Alternatives to HRT - Hormone replacement therapy (HRT)

If you cannot take HRT or decide not to, there are other ways to relieve your symptoms of menopause.

These include lifestyle measures and alternative medications:

Lifestyle measures

Changing your lifestyle can help to reduce hot flushes, improve sleep, boost your mood and keep your bones strong.

You may want to try:

Wear loose clothes and sleep in a cool, well-ventilated room if you have hot flushes and night sweats.

Activities such as yoga and tai chi may help you relax.

Vaginal lubricant

Try vaginal lubricant or moisturiser if you have vaginal dryness. There are several different types available to buy from shops and pharmacies.

Tibolone

Tibolone is a prescription medicine that's similar to combined HRT (oestrogen and progestogen).

It's taken as a tablet once a day. Tibolone is also known as Livial.

Uses of tibolone

Tibolone can help relieve:

  • hot flushes
  • low mood
  • reduced sex drive

But tibolone may not work as well as combined HRT. It's only suitable for women who had their last period more than 1 year ago.

Side effects of tibolone

Side effects of tibolone can include:

  • tummy (abdominal) pain
  • pelvic pain
  • breast tenderness
  • itching
  • vaginal discharge

Risks of tibolone

Risks of tibolone are similar to the risks of HRT.

This includes 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.

Antidepressants

Some antidepressants can help with hot flushes and night sweats.

But they can also cause unpleasant side effects such as agitation and dizziness.

There are 2 types of antidepressants that can help with hot flushes caused by the menopause:

  • selective serotonin reuptake inhibitors (SSRIs)  
  • serotonin-noradrenaline reuptake inhibitors (SNRIs)

But they are not licensed for this use.

This means they have not undergone clinical trials for use in treating hot flushes. But many experts believe they're likely to be effective. Your GP will discuss the possible benefits and risks with you.

Side effects of SSRIs and SNRIs

Side effects of SSRIs and SNRIs can include:

  • feeling agitated, shaky or anxious
  • feeling sick
  • dizziness
  • reduced sex drive

Any side effects usually improve over time. Talk to your GP if they do not.

Clonidine

Clonidine is a non-hormonal prescription medicine.

It can help reduce hot flushes and night sweats in some menopausal women.

It's taken as tablets 2 or 3 times a day.

Risks of clonidine

Clonidine does not affect hormone levels. It does not increase the risk of problems such as breast cancer.

But research suggests it only has a very small effect on menopausal symptoms.

Side effects of clonidine

Clonidine can also cause some unpleasant side effects, including:

  • dry mouth
  • drowsiness
  • depression
  • constipation

It may take 2 to 4 weeks to notice the effects of clonidine.

Speak to your GP if your symptoms do not improve or you experience any side effects.

Bioidentical or 'natural' hormones

Bioidentical hormones are hormones made from plant sources.

They are promoted as being similar to human hormones.

Some people claim these hormones are a 'natural' and safer alternative to standard HRT.

The balance of hormones used in 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.

Bioidentical preparations are not recommended because:

  • they are not regulated
  • it's not clear how safe they are
  • there's no good evidence to suggest that they're safer than standard HRT
  • it's not known how effective they are

Many standard HRT hormones are made from natural sources. They're closely regulated and have been well-researched. This ensures they're as effective and safe as possible.

Complementary therapies

Several products are sold in health shops for treating the symptoms of menopause.

For example, herbal remedies like:

  • evening primrose oil
  • black cohosh
  • angelica
  • ginseng
  • St John's Wort

Some of these remedies, including black cohosh and St John's Wort, may help reduce hot flushes.

St John’s Wort may affect your liver’s ability to break down and metabolise certain medications. Talk to your GP or pharmacist if you intend to take it with prescribed medication.

There's no scientific evidence that complementary therapies work.

Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.


Content supplied by the NHS and adapted for Ireland by the HSE

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This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.

Page last reviewed: 7 July 2021
Next review due: 7 July 2024