What are the treatment options for perimenopause and menopause?

Helping you to navigate the choices available to you.


So, you’re perimenopausal or menopausal - now what?!

There’s a lot of things to consider when it comes to treatment options. This article will take you through a range of options that may reduce your symptoms - Hormone Replacement Therapy (HRT), nutrition, supplements, exercise, stress-reduction and more.

Use the contents list above to navigate to information on a specific option, or browse through our full article below.

We should emphasise at this point that while all of the information below is evidence-based it’s not a substitute for personalised medical advice. One of the things you’ll hear us frequently saying is that what works for one person may not work for another.

So, we really encourage you to take a look through to explore the different options then go through your preferences with your GP or your menopause specialist.

Hormone replacement therapy (HRT) replaces the hormones lost as we go through menopause.

Hormone Replacement Therapy

What is HRT?

Hormone replacement therapy (HRT) does what it says on the tin - it replaces the hormones that are lost as we go through menopause.

The hormones that we lose during menopause do not come back and there’s no way to reverse the decrease in hormone production in our bodies.

Therefore HRT is the only way to replace the hormones. A lot of menopausal symptoms happen because of your hormone depletion. When you replace these hormones using HRT a lot of your symptoms will reduce too.

In this article, Dr Louise Newson, explains more about what HRT is and how it can help during menopause.

What are the benefits of HRT?

The main appeal of HRT is that it replaces the hormones lost during menopause. This in itself will ease many symptoms which are caused because of the low hormone levels.

There are more benefits to HRT too. It can:

  • protect against heart disease - oestrogen can decrease the risk of heart disease by 40-50%* 
  • help you maintain strong bones - protecting against the risk of osteoporosis and reduce the risk of osteoporotic hip fracture by 30-50%*
  • reduce the risk of Alzheimers by 24-65% (when started within ten years of menopause)*. 
  • Reduce the risk of colorectal cancer

*All of this research is taken from the findings of Dr Avrum Bluming and Dr Carol Tavris and their groundbreaking book ‘Oestrogen Matters.’ You can watch Dr Bluming explain this research in the highlights of a talk Dr Bluming gave to The Latte Lounge.

Whether or not to take HRT is a personal choice - our advice is to read widely to help you make the decision that's right for you!

Is HRT safe?

The decision about whether or not to take HRT can be a big one, despite the benefits outlined above.

You may have concerns about its safety, whether it’s an ‘unnatural’ thing to do, or whether there are any unwanted side effects.

Doctors and researchers now conclude - HRT is a safe option for most women in menopause to replace the oestrogen that is lost.

Unfortunately, there is contradictory and often misleading information from time to time in the media about HRT. Much of the root cause of this is a now-debunked 2002 Women’s Health Initiative study which claimed that HRT could increase the risk of breast cancer. 

This study has since been disproven. A large and growing bank of evidence shows that it is safe for most women and this is backed by menopause specialists too – including the International Menopause Society.

Our advice to all women is to do your own research on HRT to make your own decision, about what’s right for you.

Evidence and research about HRT

To help you with your decision, this article covers a lot of the main factual information about HRT and frequently asked questions. Once you have an overview, we have compiled a number of evidence-based research and resources available to help you:

  • We encourage all women to read the widely-acclaimed book ‘Oestrogen Matters’ by Dr Avrum Bluming and Dr Carol Tavris (please note, we receive NO payment or otherwise for you purchasing this book). In this book, Dr Bluming & Dr Tavris share their research on the benefits and risks of HRT and the links with breast cancer, heart health, osteoporosis and Alzheimers. You can watch Dr Bluming explain the key findings in a video interview he took part in with The Latte Lounge. Dr Bluming’s own wife and daughter have had breast cancer and both remain on HRT.
  • If you are able to afford a private consultation, we recommend that you see a menopause specialist to help you with your decision.
  • The Latte Lounge also holds monthly 'menopause lounge' sessions - where you can join a small group of other women in a private, safe and confidential 90-minute virtual session with a doctor from The Menopause Consultancy to ask all of your questions about hormones, perimenopause, menopause and more. Find out more about The Menopause Lounge here.

A note: Yes, this is a long list of resources and we know it will take you some time to review and watch / listen to. But that’s because we strongly believe in empowering you with the facts you need, to make the right decisions, for YOU.

Ultimately, The Latte Lounge believes that all women should have access to evidence based, unbiased information and support in order to make an informed decision about HRT – or indeed all aspects of their own health.

