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Alternatives - Hormone replacement therapy (HRT)

If you're unable to take hormone replacement therapy (HRT) or decide not to, you may want to consider alternative ways of controlling your menopausal symptoms.

Lifestyle measures

The following lifestyle measures can help reduce some menopausal symptoms:

  • Do regular exercise – regular physical activity can reduce hot flushes and improve sleep. It's also a good way of boosting your mood if you feel anxious, irritable or depressed. Weight-bearing exercises can help keep your bones strong
  • have a healthy diet – a balanced diet can help ensure you do not put on weight and can keep your bones healthy
  • stay cool at night – wear loose clothes and sleep in a cool, well-ventilated room if you experience hot flushes and night sweats
  • cut down on caffeine, alcohol and spicy food, as they have all been known to trigger hot flushes
  • try to reduce your stress levels to improve mood swings, make sure you get plenty of rest, as well as getting regular exercise. Activities such as yoga and tai chi may help you relax
  • 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
  • try vaginal lubricant or moisturiser if you experience vaginal dryness – several different types are available to buy from shops and pharmacies


Tibolone (brand name Livial) is a prescription medicine that is similar to taking combined HRT (oestrogen and progestogen). It's taken as a tablet once a day.

It can help relieve symptoms such as hot flushes, low mood and reduced sex drive, although some studies have suggested it may not be as effective as combined HRT.

It's only suitable for women who had their last period more than a year ago (known as the post-menopause).

Side effects of tibolone can include tummy (abdominal) pain, pelvic pain, breast tenderness, itching and vaginal discharge.

Risks of tibolone are similar to the risks of HRT, and include an increased risk of breast cancer and strokes. Talk to your GP about the risks and benefits of tibolone if you're considering taking it.


There are 2 types of antidepressants – selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) – which may help with hot flushes caused by the menopause.

These medicines are not licensed for this use. This means they have not undergone clinical trials to test if they help this symptom, but many experts believe they're likely to help and your doctor will discuss the possible benefits and risks with you.

Side effects of SSRIs and SNRIs can include feeling agitated, shaky or anxious, feeling sickdizziness and a reduced sex drive.

Any side effects will usually improve over time, but you should see a GP if they do not.


Clonidine is a prescription medicine that can help reduce hot flushes and night sweats in some menopausal women. It's taken as tablets 2 or 3 times a day.

It does not affect hormone levels, so unlike HRT it does not carry an increased risk of problems such as breast cancer. But research suggests it only has a very small effect on menopausal symptoms.

Clonidine can also cause some unpleasant side effects, including dry mouth, drowsiness, depression and constipation.

It may take 2 to 4 weeks to notice the effects of clonidine. Speak to a GP if your symptoms do not improve or you experience troublesome side effects.

Compounded bioidentical hormones

Compounded bioidentical hormones are not available on the NHS. Some private clinics offer them.

Compounded bioidentical hormones are not recommended for menopausal symptoms because:

  • they are not regulated and it's not clear how safe they are
  • it's not known how effective they are in reducing menopausal symptoms
  • the balance of hormones used in compounded bioidentical preparations is usually based on the hormone levels in your saliva, but there's no evidence that these levels are related to your symptoms

Regulated bioidentical, or body identical, hormones are different from compounded bioidentical hormones.

Regulated bioidentical hormones are safe and available on the NHS. They're effective in treating menopause symptoms.

Complementary therapies

Several products are sold in health shops for treating menopausal symptoms, including herbal remedies such as evening primrose oil, black cohosh, angelica, ginseng and St John's wort.

There's evidence to suggest that some of these remedies, including black cohosh and St John's wort, may help reduce hot flushes, but many complementary therapies are not supported by scientific evidence.

Even when there is some supporting evidence, there's uncertainty about the right doses to use and whether the health benefits last. Some of these remedies (especially St John's wort) may also cause serious side effects if they're taken with other medicines.

These products are often marketed as "natural", but this does not necessarily mean they're safe. The quality, purity and ingredients cannot always be guaranteed, and they may cause unpleasant side effects.

It's a good idea to ask a GP or pharmacist for advice if you're thinking about using a complementary therapy.

Page last reviewed: 09 September 2019
Next review due: 09 September 2022