Managing Menopause Without HRT…
This is an extract of my book ‘A Bloody Good Hysterectomy’ which will be out soon.
For some people, avoiding HRT is medically necessary. For others, it’s a personal choice. Some may not be able to take HRT because it interacts with medication they are already on, some because of cancer risks. Whichever category you fall into, this section will give you an idea of how you might manage your symptoms without it.
Firstly, it’s important to consider the severity and type of symptoms you are experiencing. For some, small lifestyle adjustments may be enough, improving diet, walking regularly, reducing caffeine, and maintaining a consistent bedtime routine. For others, symptoms can be more severe, and medical support may still be needed.
It’s important to know that you do not need to suffer in silence simply because you can’t take HRT. There are a range of non-hormonal treatments available that can help manage menopause symptoms.
It’s also worth acknowledging that HRT is now considered very safe for many people, particularly body-identical HRT. Personally, I do take HRT despite having had borderline ovarian cancer. I was very young to enter surgical menopause, and after careful discussion, my doctor and I decided that, in my case, the benefits outweighed the risks.
I also chose to be tested for the BRCA gene to better understand my personal risk. That information gave me additional peace of mind when making decisions about my treatment.
Non-Hormonal Medications
If HRT isn’t right for you, there are several non-hormonal medications that may be worth discussing with your doctor:
Gabapentin
Pregabalin
Clonidine
Senna/Senoko (if appropriate, depending on context)
Ospemifene
In addition, some antidepressants prescribed at low doses can help alleviate menopause symptoms:
SSRIs (such as fluoxetine, paroxetine, citalopram, escitalopram, sertraline)
SNRIs (such as venlafaxine)
As with any medication, there can be side effects, so it’s important to have an informed discussion with your doctor.
Alternative Therapies
There are also complementary and alternative therapies that can be used either alongside HRT or on their own. Many people find these helpful:
Acupuncture has been shown to help with joint pain, hot flushes, and sleep. Reflexology is thought to promote relaxation and improve sleep, while also supporting overall wellbeing. Massage, which may feel like a luxury, can be incredibly beneficial if you are experiencing tension, anxiety, or aches, helping to reduce stress and lower cortisol levels. If joint or bone pain is significant, it may also be worth seeing a physiotherapist.
If you choose this route, try to find a practitioner who specialises in menopause.
Supplements & Natural Remedies
There are also many supplements and natural remedies available. With supplements, I always recommend getting your levels checked where possible, and introducing one at a time so you can clearly identify what is helping. Starting multiple supplements at once can make it difficult to know what’s actually making a difference.
It’s also worth being aware of “menowashing”, where products are marketed specifically for menopause and priced higher, when in reality they may contain very standard ingredients.
Some supplements with a good reputation include:
Black Cohosh – may have oestrogen-like effects and can support mood and night sweats
Maca Root – often used for energy and libido
Evening Primrose Oil – may help with mood swings and irritability
Red Clover – contains compounds that can mimic oestrogen
St John’s Wort – sometimes used for low mood
Magnesium – supports sleep, muscle function, and relaxation (a personal favourite I often recommend)
Please note: some of these contain phytoestrogens or isoflavones and may not be suitable for those with oestrogen-sensitive cancers or those taking certain medications, including blood thinners. Always speak to your doctor before starting any new supplement.
Lifestyle
Lifestyle factors can also have a significant impact on symptoms.
If sleep is an issue, your bedtime routine becomes crucial. If you’re waking in the early hours, it may be worth looking at your evening meals, as blood sugar balance can play a role. While I am not a nutritionist, I have seen first-hand how food choices can affect symptoms.
Weight-bearing exercise is also important for joint and bone health, even if it feels counterintuitive when you’re tired.
My Lifestyle ‘Recipe’
For me, my lifestyle “recipe” has evolved over the past seven years.
I usually wake naturally around 6:30am. I avoid going on my phone for at least 30 minutes, as I find it raises my stress levels first thing. I’ll have a tea with a splash of oat milk, I’ve never been a coffee-on-an-empty-stomach person, and I find caffeine can exacerbate symptoms.
I try to eat within about 30 minutes of waking. I don’t always find this easy, but I know it helps regulate energy and reduces stress on the body. Breakfast is typically something balanced with protein and fibre, for example, granola with plant-based yoghurt and berries, or an omelette with vegetables.
I often write down a few intentions for the day or a short gratitude list, and then I go for a walk. Morning daylight has a real impact on my energy and sleep, and it’s become a non-negotiable for me.
I work from home in a desk-based role, so I’ve adapted how I work too. I now prefer calm music to help me focus, and I take regular breaks without guilt, something I used to struggle with. Those breaks actually make me more productive.
I’ll usually exercise or walk again later in the day, and I pay attention to my nutrition, focusing on protein and fibre rather than just calories, which is a shift from how I approached food before menopause.
In the evening, I eat around 6pm and avoid late-night snacking. I reduce screen time before bed and try to wind down properly, often with a few moments of reflection or gratitude.
Reading this back, it might sound very “put together,” but this routine has been built gradually over seven years. I didn’t change everything overnight.
In fact, I had plenty of habits that were making my symptoms worse, I just didn’t realise it at the time.
You don’t need a perfect routine. You just need to find what works for you, one step at a time. The things that help will stick, because you’ll feel the difference.
And for the record, I still have a coffee in a café at least once a week, even though I know exactly how it makes me feel afterwards.
I’m not perfect, and I never will be. But I do now have a routine that supports me, and I truly believe you can find one that supports you too.
Hope this helps you
Rachel
Disclaimer: I am not a doctor. This is based on my experience and managing my own symptoms. I have completed my Menopause Champion Qualification.
