Menopause treatment options work better when they don't rely solely on hormone replacement therapy. Women who stay active usually experience fewer menopausal symptoms . However, sporadic high-impact exercise might make some symptoms worse . Research shows alternative treatments typically reduce symptoms by 50-60%, while traditional HRT provides 80-90% relief .
Women often need to try different approaches to find the right menopause relief. Doctors can prescribe specific medications beyond hormonal treatments. These include antidepressants, blood pressure medication clonidine, and epilepsy medication gabapentin that help with hot flushes, night sweats, low mood, anxiety and vaginal dryness . It also helps to make lifestyle changes - quitting smoking can reduce hot flushes and lower the risk of serious health conditions like heart disease, stroke and cancer . This piece gives a detailed look at all available menopause treatment options in the UK, which helps women make better decisions about managing their symptoms.
Understanding Menopause and Treatment Needs
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Menopause represents a biological transition that affects about 13 million women in the UK alone [1]. This natural process happens when a woman hasn't had a menstrual period for 12 straight months, typically around age 51 in the UK [1].
What happens during menopause?
The journey through menopause has three distinct stages. Perimenopause begins as ovaries start producing less oestrogen, usually 8-10 years before menopause strikes women in their 40s [2]. Hormone levels bounce up and down during this time, which leads to irregular periods and various symptoms.
Menopause itself marks the second stage—the point where menstruation stops for good. The ovaries stop releasing eggs and oestrogen production drops substantially [2]. Postmenopause follows and lasts throughout a woman's life, though some symptoms might stick around.
These hormonal shifts affect many body systems. About 80% of women experience symptoms of menopause as oestrogen levels fall, and a quarter say their symptoms are severe [1]. Common symptoms include:
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Hot flushes and night sweats (75-80% of women deal with these) [2]
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Vaginal dryness and sexual discomfort (50-75% of women) [2]
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Sleep problems and insomnia
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Mood swings, including anxiety and depression (up to 70% of women) [2]
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Changes in thinking, like memory lapses or "brain fog" [1]
Why treatment is sometimes needed
Menopausal symptoms last much longer than most women expect. Women typically experience symptoms for 7 years, but all but one-third see their symptoms end there. Some 10% of women live with symptoms for 12 years or more [1].
Lower oestrogen levels also raise the risk of long-term health issues like osteoporosis and cardiovascular disease [2]. These conditions can disrupt quality of life and overall health without proper treatment.
Treatment becomes essential when symptoms interfere with daily life or threaten long-term health. The NICE guidelines point out that "the experience of menopause varies considerably" [1], which means care must be tailored to each woman.
When to consider HRT or alternatives
Women should look into HRT or alternatives once symptoms start affecting their quality of life. You don't need to wait until symptoms become unbearable to ask for help [3].
HRT works best if you have:
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Moderate to severe vasomotor symptoms (hot flushes and night sweats) [2]
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Genitourinary symptoms like vaginal dryness or urinary issues [2]
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Early menopause (before 45) or premature menopause (before 40) [3]
Women experiencing early or premature menopause need HRT or the combined pill to protect against conditions like osteoporosis until at least age 51 [3].
Several alternatives exist for those who can't or prefer not to use HRT. Options include medications like SSRIs, gabapentin, and clonidine [2], plus lifestyle changes, CBT, and some natural remedies.
Menopause affects each woman differently, so healthcare decisions should weigh individual benefits and risks [1]. Getting professional advice early helps many women minimise menopause's effect on their health, relationships, and work [1].
HRT Options in the UK: What You Need to Know
"We are very keen to emphasise that HRT is our recommended first-line therapy for vasomotor symptoms [night sweats and hot flushes] and for [other] symptoms of menopause." — Prof Jonathan Benger, Chief medical officer and interim director of the centre for guidelines at NICE
HRT is the life-blood of menopause treatment in the UK. It helps many women who struggle with symptoms of menopause. Learning about your options is a vital part of making good healthcare decisions.
Types of HRT available
The NHS gives you several ways to take HRT. Each method delivers hormones differently:
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Tablets: Take one daily, available as oestrogen-only or combined HRT [4]
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Patches: Stick to your skin and release hormones over several days [4]
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Gels/creams: Apply to your skin daily so your body absorbs the oestrogen [4]
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Sprays: Use on your inner arm or thigh for daily oestrogen [4]
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Vaginal preparations: Low-dose oestrogen in creams, tablets, pessaries or rings that help with vaginal dryness [4]
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Mirena coil: Works with oestrogen to provide the progestogen your body needs [4]
Women who still have hot flushes and other symptoms after menopause can take continuous combined HRT. This means taking both hormones every day without monthly bleeding [2]. Sequential or cyclical HRT works like your natural cycle and might work better during perimenopause [2].