Our commitment is that everything we share about HRT is evidence-based and we try to remove the medical jargon to make it easy to understand.

If something is missing from this section or you need more information, do let us know so we can continue to add to our resources.

Understanding HRT

If you have made the decision to take HRT, this section helps you understand more about what you can expect.

What are the different types of HRT?

You will be prescribed the HRT that is most suitable for you and your body and symptoms.

For example:

  • The type of your HRT: If you have a womb you will take HRT that contains both oestrogen and progestogen. This is because oestrogen-only HRT can be harmful to the lining of the womb. If you don't have a womb you will not need progestogen in the HRT.
  • The dose and strength of your HRT: this will be dependent on your symptoms and other factors. You might need to tweak your dose in the first few weeks or months so that it’s right for you.
  • How you’ll take your HRT: Whether you’ll take HRT in the form of a tablet, pessary, implant, a gel, a patch or a tablet.

There are largely four different types of HRT:

  • Combined oestrogen and progesterone. In a patch or a tablet.
  • Separate oestrogen and progesterone. In this option you’ll still take oestrogen and progesterone but they won’t be combined. The progesterone known as Progestogen can be given through the Mirena Coil [link], a tablet or a cream or pessary. Can be taken alongside your choice of oestrogen-only HRT too.
  • Oestrogen only: for those who don’t have a womb. Can be taken by tablet, gel, patches or a spray. about oestrogen HRT - oestrogen only can cause thickening of the endometrium (lining of the uterus) which can be harmful.
  • Testosterone. Available on the NHS, but not necessarily widely.  All testosterone used is off licence, only preparation licensed for women is androfeme - licensed for women in australia but again off license here. A gynae consultant or a GP with specialist menopause training is your best option to have testosterone prescribed.

RELATED: Testosterone - that's the male hormone, right?

For more information on why each of these hormones is important take a look at our article ‘what is menopause’

It’s also important for you to understand the difference between body identical hormones and bioidentical hormones.

Body identical hormones

This type of HRT is prescribed by the NHS and by private doctors. It is safe to take and it is regulated so that you can be reassured of its safety.

Body identical hormones are exactly as the name suggests. They are described by the British Menopause Society as ‘precise duplicates’ of hormones which the body produces in the ovaries, adrenals and thyroid. This includes estradiol E2, estriol E3, estrone E1, progesterone, dehydroepiandrosterone, testosterone and levothyroxine. They are derived from yam.

Confusingly, body identical hormones were originally medically defined as regulated bio-identical hormones - until this was taken over as a marketing term by those making bio-identical hormones. That’s why menopause specialists now refer to body identical hormones instead to distinguish from the ones described below which are unregulated.

Bio-identical hormones

These types of hormones are not prescribed by the NHS and are only available in some private clinics. Bio-identical hormones are not regulated which means they don’t go through the same quality control process or scientific evaluations as a body identical hormone. They are compounded (custom-made) versions of the body identical HRT, produced by specialist pharmacies. While this might sound like a benefit, actually it means that the medicine won’t be standardised like you’d expect from a larger batch of medicines. If you are recommended bio-identical hormones by your private clinic, it’s important that you carry out some research into what you will be taking and ask questions about its suitability for you and effectiveness.

The NICE guidelines from 2015 state that your medical provider should: ‘Explain to women that the efficacy and safety of unregulated compounded bioidentical hormones are unknown.’

Most importantly, we really discourage you from purchasing any of these products online - always see a reputable menopause specialist (or your GP) to be prescribed your HRT.

Who can prescribe me HRT?

Your GP can prescribe HRT or they can refer you to an NHS menopause specialist who can prescribe you HRT. If waiting lists are long, you can also visit a private menopause specialist who can prescribe you HRT.

Currently, testosterone may be difficult for you to have prescribed as it’s not licensed but will still be prescribed on the NHS or privately by a gynae, a menopause specialist or doctor who is familiar with testosterone. 

As mentioned above, please do not buy any HRT online without a prescription - it’s totally unregulated, may not be effective for your symptoms and at worst could be very dangerous for your health.

Can I start HRT if I am still having periods?

Yes. You can begin to take HRT when you are perimenopausal and still having periods. Generally this is the best time to begin taking it because it’s when your symptoms from the low hormone levels will be affecting you.

How long will it take for HRT to help my symptoms?

