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Menopause: What's Available To Make The Journey Easier?




Menopause and perimenopause are times in a woman's life when it can feel that your body is starting to let you down and that you're being consigned to society's scrapheap. Not so very long ago, the medical profession tended to write it off as "one of those things", like unseasonal rainfall or verrucas.


Happily, these days there is much more awareness of the causes, available treatments and likely outcomes for menopausal women.

From outspoken celebrities such as the UK's Davina McCall, who chronicled her menopause journey*, and Oprah Winfrey's Menopause TV Specials, to prestigious journal The Lancet's articleTime For A Balanced Conversation About Menopause, awareness and readily available information has come a long way. As 70% of women notice some symptoms (menopausesupport 2025?), it's good to know what to expect and what you can do about it.


Typically beginning in a woman's mid 40's to their 50's, menopause is "...one point in a continuum of life stages for women and marks the end of their reproductive years."(WHO 2024) This means that it isn't a disease (WHO 2024), but a normal event, even though the effects on the body may be described by medical personnel as symptoms. The body's circulating levels of female hormones, particularly estrogen, fall to such a level that the ovaries stop releasing follicles (eggs) and therefore a fully menopausal woman is unable to conceive children.


However, the decrease is not uniformly gradual in the case of estrogen, hence the wide variety of "symptoms" that may be experienced:



  • Menopause itself is defined as a medical state where a woman has not had menses (periods) for a full year (The Lancet 2024). This is where the uterus (womb) lining is shed along with any unfertilised eggs that have been released, approximately every month.

  • Perimenopause is the runup to actual menopause and may last for several years, with the menstrual cycle gradually being affected (irregular periods, spotting and bleeding between periods) and other effects such as hot flashes, brain fogginess, sleep disturbance, joint pain and vaginal dryness (The Lancet 2024). These effects are very variable in their severity between women and the degree to which they affect normal life. (WHO 2024)

The types of help and self-help that are available to women experiencing perimenopause and menopause fall into several types:


  • lifestyle changes

  • hormone replacement therapy (HRT)

    • systemic (oral tablets and patches that enter the bloodstream)

    • local (vaginal creams, gels and rings)

  • non-hormonal treatments

  • alternative/complementary therapies



Lifestyle Changes


Reconsidering your lifestyle may in fact improve your life as a whole. It could include examining your diet, exercise, alcohol consumption and stress levels. Reducing sugar, caffeine, alcohol, giving up smoking and reducing spicy foods can all have a positive impact on symptoms.(menopausesupport 2025? (a))


Dietary changes, such as to the Mediterranean Diet, that is rich in fruits, vegetables, beans wholegrains and healthy fats, can be beneficial both to symptom management and long-term health.(menopausesupport 2025?) There is a lot of evidence that it improves people's longevity (The Lancet 2024).


The basis of dietary change effects and their advantages:

• Mediterranean-style diets—rich in fruits, vegetables, whole grains and healthy fats may modestly improve vasomotor symptoms and support bone and heart health. 

• Soy isoflavones in soya milks, yogurts, some breads and most health store menopause remedies (e.g., genistein, daidzein) reduce hot flush frequency/severity; ~20 mg daily shows benefit, though results vary. (Shariatpanahi et al 2020)

• Plant-based, low-fat vegan diets with soybeans reduced severe hot flashes by ~92% over 12 weeks in one RCT (random controlled trial). (British Dietetic Association n.d.)


Weight loss

• Loss of ~5 kg in a woman's weight is linked to ~30% improvement in vasomotor symptoms. (British Dietetic Association n.d.)


Physical activity

• Regular exercise improves mood, sleep quality, bone and cardiovascular health. Evidence for hot flush reduction is mixed—one meta-analysis found no significant difference, though co-interventions (e.g., exercise + soy milk) showed benefits. (Daley et al 2014)

  • Exercise may reduce severity of hot flushes in some women.(menopausesupport 2025? (a))


Avoiding triggers (alcohol, caffeine, spicy foods, smoking)

  • These are often reported as vasomotor (blood vessel constriction and relaxation) triggers. Reducing intake may help symptom control. (Conaboy, K 2023)

  • Smoking cessation is associated with fewer and less severe hot flushes.

• Reducing alcohol consumption may improve sleep and reduce breast cancer risk.(menopausesupport 2025? (a))


Lifestyle change disadvantages:

• Effects are generally modest and not consistently shown across all individuals.

• High intake of phytoestrogens may interact with certain medications (e.g. tamoxifen).


• Evidence for a direct effect of exercise on vasomotor symptoms is mixed.