Body-identical vs bioidentical hormones
These terms often cause confusion, so let's clear things up:
Body-identical hormones come from plants like yams or soy. They match the molecular structure of hormones your body makes naturally [5]. The MHRA regulates and licences these hormones, which you can get on the NHS [6]. You'll find them in estradiol patches, gels and sprays, along with micronised progesterone (called Utrogestan in the UK) [5].
Compounded bioidentical hormones are different. These unregulated products market themselves as "natural" or "custom-made" [6]. They might use similar ingredients but lack the testing and quality controls that body-identical HRT goes through [5]. Medical experts don't recommend them because their doses aren't consistent and their safety isn't proven [6].
Who can and cannot take HRT
Most women with troublesome menopause symptoms can take HRT. Women who hit menopause early (before 45) or prematurely (before 40) should take it until at least age 51. This helps protect their bones from osteoporosis [3].
Some conditions might mean HRT isn't right for you:
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Current, past or suspected breast cancer [7]
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Unexplained vaginal bleeding [7]
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Untreated endometrial hyperplasia [7]
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Current venous thromboembolism (VTE) [7]
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Recent arterial thromboembolic disease [7]
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High blood pressure that's not treated or active liver disease [7]
Patches and gels starting with low doses might work better if you get migraines [7]. Women with VTE in their family history should look at patches or gels instead of tablets [8].
Risks and benefits of HRT
Women under 60 usually find HRT's benefits outweigh its risks [1]. Beyond easing night sweats, hot flushes, anxiety and vaginal dryness, HRT helps keep your bones strong [3].
Combined HRT (oestrogen with progestogen) shows a small increase in breast cancer risk - about 5 extra cases per 1,000 women who take it for 5 years [1]. This risk goes down after you stop. Women who've had hysterectomies can take oestrogen-only HRT, which has little to no extra breast cancer risk [1].
Blood clot risks mainly come from tablets, not patches or gels [1]. Standard doses of patches, gels, and sprays don't increase your VTE risk compared to women who don't take HRT [8].
Many specialists now call it the gold standard when you use body-identical HRT through your skin with micronised progesterone [5]. You should get a check-up every year if you're on long-term treatment [7].
The best menopause relief method depends on your health history, symptoms, and what works for you.
Non-HRT Medications for Menopause Relief
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Women who can't take HRT or don't want to still have several prescription medication options to ease their menopause symptoms. These alternatives work well for those who can't use hormonal treatments due to their medical history or personal choice.
SSRIs and SNRIs for hot flushes
SSRIs (Selective serotonin reuptake inhibitors) and SNRIs (serotonin-noradrenaline reuptake inhibitors) started as antidepressants. They now help reduce hot flushes. The common options include:
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Paroxetine, fluoxetine, escitalopram and citalopram (SSRIs)
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Venlafaxine and desvenlafaxine (SNRIs)
These medications can bring quick relief if they work for you. A one to two week trial usually tells you if they'll help [9]. Studies show SSRIs can cut hot flushes by up to 65% compared to placebo [4]. Venlafaxine works faster than SSRIs but might have more side effects [4].
Gabapentin for night sweats
Doctors usually prescribe gabapentin for epilepsy and nerve pain. Now it's a good option for night sweats and sleep problems. Higher doses of gabapentin can work as well as oestrogen to reduce how often and severe hot flushes are [2].
The treatment starts with a low dose (100mg three times daily) and can go up to 300mg three times daily as needed [10]. Many women feel better after their first dose. Some even sleep through the night without waking up or sweating [11]. You should try it for four weeks to see if it works [2].
Clonidine and other off-label options
Blood pressure medication clonidine might help with hot flushes when other treatments aren't possible. The evidence isn't as strong as it is for SSRIs and gabapentin [12]. Doctors start with 25 micrograms twice daily and might increase it to 50-75 micrograms twice daily if needed [13].
Other options include oxybutynin (for overactive bladder) and bupropion (Wellbutrin). These might boost sexual satisfaction, arousal, and orgasm intensity [5].
