Introduction
The menopause transition can bring significant changes, and for many women these shifts affect physical, emotional, and sexual wellbeing. While Hormone Replacement Therapy (HRT) remains the most effective option for managing menopause related symptoms, it isn’t right for everyone. Some women prefer non-hormonal approaches, and for others hormones may be unsuitable or need to be used with caution.
As menopause specialists, our aim is to help you understand all the evidence-based options available so you can make informed choices that fit your health, values, and lifestyle. This leaflet summarises non-hormonal treatments recommended or supported by the British and international Menopause Societies.
1. Prescription Non-Hormonal Options
These medicines aren’t hormones, but research shows they can reduce specific menopause symptoms, particularly vasomotor symptoms (flushes and sweats). The right option depends on your medical history and symptom profile.
Fezolinetant (Veoza)
- What it is:
A neurokinin-3 receptor antagonist licensed for moderate to severe vasomotor symptoms. - How it works:
It targets the thermoregulatory pathways in the brain involved in flushes and sweats. - Effectiveness:
Clinical trials show around 60 percent improvement in frequency and severity of hot flushes. - Availability:
Now available privately in the UK. NICE is appraising it for NHS use but it isn’t currently available on the NHS. - Who can use it:
Suitable for many women, but not recommended for those with active liver disease or on certain hormone-dependent cancer treatments. Liver function tests are required before and during treatment. - Tolerability:
Generally well tolerated, with most side effects mild. Possible side effects include headache, nausea, abdominal discomfort and occasional sleep disturbance.
Antidepressants (SSRIs/SNRIs)
- Certain antidepressants reduce hot flushes and night sweats, particularly when HRT isn’t an option.
- Examples:
Venlafaxine, Paroxetine. - Benefits:
Helpful for women experiencing both mood symptoms and vasomotor symptoms. - Important notes:
- Some antidepressants can interfere with tamoxifen; alternatives exist and should be discussed individually.
- For women who can take HRT, evidence suggests HRT improves mood more effectively when symptoms are menopause-related.
Oxybutynin
Oxybutynin is a medication usually used for overactive bladder, but studies show it can also help reduce hot flushes and night sweats. It works on the brain pathways involved in temperature regulation.
- Benefits:
Can significantly reduce flushes for some women and may be particularly helpful if bladder urgency is also an issue. - Considerations:
Dry mouth and constipation are the most common side effects. Because it is an anticholinergic drug, it may not be suitable for women who have other medical issues such as glaucoma.
Clonidine
- Originally a blood-pressure medication, clonidine can help reduce hot flushes for some women.
- Pros:
May reduce flushes and night sweats. Is licensed for use in hot flushes. - Cons:
Not very effective for some women. Dry mouth, dizziness, and low blood pressure are common limiting factors.
Gabapentin / Pregabalin
- Medications commonly used for nerve pain, epilepsy, and migraine prevention.
- Benefits:
Evidence shows small improvement in hot flushes, especially at night, and better sleep quality for some women. - Considerations:
Use often limited by side effects – drowsiness and dizziness may occur, particularly at the start. Has potential to become addictive.
2. Natural and Complementary Approaches
Many women explore herbal or plant-based options. It’s important to choose reputable products (look for the THR mark in the UK) and to understand potential interactions.
Herbal Remedies
Agnus Castus
- Traditionally used for premenstrual symptoms.
- Caution: May interact with hormonal contraception or HRT.
Black Cohosh
- Some evidence for reducing hot flushes.
- Avoid if: You take tamoxifen or are sensitive to aspirin/salicylates.
Evening Primrose or Starflower Oil
- Contains GLA, sometimes helpful for breast tenderness.
- Caution: May increase seizure risk or bleeding tendency.
Ginkgo Biloba
- Limited evidence for cognitive symptoms.
- Avoid with: Blood-thinning medications such as warfarin.
Sage
- May reduce hot flushes for some women.
- Avoid with: Uncontrolled high blood pressure.
St John’s Wort
- May help mild depression and anxiety.