• Excessive exercise without adequate nutrition may worsen fatigue or bone health. (menopausesupport 2025? (a), WHO 2024)


• Behavior changes such as stopping smoking or drinking can be challenging; withdrawal symptoms may transiently worsen mood or sleep. (Shariatpanahi

et al 2020)


Looking at your sleep hygeine may help to alleviate some of these effects of lifestyle change. Improved sleep routines (e.g. consistent bedtime, limiting screen time) can often help with insomnia related to menopause. However behavioral strategies require consistent effort and may not be sufficient for severe insomnia. (menopausesupport 2025? (b))



Hormone Replacement Therapy (HRT)


(i) Systemic HRT (oral/transdermal estrogen and/or progestogen)

Benefits

• Strongest intervention for vasomotor symptoms, sleep, mood, and bone density.

• Lowers fracture risk .

• Transdermal estrogen avoids the increased VTE risk seen with oral formulations.(Manson et al 2017)


Risks

• Combined HRT increases breast cancer risk after ~3–5 years, which gradually declines after cessation but may persist for 10+ years.

• Oral estrogen (especially in combination) slightly increases stroke and VTE risk; transdermal forms do not.

• Dementia risk may rise if started at age 65+.

• Contraindicated with hormone-sensitive cancers, clotting disorders, uncontrolled hypertension.

(Manson et al 2017, Hamoda 2020)


(ii) Local (vaginal) estrogen


Benefits

• Effective for genitourinary symptoms (dryness, pain, urgency); minimal systemic absorption and low side effects. (The Lancet 2024)


Limitations

• Does not treat systemic vasomotor symptoms. Requires ongoing use to maintain benefits. (The Lancet 2024)



Non-Hormonal Pharmacological Options


• SSRIs/SNRIs (e.g., paroxetine, venlafaxine, escitalopram) SSRIs (Selective Serotonin Reuptake Inhibitors) are treatments for depression that primarily increase serotonin levels in the brain, while SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) increase both serotonin and norepinephrine levels. Both types work by affecting neurotransmitters, chemicals that help nerve cells communicate, to improve mood and reduce symptoms of depression and other conditions like anxiety. (Loprinze et al 1998)

• Paroxetine is FDA-approved for hot flushes; effectively reduces vasomotor symptoms and improves mood.(Freeman & Powell 2011)

• Side effects include nausea, drowsiness, sexual dysfunction, and withdrawal symptoms.(Liu et al 2006)

• Gabapentin (and newer fezolinetant)

• Reduces vasomotor symptoms; side effects may include dizziness, drowsiness, headache Serra et al 2023)

• Clonidine

• May reduce hot flushes by ~40%; side effects include dry mouth, constipation, hypotension.(Duich et al 2010)

(Freeman & Powell 2011)


Alternative / Complementary Therapies


(i) Cognitive Behavioral Therapy (CBT)

• Reduces perceived severity of hot flushes, stress, anxiety, and improves sleep. Effective but requires engagement and professional support. (Hunter & Liao 2010)


(ii) Acupuncture

• May modestly reduce hot flush incidence; evidence quality is low. (Smith et al 2013)


(iii) Herbal/supplementary remedies (e.g. black cohosh, red clover, flaxseed)

• Red clover isoflavones reduced ~1.7 hot flushes/day in meta-analysis; short-term use appears safe, but long-term safety uncertain  .

• Black cohosh and St John’s Wort show limited, inconsistent effects; some risk of liver toxicity is reported.

• Flaxseed interventions show potential but data remain preliminary.

(Tice et al 2003)


Mindfulness, yoga, meditation


• Improve mood, stress, and sleep quality; however, evidence for reducing vasomotor symptoms is minimal. (menopausesupport 2025? (a), Palmero et al 2019, Freeman & Powell 2011)







Menopause Strategies Pros and Cons At A Glance:


Strategy

Pros

Cons

Reference to find out more

Mediterranean/plant-based diet

 Heart, bone, mood benefits; reduced hot flushes

Symptom relief modest; soy may interact with meds

Shariatpanahi et al. (2020); BDA (n.d.)