Side effects and safety considerations
Non-hormonal options can cause side effects:
SSRIs/SNRIs often cause nausea, lower sex drive, tiredness and dry mouth [9]. Women taking tamoxifen should avoid paroxetine and fluoxetine since these drugs can make tamoxifen less effective [4].
Gabapentin might make you dizzy, drowsy and tired, but these effects usually get better with time [6]. You need to stop taking it slowly to avoid withdrawal symptoms [2].
Clonidine can cause dry mouth, drowsiness, dizziness, constipation and sleep problems in up to half of all users [14]. Your doctor should check your blood pressure while you're taking it [13].
Venlafaxine and desvenlafaxine work best for women with breast cancer history because they don't affect tamoxifen much [4]. A research review found that venlafaxine 75mg, escitalopram 10-20mg, and gabapentin 900mg help most women who need non-hormonal menopause relief [10].
Complementary and Alternative Therapies Reviewed
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"We are not suggesting that CBT is an alternative to HRT. It's not an either/or, and we have worked through the guidelines extensively to really clarify this point." — Prof Jonathan Benger, Chief medical officer and interim director of the centre for guidelines at NICE (National Institute for Health and Care Excellence)
Many women look beyond conventional medication and explore complementary and alternative treatments to ease their menopause relief. These options appeal to women who can't take HRT or prefer non-hormonal approaches. Everything in their effectiveness and safety profiles needs careful evaluation.
Herbal remedies: black cohosh, red clover, soy
Several plant-based supplements help with menopause treatment:
Native Americans used black cohosh traditionally, and it might reduce early menopause symptoms to some degree. Research results tell different stories. A study review of 1,400 menopausal women showed black cohosh reduced hot flushes and sweating by 25% [15]. The supplement can trigger side effects like stomach upset and rashes. In rare cases, it causes liver problems [16].
Red clover has isoflavones (phytoestrogens) that act like natural oestrogen. Eight trials analysed together showed a real drop in hot flushes [16]. The herb might also help reduce blood triglyceride levels. This matters because heart disease risk goes up after menopause [15].
Soy products also contain phytoestrogens and feature heavily in traditional Japanese diets. These diets associate with fewer menopausal symptoms [3]. The best results show these preparations cut hot flushes roughly in half [3]. Results vary quite a bit though.
Acupuncture, reflexology, and homoeopathy
These therapies' evidence base varies quite a bit. Some research shows acupuncture helps with hot flush frequency and physical symptoms [16]. Notwithstanding that, controlled studies paint a different picture. They don't reliably improve hot flushes or sleep disturbances compared to non-specific acupuncture or superficial needling [7].
Reflexology practitioners apply pressure to specific points on feet, hands or ears. These points supposedly link to other body areas. Some studies hint that twice-weekly reflexology for six weeks reduced night sweats [17]. Controlled studies couldn't prove benefits beyond placebo effects [7].
Homoeopathy substantially improved hot flush frequency, mood, and anxiety measures in uncontrolled, open-label studies [7]. We need more research to back up these findings.
CBT and mindfulness-based therapies
CBT for menopause works well for easing low mood and anxiety. It also helps with hot flushes and sweats [16]. A recent analysis showed CBT had a small but real effect in reducing anxiety (d = -0.22) and depression (d = -0.33) [18].
Mindfulness-based treatments showed better results for anxiety (d = -0.56) and similar effects for depression (d = -0.27) [18]. These methods help people become aware of their body's sensations and thoughts without judgement [19]. An 8-week programme that combined mindfulness-based cognitive therapy with meditation, breathing exercises, and yoga helped improve menopausal quality of life [19].
Regulation and safety of natural products
Herbal remedies and supplements don't face the same strict testing and regulation as prescription medicines [1]. The MHRA oversees some products, but many "natural" treatments lack proper quality controls [1].
Medical experts don't recommend bioidentical hormones (custom-made preparations). These products lack regulation, have unclear safety profiles, and no solid evidence backs their effectiveness [1]. Body-identical hormones, on the other hand, undergo regulation, testing, and extensive research [1].
New rules for traditional herbal medicines will start under the Windsor Framework in January 2025 [20]. These rules will keep the 2021 provisions. They'll accept 15 years of traditional use evidence from countries beyond the EU/EEA, as long as these countries maintain similar alertness standards [20].
Healthcare professionals should review any complementary approach for menopause treatment options. Some remedies can interact with medications and might cause unwanted effects.
