Hormone replacement therapy (HRT) is the most effective treatment for menopause symptoms, but it isn't suitable or
wanted by everyone. Several non-hormonal treatments work well, and some lifestyle and complementary approaches
help a little. This page compares the options honestly. For HRT itself and the menopause transition, see our
menopause page.
Who looks for alternatives?
Women with a history of breast cancer or some other hormone-sensitive cancers
Those with a history of blood clots, stroke, active liver disease, or unexplained vaginal bleeding (which must be investigated first)
Women who have tried HRT and had side effects, or who prefer not to take hormones
For many women, HRT's risks are smaller than commonly feared — especially under 60 and with patches or gels,
which carry less clot risk than tablets. It is worth a balanced discussion with a doctor before ruling it out.
Slow, unforced breathing and gentle yoga help manage stress. Avoid breath-holding and forceful techniques if you have heart disease, high blood pressure or are pregnant.
Options compared
Non-hormonal options for hot flushes and menopause symptoms, with strength of evidence
Option
Helps with
Evidence
Notes
Cognitive behavioural therapy (CBT)
Flushes, sleep, mood
Good
Reduces how much flushes bother you; no side effects
Some antidepressants (SSRIs/SNRIs, e.g. venlafaxine, escitalopram)
Flushes, mood
Good
Low doses; nausea at first. See interactions below
Fine as food; take care with supplements after breast cancer
Herbal remedies (incl. Ayurvedic)
Varies
Weak
Quality varies; possible interactions and liver effects
“Bioidentical” compounded hormones
—
Not recommended
Unregulated doses; these are still hormones, not an alternative
Vaginal dryness & bladder
Dryness, painful sex, urgency and repeated urine infections often worsen over time and don't improve on their own.
Regular vaginal moisturisers (used every few days) and lubricants (during sex) help
many women. Low-dose vaginal oestrogen is very effective and very little is absorbed; many women who
cannot take HRT can use it, though women with a history of breast cancer should discuss it with their cancer
specialist. Pelvic floor physiotherapy helps bladder symptoms.
Important interactions
Women taking tamoxifen after breast cancer should avoid the antidepressants paroxetine
and fluoxetine, which can make tamoxifen less effective. Venlafaxine or others are preferred. Always
tell every doctor and pharmacist about all your medicines, herbs and supplements.
Ayurvedic view
Pacify Vata, cool Pitta → steady digestion and routine → nourish tissues with Rasayana → calm the mind.
Ayurveda regards the end of menstruation (Rajonivritti) as a natural transition into the Vata stage
of life. It has no equivalent of hormone replacement; its approach is to smooth the transition through routine,
diet, oil massage, breathing practices and Rasayana herbs. These fit well with lifestyle and psychological
approaches, and can be used alongside medical treatment with your doctor's knowledge.
Herbs & safety
Shatavari — used for dryness, flushes and irritability; limited evidence
Ashwagandha — for stress and sleep; can affect thyroid function; rare liver injury reported
Brahmi and Jatamansi — for anxiety and sleep; can add to the effect of sedating medicines
Some plant products have weak oestrogen-like effects. If you have had breast or womb cancer, or take tamoxifen,
an aromatase inhibitor, blood thinners or thyroid medicine, check with your specialist before taking any herbal
product. Use licensed products from a qualified practitioner, and report side effects to the Ministry of Ayush
pharmacovigilance programme.
Lifestyle that helps
Dress in layers of cotton; keep a fan and cold water nearby; keep the bedroom cool.
Notice and reduce personal triggers — spicy food, hot drinks, caffeine, alcohol, stress.
Paced slow breathing (about 6 breaths a minute) at the start of a flush; Sheetali and Nadi Shodhana are calming.
Regular exercise, including strength training, protects bones and mood; stop smoking.
Eat calcium-rich foods (milk, curd, ragi, sesame, leafy greens) and get safe daylight for vitamin D.
A warm sesame-oil self-massage (abhyanga) before bathing may help relaxation and sleep.
When to see a doctor
Any vaginal bleeding after menopause — must be checked promptly
Symptoms affecting your sleep, work, relationships or mood
Low mood that persists, or thoughts of self-harm — call Tele-MANAS on 14416
Yellowing of the skin or eyes, dark urine or abdominal pain while taking any herbal remedy
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