Hormone replacement therapy (HRT) - Alternatives 

Alternatives to HRT 

If you are unable or decide not to take hormone replacement therapy (HRT), alternative approaches and treatments are available that may help control your menopausal symptoms.

Lifestyle changes

Making changes to your lifestyle may help ease your menopausal symptoms. For example, you should:

  • Take regular exercise: regular activity has been shown to reduce symptoms of hot flushes and improve sleep; it is also a good way of boosting your mood if you feel anxious, irritable or depressed.
  • Stay cool at night: wearing loose clothes and sleeping in a cool, well-ventilated room may help relieve hot flushes and night sweats.
  • Cut down on caffeine, alcohol and spicy food, as they have all been known to trigger hot flushes.
  • Give up smoking: if you smoke, giving up will help reduce hot flushes and your risk of developing serious health conditions, such as heart diseasestroke and cancer.


Tibolone is a synthetic (man-made) hormone that can be used as an alternative to HRT. It contains a combination of oestrogen and progestogen, so you only need take one tablet.

If you are unable to take HRT for medical reasons, for example, if you have a history of breast cancer or heart disease, it is likely you will not be able to take tibolone.


The following antidepressants have proven effective in treating hot flushes in some menopausal women:

Side effects of these antidepressants include:

  • nausea
  • blurred vision
  • diarrhoea or constipation
  • dizziness
  • dry mouth 
  • loss of appetite
  • sweating
  • feeling agitated
  • insomnia (difficulty getting or staying asleep)

SSRIs have also been associated with a loss of libido (sex drive).

Any side effects will usually improve over time, but visit your GP if they do not.

You may need to have regular blood tests or blood pressure checks when taking antidepressants, particularly if you also take the anti-clotting medicine, warfarin, or have high blood pressure (hypertension).


Clonidine is a medicine originally designed to treat high blood pressure, but research shows it may reduce hot flushes in some menopausal women.

Side effects of clonidine include:

  • low blood pressure
  • dizziness
  • drowsiness
  • dry mouth
  • fluid retention

Using clonidine is not recommended if you have depression or insomnia because it could make these conditions worse.


Gabapentin is a medicine originally designed to treat pain and epileptic seizures. However, as with clonidine, gabapentin has been shown to help ease hot flushes in some menopausal women.

Side effects of gabapentin can include:


In some menopausal women, a medicine called pregabalin has been shown to reduce the frequency and severity of hot flushes.

Side effects of pregabalin can include:

  • dizziness
  • weight gain
  • sleepiness
  • co-ordination problems
  • difficulty concentrating
  • blurred or double vision

These side effects are usually mild.

Complementary therapies

Some products are sold in health shops for treating menopausal symptoms. These herbal remedies include ginseng, black cohosh, red clover and evening primrose oil.

These products are often marketed as "natural", but this does not necessarily mean they are safe to use. Concerns exist over the quality of "natural products", and some may interact with other treatments and cause harmful side effects.

There is also very little evidence to show that these remedies are effective. Therefore, always consult your GP before using a complementary therapy to treat menopausal symptoms. 

Page last reviewed: 11/05/2012

Next review due: 11/05/2014


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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

riettevdm said on 23 February 2013

If you know haw they farm Premarin that is in HRT you would rather go for alternative options.

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