Alternatives to HRT
Although replacement of declining estrogen with HRT has been shown to improve menopause symptoms and provide bone and cardiovascular protection as well as other long term health benefits, not everyone chooses to take HRT, and in fact, HRT may not be suitable for some people for medical reasons. Consequently, some women prefer to try non-hormonal treatments.
Alternatives to HRT include lifestyle changes, complementary therapies, herbal remedies and non-hormonal medicines.
Before deciding on the best course of action to manage the menopause, it is important to consider what happens to a women’s body once menopause occurs and levels of estrogen start to decline: rates of cardiovascular (heart and blood vessels) disease, osteoporosis (bone thinning), dementia (particularly Alzheimer’s disease) and type 2 diabetes are much lower before the menopause than post-menopause because these and other organ systems are protected by estrogen. After menopause, as estrogen levels fall and eventually disappear, these conditions become more common, along with declines in muscle and joint function, skin health and sexual function, which may result in long term poorer health outcomes as well as poorer quality of life.
It’s also important to know that HRT on its own will usually not be enough to ward off all the long-term consequences of the menopause, and women who take HRT are also advised to address their diet and lifestyle by eating a healthy diet and doing specific types of exercise that optimise muscle, bone and cardiovascular health (see below). These may also potentially reduce some of the body changes that many women will start to experience, such as increased fat deposition around the abdomen which itself is associated with an increased risk of cardiovascular disease.
There’s good evidence that in addition to long term health benefits, healthy lifestyle behaviours can also improve some menopausal symptoms.
Lifestyle changes include regular aerobic exercise that increases your heart rate and breathing.
Aerobic exercise can improve hot flushes and night sweats and sleep quality. Weight bearing exercises such as yoga, walking, running and weight training are also beneficial for bone health.
Research shows that diet may counteract changes in metabolism during menopause. Eating a wholefood diet consisting of coloured fruits and vegetables, “good” fats such as olive oil, whole grains and oily fish and cutting down on alcohol and smoking may also improve hot flushes and night sweats and are good for your overall health.
Wearing lighter clothing, sleeping in a cooler room, avoiding spicy food, caffeine and alcohol can also help reduce hot flushes.
It’s important to prioritise your mental well-being during menopause. Reducing stress through exercise, cognitive behavioural therapy or CBT, mindfulness, yoga or just doing something you enjoy can all help.
CBT is a talking therapy that can be helpful for managing mood as well as hot flushes and night sweats. It focuses on the effect of your thoughts and beliefs on your feelings and behaviour.
Several over the counter herbal menopause preparations are marketed for the management of menopause symptoms, including plant-based estrogens such as isoflavones found in soy products, and red clover. Other treatments include St John’s wort and black cohosh. The data on the effectiveness of herbal remedies are mixed and many of these preparations don’t undergo the rigorous safety and quality testing that are legally required for pharmaceutical medicines.
There is also evidence that some may be harmful; for example, red clover and soya products should not be used in women with a history of breast cancer, and black cohosh has been associated with an increased risk of liver disease. St John’s wart may react with some medication s for other conditions, such as epilepsy, heart disease or asthma.
Some women find alternative and complimentary therapies such as acupuncture and aromatherapy to be helpful, but at present there is limited scientific evidence of any benefit.
Non-hormonal medicines, such as certain antidepressants and antiepileptic medications, may also be used to treat hot flushes and night sweats. They also often have an impact on mood and well-being. Although not as effective at easing menopause symptoms compared with HRT, they may be useful for women who can’t take estrogen for medical reasons.