Lifestyle Changes That Can Help
Basic lifestyle changes can make remarkable improvements in menopause symptoms. These changes can work just as well as medications.
Exercise and weight management
Physical activity plays a vital part in managing symptoms of menopause. The NHS recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise weekly [21]. Women with active lifestyles experience fewer hot flushes and sleep better [22].
Your weight matters too. Extra pounds can make hot flushes more frequent and intense [22]. You can manage weight gain during menopause through regular exercise during menopause and balanced nutrition.
Diet and hydration
A Mediterranean-style diet can substantially reduce menopausal symptoms [23]. This diet should include fruits, vegetables, wholegrains and healthy fats. Foods rich in phytoestrogens like soy products, lentils, and linseeds might help with hot flushes and vaginal dryness [21].
Your body needs more water during menopause as it retains less moisture. The NHS suggests drinking 6-8 glasses of fluid daily [24]. You can find Magnesium for menopause symptoms in leafy greens, nuts and seeds [8].
Sleep hygiene and stress reduction
Regular sleep patterns help curb insomnia. Sleep experts suggest sticking to regular bedtimes. They also recommend a cool, dark bedroom and avoiding screens before sleep [25]. Your sleep after menopause gets better with morning sunlight exposure and evening relaxation routines [8].
CBT for menopause and mindfulness techniques help reduce stress and improve sleep quality [26].
Avoiding triggers like caffeine and alcohol
Research shows caffeine can worsen vasomotor symptoms [27]. Alcohol might trigger hot flushes and night sweats by expanding blood vessels [28].
Medical experts suggest limiting alcohol to 14 units weekly. They recommend several alcohol-free days [21]. Spicy foods can also trigger hot flushes, so eat them carefully [29].
Symptom-Specific Treatments and Approaches
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Better results come from targeting specific menopause symptoms with the right treatments instead of using a one-size-fits-all approach. Every woman needs personalised interventions that match her symptoms.
Hot flushes and night sweats
Hot flushes affect up to 74% of European women [4]. These episodes typically last 3-4 minutes but can continue for an hour [4]. A new drug called Fezolinetant, which blocks Neurokinin 3 receptors, has received approval to treat vasomotor symptoms [30]. Many women find relief from night sweats with gabapentin and notice improvements after their first dose [31]. Simple changes like switching to lighter bedding or placing a cool pack under the pillow can help with sleep disruption [32].
Low libido and sexual discomfort
Sexual interest-arousal disorder affects many women during menopause and leads to decreased desire and reduced pleasure [33]. Doctors may prescribe testosterone if other treatments don't work [34]. Your libido can take a hit from psychological factors, especially when you have stress [35]. Better intimacy often results from open discussions about changing needs and relationship concerns [35].
Vaginal dryness and urinary issues
Direct relief from vaginal dryness comes from oestrogen creams, pessaries, tablets or rings [36]. Available options include Vagifem tablets, Ovestin cream, and Estring - a flexible silicon ring that lasts three months [11]. Women who prefer non-hormonal solutions can use vaginal moisturisers (YES VM, Sylk Intimate) for daily comfort and specific lubricants during intercourse [11].
Bone health and osteoporosis prevention
Bone loss happens faster in the early post-menopausal years, which increases your risk of fractures [2]. Treatments for osteoporosis include bisphosphonates that reduce both spine and hip fractures [6]. Denosumab works well but should be avoided if you're prone to infections [6]. Getting enough calcium and vitamin D remains vital for maintaining bone health [6].
Navigating NHS vs Private Menopause Care
People seeking menopause treatment often face a choice between NHS and private care. Each path takes a different approach to managing symptoms of menopause.
What the NHS offers for menopause treatment
GP practises serve as the first stop for NHS menopause care. Nurses and pharmacists can also guide you through the process. Many local surgeries have their own menopause specialists, so check this option before you look at private care. NHS menopause services give you access to helpful tools like CBT for menopause - you don't even need a GP referral [37]. Your GP can connect you with specialist services if your case is severe or needs complex treatment.
Private clinics and compounded hormones
Private menopause clinics give you quick access to specialists and create personalised care plans, but they come at a high cost. The original consultation usually costs around £300 [38]. Some clinics offer bioidentical hormone treatments - these custom-made preparations don't match the safety standards of body-identical hormones because they lack proper testing and oversight [39]. You can get body-identical hormones through the NHS, and they share the same molecular structure as natural hormones.