Exercise & weight control

 Improves overall health

Mixed evidence for vasomotor relief

Hamoda et al. (2020); Manson et al. (2017)

Systemic HRT

Most effective for hot flushes, sleep, bone health

Cancer, VTE, stroke risks; not for everyone

Duich et al. (2010)

Local HRT

Excellent for vaginal symptoms, Not systemic

Ongoing use required

Manson et al. (2017)

Non-hormonal pharmacological treatments: SSRIs/SNRIs, Gabapentin, Clonidine

Non-hormonal relief

Side effects, mostly symptom-specific

Loprinzi et al. (1998) Liu et al. (2006); Serra et al. (2023) Duich et al. (2010)

CBT & acupuncture & herbs

Low-risk, some supportive evidence for hot flushes

Varying evidence; may require specialist input

Smith et al. (2013)

Tice et al. (2003)

Mindfulness/Yoga

Good for stress and sleep

Limited direct effect on vasomotor symptoms

Palmero et al (2019)


*Menopausing: The Ultimate Menopause Health Book (2023) by Davina McCall and Dr Naomi Potter.


It's clear that there are quite a few ways to help yourself during your perimenopause and menopause journey, with or without going down a pharmacological route. Sometimes, a lifestyle review and some relatively minor changes will be enough.If this is not the case for you, it is a good idea to meet with your doctor or healthcare provider and talk about the problems that you are having and the help that is available.





References


General Menopause References

Conaboy, K . (2023) 6 Ways To Deal With Night Sweats During Menopause [online] https://www.self.com/story/night-sweats-menopause-tips


Lancet, The (2024) Time For A Balanced Conversation About Menopause [online] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext


menopause support (2025?) (a) Too Many Women Are Suffering In Silence [online]  https://menopausesupport.co.uk








Lifestyle & Diet

British Dietetic Association. (n.d.). Diet and the menopause. Retrieved from Nutrition Society. menopausesupport (2025?) [online] https://www.bda.uk.com/resource/diet-and-the-menopause.html


Daley, A., Stokes-Lampard, H., Thomas, A., MacArthur, C. (2014) Exercise for vasomotor menopausal symptoms Cochrane Gynaecology and Fertility Group, Cochrane Library. [Online] https://pmc.ncbi.nlm.nih.gov/articles/PMC10116337  


Shariatpanahi, S. F., Sadatsafavi, M., Roudsari, P. D., Homayounfar, R., & Khalaj Abadi Farahani, Z. (2020). Effects of plant-based or Mediterranean-style diets on vasomotor symptoms among menopausal women: A randomized controlled trial. Menopause, 27(1), 14–23.



 Hormone Replacement Therapy (HRT)

Hamoda, H., Panay, N., Pedder, H., Arya, R., & Savvas, M. (2020). The British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy in menopausal women. Post Reproductive Health, 26(4), 202–216.


Manson, J. E., Aragaki, A. K., Rossouw, J. E., Anderson, G. L., & Prentice, R. L. (2017). Menopausal hormone therapy and long-term all‑cause and cause‑specific mortality: The Women’s Health Initiative randomized trials follow-up. JAMA, 318(10), 927–938.



Non‑Hormonal Pharmacological Treatments

Duich, R., et al. (2010). Nonhormonal therapies for menopausal hot flashes: Systematic review and meta-analysis. JAMA, 294(2), 210–216.


Loprinzi, C. L., Sloan, J. A., Pérez, E. A., Quella, S. J., Stella, P. J., Wolf, S. L., & Mailliard, J. A. (1998). Efficacy of antidepressants for vasomotor symptoms: A randomized clinical trial. Obstetrics & Gynecology, 91(5 Pt 1), 583–588. ()


Liu, J. H., et al. (2006). Gabapentin for hot flashes in women with and without breast cancer: A randomized controlled trial. The Lancet, 366(9488), 818–824.



Alternative & Complementary Therapies

Hunter, M. S., & Liao, K. (2010). A randomized controlled trial of cognitive behavioural therapy for menopausal hot flushes: MENOS 2 trial. British Journal of Health Psychology, 15(Pt 4), 625–639.


Palermo, T., et al. (2019). Mindfulness-based stress reduction for menopausal symptoms: A meta-analysis. BJOG, 126(4), 419–429.


Smith, C., Levétrier, M., & Needleman, L. (2013). Acupuncture for menopausal vasomotor symptoms: A systematic review. Menopause, 20(6), 597–606.


Tice, J. A., Ettinger, B., Ensrud, K., Wallace, R. B., & Blackwell, T. (2003). Phytoestrogens and breast cancer risk: A randomized controlled trial evaluating efficacy. JAMA, 290(2), 207–214.



Comprehensive Reviews on Non‑Hormonal Options

Freeman, E. W., & Powell, M. (2011). Nonhormonal therapies for vasomotor symptoms: Focus on SSRIs, SNRI, gabapentin, and clonidine. Cleveland Clinic Journal of Medicine, 78(4), 123–130.


Serra, N., et al. (2023). Non-hormonal strategies for managing menopausal symptoms in cancer survivors. Ecancermedicalscience, 17, 909.


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