- Important: Interacts with many medications including antidepressants, oral contraceptives, warfarin, digoxin, and several cancer treatments. Always seek medical advice first.
Phytoestrogens & Isoflavones
- Found in foods like soy, red clover, and linseed.
- Effectiveness:
Evidence shows modest improvement in hot flushes for some women. - Dietary impact:
Traditional diets rich in phytoestrogens are associated with fewer vasomotor symptoms and potentially lower cardiovascular and bone-health risks. - Not recommended for:
Women with a history of hormone-dependent cancers unless advised otherwise by their specialist.
Food sources include:
- Whole grains such as barley, rye, and oats
- Soya products (tofu, edamame, tempeh)
- Linseeds, sesame seeds, pumpkin seeds
- Chickpeas, lentils, kidney beans
- Vegetables like broccoli, tomatoes, peppers, and garlic
3. Lifestyle Approaches
Lifestyle changes are powerful tools during the menopause transition. Evidence shows they can reduce symptoms, support long-term health, and improve overall wellbeing.
Diet
There’s no single “menopause diet”, but several patterns are beneficial.
Helpful approaches:
- Reducing caffeine and alcohol to ease flushes, anxiety, and bladder sensitivity.
- Following a Mediterranean-style diet: rich in fruit, vegetables, whole grains, oily fish, nuts, and olive oil.
- Ensuring sufficient calcium and vitamin D for bone health.
- Keeping a symptom and food diary if bloating or gut changes occur.
Weight changes:
Menopause can alter metabolism and body composition. Small, sustainable dietary adjustments often beat restrictive plans.
Exercise
Regular movement is one of the most effective non-medical strategies.
Benefits:
- Improves mood and sleep
- May reduce vasomotor symptoms
- Supports weight management
- Protects bone density and muscle mass
- Reduces cardiovascular risk
Evidence-supported activities:
- Brisk walking
- Strength or resistance training
- Pilates, yoga, and balance training
- Short, frequent sessions are often more achievable than long workouts
Stopping Smoking
Smoking worsens hot flushes and significantly increases the risks of heart disease, osteoporosis, and certain cancers.
Good news:
Stopping at any age produces meaningful benefits, and specialist NHS support improves success rates.
4. Psychological and Integrative Therapies
Non-hormonal support isn’t limited to medicines or supplements. Psychological and therapeutic approaches can make a genuine difference.
Cognitive Behavioural Therapy (CBT)
- NICE and BMS recommend CBT for problematic hot flushes, night sweats, low mood, anxiety, and sleep disturbances.
- How it helps:
- Alters the way symptoms are interpreted
- Reduces symptom distress
- Improves coping and emotional wellbeing
CBT can be delivered individually or in groups, in person or online.
Mindfulness and Meditation
Mindfulness-based interventions can reduce stress, improve sleep, and help manage emotional symptoms. Many women find them grounding during periods of hormonal fluctuation.
Coaching
Lifestyle and wellbeing coaching can help you reassess priorities, set boundaries, and navigate career or personal changes that often coincide with midlife.
Sex and Relationship Therapy
Falling libido, discomfort, and body-image concerns are common but often under-discussed.
Therapy can support:
- Communication and confidence
- Navigating changes in desire
- Rebuilding intimacy
Vaginal dryness and discomfort can also be treated effectively with non-hormonal lubricants, moisturisers, and local vaginal oestrogens where appropriate.
Physiotherapy
Specialist pelvic health physiotherapy can help with:
- Pelvic organ prolapse
- Bladder urgency or stress incontinence
- Painful sex
- Pelvic floor weakness
Physiotherapists offer targeted exercises and behavioural strategies, and sometimes recommend pessaries or onward referral for surgical assessment.
Choosing the Right Approach for You
There is no single “best” treatment pathway. The right approach depends on your medical history, symptoms, personal preference, and lifestyle. Many women benefit from a combination of options, and small changes often lead to big improvements over time.
A personalised consultation enables us to explore all the relevant choices, review guideline-based recommendations, and develop a plan tailored to your needs.
If you’d like help deciding which non-hormonal treatments may suit you, we’d be happy to provide further information and support.