It usually takes a few weeks before you feel the initial benefits of HRT and up to three months to feel the full effects. It may also take your body time to get used to HRT. Some women may need to tweak the type of HRT they take and the dose during the first few months - it’s therefore important to let your doctor know if your symptoms are not reducing after a reasonable amount of time.

How long can I stay on HRT?

The length of time a woman takes HRT will vary depending on your individual circumstances. The good news is that there is no set length of time that you should take HRT for. Some women choose to take HRT just for a few years to offset the worst symptoms of menopause. Many find that they stop taking HRT after a few years and they then have no more symptoms of menopause.

However, if your symptoms return when you stop taking HRT this is not an effect of taking hormones, this is your symptoms returning as if you hadn’t taken HRT. This is because HRT is only effective while you’re on it - when you stop, your symptoms may return.

Some women therefore decide to take HRT for a much longer period of time than a few years. This is often because they feel better and have more energy when they take HRT and they also want to benefit from their reduction in risk of osteoporosis and heart disease when they take HRT.

It’s good to review your decision each year with your doctor and come to a decision that is right for you about how long you take HRT. 

“We do annual reviews - checking mammograms and smear history and checking if either are due, and then discussing any changes in personal and family history, weight and blood pressure."

Dr Rachel Hines, GP & Menopause Specialist

I’ve been refused HRT, what should I do?

We hear regularly from women who are in their 40s who are refused HRT because they are told they are too young to be perimenopausal, or women who are told the risks are too high to take HRT.  

Unfortunately, while there are many excellent GPs, GP training on menopause is very limited. Some may still be uninformed about the benefits of HRT, the low risk levels of HRT and/or the age that women may benefit from taking HRT.

Equally, other GPs are quite right to suggest that if you would like to take HRT and may have an increased risk (due to breast cancer for example) that generally you would need to discuss and take advice from an oncologist and/or specialist for a prescription. 

Our advice is to:

  • Carry out your own research about the benefits and risks of HRT for your specific circumstances.
  • Revisit your doctor taking this information with you including the GMC guidance on decision making and consent.
  • Consider getting a second opinion through another NHS practitioner, a women’s health specialist or oncologist and/or through a private consultation.

Is HRT a contraceptive too?

No. HRT isn’t a contraceptive, so if you haven’t gone through menopause (officially the classed as more than 12 months without a period) this means you may still be ovulating and may still get pregnant. It’s best to therefore still use contraception while you are taking HRT if this is your situation. 

You also need to use contraception for one year after your last period if you are 50 years or more, and need to use contraception for two years if the last period is under the age of 50. 

The only HRT with contraceptive effect is the mirena coil so this may be a good option for you to consider.

This article, by GP Philippa Kaye explains more about contraception and the menopause.

How can I manage my menopausal symptoms without HRT?

Good lifestyle choices are important whether or not you take HRT. Our bodies are ageing and changing and need us to take care of ourselves!

By lifestyle choices we mean things like: your exercise & activity levels, nutrition (and possibly supplements), sleep and stress management. All of these things can help to reduce menopausal symptoms and for many women this may be sufficient if their menopausal symptoms are mild.

And, even if you choose HRT as a treatment option, it doesn’t mean that you can ignore good lifestyle choices. HRT isn’t a magic eraser for symptoms - so it’s still important to have a balanced diet, good exercise & focus on stress management.

Nutrition

A healthy, balanced diet becomes even more important as we age. It’s about making healthy, sustainable choices that provide the nutrition you need to keep your body and mind healthy, reduce the risk of long-term health issues, and to help to manage (or at least not worsen) your menopause symptoms.

  • Eating whole foods, rich in calcium, protein and healthy fats with plenty of green, leafy veg.
  • Reducing processed food (which often makes us eat more of it anyway)
  • Reducing sugar
  • Reducing alcohol and caffeine
  • Focusing on gut health

Here are some useful articles for nutrition in midlife:

Supplements

The Latte Lounge and many of the expert dieticians, doctors and nutritionists in our team supports a ‘food-first’ approach where you should be looking to get as many of your nutrients as possible from a balanced, healthy diet. This also saves you money too on supplements that you may not need.

If you do choose to use supplements, it’s really important to choose a supplement wisely. There is little regulation over the supplement industry and what goes into a supplement and whether it is quality, meaning that literally anyone can produce and market a supplement.

