomach upset or rashes. Always check with a healthcare provider before starting.

St John’s Wort

Widely known as a natural remedy for mild depression and anxiety, St John’s Wort may also help with hot flushes:

• Mechanism: Believed to influence neurotransmitters like serotonin.
• Drug Interactions: St John’s Wort can reduce the effectiveness of certain medications (like birth control pills or antidepressants), so always consult a doctor or pharmacist before use.

Published: Dec 23, 2025