Cost comparison: NHS vs private options
HRT in England needs payment but comes with a yearly prepayment certificate that costs £19.80 for unlimited HRT prescriptions [38]. The deal gets better in Wales, Scotland, and Northern Ireland - HRT is free [38]. Private care costs much more. Beyond your first consultation, you'll pay extra for follow-ups, blood tests, and prescriptions [38].
How to access menopause specialists
The British Menopause Society keeps an online database of menopause specialists. These healthcare professionals have shown their expertise and follow national guidelines like NICE NG23 [10]. A simple postcode search helps you find nearby specialists, whether they work with the NHS or private practise.
Conclusion
Understanding the full spectrum of menopause treatment options helps navigate this complex phase of life. Each woman should think over her unique symptoms, medical history, and priorities when making healthcare decisions. Body-identical HRT remains the gold standard that manages moderate to severe symptoms of menopause, especially when you have early or premature menopause.
In spite of that, non-hormonal medications like SSRIs, gabapentin, and clonidine provide viable alternatives for women who cannot or choose not to use hormone therapy. These medications target specific troublesome symptoms such as hot flushes, night sweats, and mood disturbances with different levels of effectiveness.
Evidence supports certain lifestyle modifications as effective tools for symptom management beyond pharmaceutical interventions. Quality of life improves by a lot through regular exercise during menopause, mindful dietary choices, stress reduction techniques, and CBT for menopause. Some women find relief through carefully selected natural remedies for menopause, though results vary among individuals.
Healthcare access is a vital consideration. NHS services provide budget-friendly care options, while private clinics may offer more specialised attention at higher costs. Treatment outcomes improve dramatically when you find the right menopause specialist, whatever pathway you choose.
Women with menopausal symptoms can find help through various channels. Treatment plans should evolve with changing symptoms and needs through regular healthcare provider consultations. This natural life stage becomes more comfortable with appropriate management strategies, even though it marks a significant transition. Women can maintain their quality of life and look forward to positive life after menopause with proper support and treatment.
Key Takeaways
Understanding your menopause treatment options empowers you to make informed decisions about managing symptoms effectively, whether through hormonal, non-hormonal, or lifestyle approaches.
• HRT remains the gold standard: Body-identical HRT (patches, gels, sprays with micronised progesterone) provides 80-90% symptom relief and is recommended as first-line treatment for moderate to severe symptoms.
• Non-hormonal alternatives exist: SSRIs, gabapentin, and clonidine offer effective relief for hot flushes and night sweats when HRT isn't suitable, with success rates of 50-65%.
• Lifestyle changes deliver real results: Regular exercise, Mediterranean diet, stress reduction, and avoiding triggers like caffeine can significantly reduce symptoms, sometimes matching pharmaceutical effectiveness.
• Symptom-specific treatments work best: Tailored approaches targeting individual symptoms (vaginal oestrogen for dryness, gabapentin for night sweats) often yield better outcomes than one-size-fits-all solutions.
• NHS provides comprehensive care: HRT costs just £19.80 annually in England through prepayment certificates, with specialist referrals available when needed, making quality menopause care accessible to all.
The key is finding the right combination of treatments that work for your unique situation. Don't suffer in silence—effective help is available through multiple pathways, and early intervention often prevents symptoms from becoming severe.
FAQs
Q1. What are some alternatives to HRT for managing menopause symptoms? There are several non-hormonal options available, including SSRIs and SNRIs for hot flushes, gabapentin for night sweats, and clonidine for vasomotor symptoms. Lifestyle changes like regular exercise, a healthy diet, and stress reduction techniques can also be effective. Some women find relief through herbal remedies like black cohosh or red clover, though their effectiveness varies.
Q2. How effective is bioidentical hormone therapy for menopause? Body-identical hormone therapy, which is regulated and available on the NHS, can be very effective in managing menopause symptoms. It provides relief for 80-90% of women experiencing moderate to severe symptoms. However, compounded bioidentical hormones, which are unregulated, are not recommended due to inconsistent dosing and unproven safety profiles.
Q3. Are there natural supplements that can help with menopause symptoms? Some natural supplements may help alleviate menopause symptoms. Soy products and red clover contain phytoestrogens that may reduce hot flushes. Black cohosh has shown moderate effectiveness in some studies. However, it's important to note that the effectiveness of these supplements can vary, and they should be used under medical supervision as they may interact with other medications.
