Hormone Replacement Therapy (HRT) often comes up in conversations about menopause. For many women, it can be life-changing – easing hot flushes, lifting mood, and helping with sleep. But here’s the important truth: HRT isn’t the right choice for everyone, and that doesn’t mean you’re left without options.

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Let’s talk about why, and what else you can do to feel more like yourself again.When HRT Isn’t the Right FitHRT works by topping up the hormones your body makes less of during menopause, like estrogen and progesterone. But it’s not a “one-size-fits-all” treatment. Some women may not tolerate it well, while for others, medical conditions make HRT unsafe. Examples include:

• A history of certain cancers (like breast or womb cancer)
• Blood clotting disorders or previous stroke
• Significant liver disease
• Unpleasant side effects, such as breast tenderness, headaches, or bloating

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And sometimes, it’s simply personal preference – maybe you don’t feel comfortable taking hormones, or you’d rather try other approaches first.Common Symptoms – and What Else Can HelpMenopause brings a wide range of symptoms, and while HRT can help with many of them, it’s not the only way forward. Here are some alternatives and lifestyle tweaks worth exploring:

‍Hot Flushes & Night Sweats

• Cool tricks: Keep your bedroom cool, wear light layers, and avoid triggers like caffeine, alcohol, or spicy food.
• Mind-body tools: Relaxation techniques, yoga, and paced breathing can reduce the intensity of flushes.
• Non-hormonal medicines: Certain antidepressants or other prescribed medications may help, even if you’re not depressed.

Sleep Problems

• Sleep hygiene: Create a bedtime routine, keep screens away, and avoid late-night caffeine.
• Exercise: Regular activity helps regulate sleep cycles.
• CBT-I: A type of talking therapy designed for insomnia can be highly effective.

Mood Swings, Anxiety, & Brain Fog

• Talking therapies: Cognitive behavioural therapy (CBT) can support mood and coping strategies.
• Movement: Even a brisk walk boosts endorphins and clears the mind.
• Mindfulness & meditation: Can calm anxious thoughts and improve focus.

Bone Health & Joint Aches

• Diet: Get enough calcium and vitamin D.
• Strength training: Weight-bearing exercises strengthen both muscles and bones.
• Supplements or medicines: If you’re at higher risk of osteoporosis, your doctor can discuss alternatives to HRT.

Vaginal Dryness & Discomfort

• Local oestrogen creams/pessaries: These act only in the vaginal area, with minimal absorption.
• Moisturisers & lubricants: Over-the-counter products can make intimacy and daily comfort easier.

The Bigger Picture – Lifestyle Matters

Think of menopause as a new chapter in your health story. Choices you make now can influence how you feel for years to come:

• Stay active – exercise is medicine for body, mind, and sleep.
• Eat smart – balanced meals, lots of plants, enough protein.
• Limit alcohol and smoking – both worsen hot flushes, sleep, and long-term health risks.
• Connect with others – support groups and open conversations help you feel less alone.

The Takeaway

HRT can be wonderful – but it isn’t the only answer, and it certainly isn’t the right path for everyone. What matters is finding the mix of strategies that works for you, whether that’s HRT, lifestyle changes, or alternative therapies.

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If you’re struggling with symptoms, speak to your GP. There are always options, and you deserve to feel heard, supported, and empowered in your choices.