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Women's health centre

Alternatives to HRT

NHS Choices Medical Reference

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If you are unable or unwilling to take hormone replacement therapy (HRT), some alternative approaches and treatments may help to control symptoms of the menopause. These are discussed below.

Lifestyle changes

Lifestyle changes may help to ease menopausal symtoms. Such changes including:

  • Taking regular exercise - this has been shown to reduce symptoms of hot flushes and improve sleep. Regular exercise is also a good way of boosting your mood if you feel anxious, irritable or depressed.
  • Cooling down at night - wearing loose clothes and sleeping in a cool, well-ventilated room may help relieve hot flushes and night sweats.
  • Cutting down on caffeine, alcohol and spicy food - these have all been known to trigger hot flushes.
  • Quitting smoking - if you are a smoker, quitting will help to reduce symptoms of hot flushes and reduce your risk of developing serious health conditions, such as heart disease, stroke and cancer.


Tibolone is a synthetic hormone that can be used as an alternative to HRT. It contains a combination of oestrogen and progestogen, so you only need to take one tablet.

Tibolone has the same associated health risks as continuous combined HRT. If you are unable to take HRT for medical reasons - for example, you have a history of breast cancer or heart disease - it is likely you will not be able to take tibolone.


The following antidepressants have proved effective in treating hot flushes in some women:

Side effects of these antidepressants include:

  • nausea
  • blurred vision
  • diarrhoea or constipation
  • dizziness
  • dry mouth 
  • loss of appetite
  • sweating
  • feeling agitated
  • insomnia (not being able to sleep)

SSRIs have also been associated with a loss of libido (sex drive).

Side effects usually improve over time. See your GP if they do not. You may need to have regular blood tests or blood pressure checks when taking antidepressants, especially if you also take the anti-clotting drug warfarin or you have high blood pressure.


Clonidine is a medicine originally designed to treat high blood pressure, but studies have shown that it may reduce hot flushes in some women.

Side effects of clonidine include:

  • low blood pressure
  • dizziness
  • drowsiness
  • dry mouth
  • fluid retention

Using clonidine is not recommended if you have depression or insomnia, as it could make these conditions worse.

Alternative medicines

Claims have been made for a number of herbal supplements for the treatment of the menopause. These include:

There is no clear evidence that any of these are effective. Little is known about their long-term effects.

Kava and red clover have been linked to liver disease. Avoid taking black cohosh, ginseng and red clover if you have a history of breast, ovarian or endometrial cancer, as there is some evidence they could trigger a relapse of the condition.

Medical Review:

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