Q4. What lifestyle changes can improve menopause symptoms? Several lifestyle changes can significantly improve menopause symptoms. Regular exercise, particularly 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity per week, can help manage weight and reduce hot flushes. A Mediterranean-style diet rich in fruits, vegetables, and whole grains may also help. Additionally, reducing caffeine and alcohol intake, practising good sleep hygiene, and managing stress through techniques like mindfulness can all contribute to symptom relief.
Q5. How can I access specialist menopause care in the UK? In the UK, you can access menopause care through both NHS and private routes. Many GP surgeries have in-house menopause specialists, and you can be referred to specialist services if needed. The British Menopause Society maintains an online register of menopause specialists, which you can search by postcode to find nearby experts. For those considering private care, there are numerous menopause clinics offering personalised treatment plans, though these come at a higher cost compared to NHS services.
References
[1] - https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/
[2] - https://www.nhs.uk/conditions/osteoporosis/
[3] - https://www.menopausecliniclondon.co.uk/non-hrt-alternatives
[4] - https://thebms.org.uk/wp-content/uploads/2015/10/Background-Oct2011.pdf
[5] - https://www.facingourrisk.org/info/risk-management-and-treatment/menopause-management-without-hormones
[6] - https://thebms.org.uk/publications/consensus-statements/prevention-and-treatment-of-osteoporosis-in-women/
[7] - https://pubmed.ncbi.nlm.nih.gov/16414335/
[8] - https://themenopausecharity.org/information-and-support/what-can-help/good-sleep/managing-sleep-in-menopause/
[9] - https://patient.info/womens-health/menopause/alternatives-to-hrt
[10] - https://thebms.org.uk/find-a-menopause-specialist/
[11] - https://themenopausecharity.org/information-and-support/symptoms/vaginal-dryness/
[12] - https://www.sciencedirect.com/science/article/abs/pii/S1521690X23000933
[13] - https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Patients-resources/Menopausal-Symptoms---Clonidine.pdf?thn=0
[14] - https://birminghammenopauseclinic.com/treatments/non-hrt-treatment-2/
[15] - https://www.hollandandbarrett.com/the-health-hub/conditions/womens-health/menopause/best-natural-menopause-cures/
[16] - https://www.menopausecare.co.uk/blog/herbal-remedies-for-menopause
[17] - https://www.menopausecare.co.uk/blog/reflexology-for-menopause
[18] - https://womensmentalhealth.org/posts/cbt-mindfulness-for-menopausal-depression-anxiety/
[19] - https://pmc.ncbi.nlm.nih.gov/articles/PMC9583372/
[20] - https://www.gov.uk/guidance/guidance-on-new-provisions-for-traditional-herbal-medicinal-products-and-homoeopathic-medicinal-products
[21] - https://www.cuh.nhs.uk/patient-information/menopause-a-healthy-lifestyle-guide/
[22] - https://www.nutrition.org.uk/nutrition-for/women/menopause/managing-menopause-symptoms-with-nutrition-and-diet/
[23] - https://themenopausecharity.org/information-and-support/what-can-help/self-care/lifestyle-medicine/
[24] - https://themenopausecharity.org/information-and-support/what-can-help/hydration/staying-hydrated/
[25] - https://www.nia.nih.gov/health/menopause/sleep-problems-and-menopause-what-can-i-do
[26] - https://www.healthline.com/health/menopause/sleep-hygiene-during-perimenopause-and-menopause
[27] - https://pubmed.ncbi.nlm.nih.gov/25051286/
[28] - https://charlottehunternutrition.co.uk/menopause-and-hot-flashes/
[29] - https://www.nhs.uk/conditions/menopause/things-you-can-do/
[30] - https://thebms.org.uk/wp-content/uploads/2025/11/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-for-menopausal-symptoms-NOV2025-C.pdf
[31] - https://www.menopausecare.co.uk/blog/night-sweats-in-menopause
[32] - https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/treating-menopause-symptoms/
[33] - https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561
[34] - https://www.rcog.org.uk/for-the-public/browse-our-patient-information/treatment-for-symptoms-of-the-menopause/
[35] - https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/sexual-wellbeing-intimacy-and-menopause/
[36] - https://www.nhs.uk/symptoms/vaginal-dryness/
[37] - https://www.nhs.uk/conditions/menopause/help-and-support/
[38] - https://www.moneysavingexpert.com/family/moneysaving-in-menopause-guide/
[39] - https://bioidhealth.com/nhs-hrt-certificate-vs-private-hrt-real-cost/