The Latte Lounge partners with a small number of ethical supplement companies who share our ethos and values when it comes to this.

One of our trusted brands, Viridian Nutrition, has compiled this thorough guide to demystifying supplements in your 40s, 50s and beyond, as well as the top 5 nutrients to support you through menopause and perimenopause.

Our general recommendation on supplements is to:

  • Check your diet: Before choosing a supplement, make sure you aren’t able to get that nutrition through food instead. There are some supplements that we need i.e NHS guidance is that we should all be taking vitamin D supplements during the winter months.
  • Check the evidence: for the claims your supplement is making
  • Check the label: many supplements are stuffed with fillers or bulking agents that aren’t natural nor any good for you. If you are vegan you’ll also want to check the ingredients list to make sure the supplement does not use any animal product derivatives.
returning to exercise after surgery

Exercise

Movement, regular activity and strength is increasingly important as we age. It will protect our mobility, our bone health and our heart health. It can also help us feel better - reducing anxiety and stress.

The type of exercise you do isn’t as important as making sure it’s regular and you enjoy it and it doesn’t cause you any pain or discomfort.

If you haven’t exercised or been active for a while, then take a look at these tips for returning to exercise. And if you want more information on choosing an activity to get started, then personal trainer Lauren Aizen takes you through all of your options and different ways to get fit in midlife.

We've also got a video interview with fitness expert Amanda Thebe about how exercise helped transform her own experiences of menopause and her tips for incorporating exercise into your life.

If weight management is an issue for you then take a look at our advice on weight loss in your 40s, 50s and beyond.

Sleep

A poor night’s sleep can impact on almost every aspect of your life - from your ability to manage stress, the motivation to be active and your relationships with those closest to you. Yep we really need our sleep!

Our guide to sleep tips can help you to get a better night’s sleep even if you’re suffering from menopausal insomnia and night sweats.

Yoga

Stress reduction

Yoga can also help with stress reduction as it’s a relaxing and calming activity that can help to balance the stress hormones in your body.

Mindfulness is another practise that can help you create more calm in your life. Never heard of it before? Here’s four things to know about mindfulness.

CBT (cognitive behavioural therapy)

CBT is an NHS-approved way to reduce menopausal symptoms. It’s non-medical, which is appealing - it works by helping you develop ways to manage situations and tools for coping with different scenarios. It can therefore be helping for women who face anxiety, stress and low mood during the menopause. This factsheet by Women’s Health Concern sets out a thorough explanation of how CBT works and its benefits.

Acupuncture

Acupuncture works by stimulating nerves under the skin which then encourage the release of pain-relieving substances and other beneficial substances. A short course is usually advised rather than a one-off treatment. If you fancy giving it a try, there is some evidence that acupuncture can help to reduce menopausal symptoms, such as hot flushes, sweating, mood swings, sleep disturbance skin and hair problems.

Antidepressants

Antidepressants should not be given as a first line treatment for menopause. They are commonly prescribed to women in menopause who are reporting low mood. However, there’s no evidence that this benefits women because the underlying issue of low mood in menopause is caused by hormone levels. 

Antidepressants can be added when you are stable on HRT and if your mood is still low. Antidepressants have an important role in women who can’t take HRT or don’t wish to take HRT. 

There is evidence that antidepressants can be very helpful with vasomotor symptoms of menopause (such as hot flushes).

Herbals

Evidence is fairly scant about the proven effectiveness of herbal preparations. However, that doesn’t necessarily mean that they don’t work or won’t work for you - we do encourage you to think carefully before spending money on new products. Our Facebook group regularly has women sharing the benefits of some herbal supplements that they have tried.

‘Magnets’ and other miracle cures

Be very wary of the plethora of miracle cures that you will see advertised online. There is little to no evidence for any of these products and they are capitalising on the vulnerabilities of women during menopause! If you are tempted then please, do your research and ask your doctor or menopause specialist before you buy.

menopause specialist category image

A final note on treatment options

Finally, as you consider all of the above options it’s worth repeating that we are all different and there is no one-size fits all when it comes to the best treatment option. 

Also, please bear in mind that HRT is the only treatment option that will replace the reduced hormones that our body no longer produces as we age. Therefore HRT is the only treatment option that can provide the protection against osteoporosis, heart disease and Alzheimers that become risk factors once our protective hormone levels drop. 

And a good healthy lifestyle is vital whether you choose HRT or not!

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