HRT stands for hormone replacement therapy and involves replacing the hormones that are at low levels during menopause, e.g. oestrogen, progesterone and testosterone.(9) They can be given as creams, patches or oral tablets. Intrauterine devices, such as the Mirena coil, can also be used as part of HRT, e.g. progesterone delivery.(9) Replacing these hormones should reduce the symptoms of menopause and help moderate the cardiovascular and bone health risks.(5, 9)

However, sometimes HRT is not suitable. For example, if someone has a history of breast cancer, blood clots, liver disease or uncontrolled hypertension.(5,9)

HRT will not suit all women too, due to the side effects of oestrogen and progesterone, which can include headaches, vaginal bleeding, mood changes, weight gain, fatigue, acne and nausea - although these symptoms will often improve with time.(9) HRT is usually delivered as creams and patches at first and started at a low dose then titrated upwards depending on symptoms.(9)

Unfortunately, weight gain in menopause is very common. Muscle mass decreases and as oestrogen levels reduce, visceral fat increases, mostly around the abdomen and upper body.(6) Basal metabolic rate (BMR) also slows down as we age, increasing the risk of excess weight gain.(5) Focusing on eating healthily, reducing portion sizes and watching energy intake can all help to reduce the risk of weight gain.(1) Regular exercise is also important to maintain muscle mass, preserve bone health and control weight.(1,4) Resistance exercise, such as weight lifting, and cardiovascular exercise, such as running and walking, will help increase muscle mass and BMR and have added psychological benefits.(4,6) It helps to reduce and/or cut out caffeine and alcohol as these are both known to worsen symptoms of menopause such as poor sleep and hot flushes.(1)

Vitamins and minerals

We have discussed vitamin D and calcium, but what other vitamins and minerals are important during menopause? Magnesium is needed for bone health, muscle function and the regulation of mood and sleep. It can help with symptoms such as anxiety, insomnia and headaches, both common during perimenopause and menopause.(5) A magnesium intake of 320mg a day is recommended for menopausal women.(5) Dietary sources include nuts, seeds, wholegrains and leafy greens.

Vitamins B6, B12 and folate are needed for energy production, mood and cognitive function and may help mood swings, fatigue and brain fog. An oral B vitamin complex for menopausal women is available, or you can increase your intake of foods such as fish, chicken, eggs and leafy greens.(1,3,5) Vitamin E is well known for its antioxidant properties, and it may help to reduce symptoms of hot flushes and night sweats. Recommended intake is 15mg a day and dietary sources include nuts, seeds and leafy greens.(1,3,5)

Finally, omega-3 fatty acids found in fish oil, flaxseeds and margarine have anti-inflammatory properties and can reduce the risk of heart problems(5) There is some evidence to suggest that omega-3s can help with cognitive function and mood regulation too.(1,3,5) Recommended intake is 100mg a day (combined EPA and DHA), which can be obtained via diet or an oral supplement.(5,11)

Phytoestrogens, glucosamine and chondroitin

Phytoestrogens (plant oestrogens) are similar to human oestrogen and if consumed regularly in large enough quantities, they can have oestrogen-like effects.(2,3) In theory, they can reduce the impact of menopause symptoms such as hot flushes.(2) The two main types of phytoestrogens are isoflavones and lignans.(11) Isoflavones are found in foods such as soya products, tofu, beans, chickpeas and lentils.(11) Lignans are found in wholegrains, linseeds, fruits and vegetables.(11)  Currently, there is not a huge amount of evidence for the beneficial effect of phytoestrogens on menopause symptoms and products high in phytoestrogens are not recommended for those with breast cancer.(11,12)

Glucosamine and chondroitin are both components of cartilage.(10) As menopause affects joint and bone health, taking a glucosamine and chondroitin supplement daily (in combination with regular exercise) can help to reduce symptoms of stiffness and pain.(10)

Alternative therapies, such as hypnotherapy, mindfulness meditation and cognitive behavioural therapy (CBT), have some evidence for reducing menopausal symptoms.(2,10,11) CBT can help with coping with mood changes and anxiety in perimenopause and menopause and can even help reduce the impact of hot flushes and night sweats.(11)

Yoga has also been shown to provide benefits in reducing menopausal symptoms and improving strength and flexibility.(2,10,11) Other potential treatments for menopausal symptoms include selective serotonin reuptake inhibitors (SSRIs), gabapentin, pregabalin, clonidine and oxybutynin, although they all have side effects.(11)

Fezolinentant (a neurokinin-3 receptor antagonist) is a new non-hormonal drug that can reduce vasomotor symptoms of menopause and was licensed for use in the UK in 2023. However, it is currently only available on private prescription.(11)