January 21

How To Manage Menopause Without HRT


By Rachel Lankester

Everyone seems to be talking about menopause these days! But the majority of discussion on helping women cope seems to center on hormone therapy (HRT/MHT). But what if you can’t or don’t want to take hormone therapy? Since my early menopause at 41, I’ve spent a decade researching all the ways women can manage menopause without HRT.

There are many diet, lifestyle and mindset changes we can proactively make that allow us to have a different experience of menopause and often a vastly improved one. I’m not anti-HRT, far from it. But I want a more balanced conversation around menopause and I want women to know the whole picture not just see HRT as a magic pill that will solve everything because it won’t.

I’ve researched differences in menopause experiences across cultures and looked at reasons why in the West, we seem to suffer worst. I’ve learnt a lot! And I’ve discovered lots of natural remedies for menopause to help. It is perfectly possible to manage menopause without HRT.

I was advised to take HRT after my early menopause diagnosis. This was to protect my bones and heart from 10 years or less of estrogen than normal. You can read more about my early menopause experience here.

The advice was to stay on HRT only until ‘average’ menopause age of 51 if I was feeling OK then, and I took this to heart. I have an inherent dislike of taking medication unless I absolutely have to. I chose to come off HRT at 51 and have managed any symptoms entirely naturally since. Click here to learn how I weaned myself off HRT.

There are plenty of natural remedies for menopause. In this article I’m going to tell you everything I know about that so you too can manage normal menopause without HRT.

There are actually reported to be 34 symptoms that can be attributed to the hormonal changes of menopause! Some people say there are even more but I think that’s a bit scary! What can you do to manage menopause without HRT? Ultimately however natural and ‘safe’ HRT may be shown to be, it’s still a drug. It’s still manufactured from its natural source. It still comes in sachet, patch or pill format which means the ‘natural’ element of it is highly processed.

HRT is touted as the cure-all for the whole range of menopause symptoms because it restores the same hormonal balance you had before perimenopause hit. But we’re designed to go through menopause and live the latter part of our lives with less estrogen.

That can be an empowering change, not in any way diminishing. So for me it makes sense to find other ways to get our hormones in balance long term, rather than necessarily extending the pre-menopause hormonal profile we’re not actually supposed to have post menopause. I prefer natural remedies for menopause.

How to balance hormones naturally

Let’s start with how to achieve better hormonal balance naturally and then I’ll also give some ideas on what you can do for some of the most common symptoms.

1. Balance your blood sugar and sort out your diet. Start with what and how you eat. As Jackie Lynch writes in her book The Happy Menopause, the most fundamental component of good hormonal balance in midlife and beyond is making sure your blood sugar levels are as stable as they can be.  As we go through the perimenopause years, estrogen decreases. But it doesn’t go away completely.

The ovaries stop producing it, but it’s still made in our adipose tissue and by our adrenal glands. It’s a weaker form of estrogen but still estrogen. The problem is that if we’re stressed and our bodies go into fight or flight mode, the adrenal glands prioritize production of our stress hormones in favor of estrogen. Then we get into trouble with menopause symptoms.

Stress can come in the form of bog standard emotional stress. Or it can be stress we put on our bodies, making them think they need to go into fight or flight mode by causing our blood sugar levels to be imbalanced. This happens either because we haven’t eaten when we should have, and blood sugar has dropped, or we’ve consumed the wrong thing that makes our blood sugar level spike.

So eating (and drinking) regularly and the right things becomes ever more important. Caffeine, alcohol, sugar and refined foods can all cause our blood sugar to spike and then plummet when their effects wears off.

All kinds of stress are bad. So we need to start with reducing stress and eating/drinking in such a way that our blood sugar levels are balanced. A little and often, and eating protein and complex carbohydrates (such as beans, whole grains, and starchy vegetables), which are high in fiber, with every meal is a good way to go.

Now is the perfect time to make your diet healthier overall and include lots of fresh vegetables. Cut out processed food as much as you can. Refined carbohydrates, in particular, are known to mess with our hormones generally, quite apart from the blood sugar spiking effect.

Eat plenty of fruit and vegetables, reduce your alcohol, sugar, and caffeine intake, all of which mess with hormones and cause hot flushes, and eat natural phytoestrogens to replace the estrogen your body no longer produces with foodstuffs like flaxseeds, lentils, tofu and soy. Here’s a comprehensive list of foodstuffs that can help.

Daily ground flaxseeds on my breakfast cereal as well as organic soya milk instead of dairy have massively helped me.

2. It’s expensive, but eat organic if you can for all food types. Pesticides used in agriculture are known to impact our hormones negatively as well as generally not being very good for you. Certain fruit and vegetables have higher proportions of pesticide residues on them than others. So some you don’t need to worry about so much if they’re not organic and others you may want to avoid unless organic. I’m still grappling with this but have printed out the lists of the worst offenders for reference. You can get these lists for the UK at Pesticide Action Network or in the US at the EWG.

3. Consider also what toxins are in your home environment and whether you can cut back on those. Household cleaning products are full of chemicals, some of which are thought to interfere with hormones. Personal products like deodorant, moisturizers, shampoos etc. often come laden with potentially suspect ingredients (there’s still controversy about parabens) – can you identify everything in the ingredients list of your favorite product?

I’ve followed advice over the years to try to cut back on these both for myself and the environment. I now use less toxic cleaning and laundry products when I can and try to keep cosmetics as natural as possible. I use organic coconut oil to clean my face and take off makeup, and make my own facial oil to moisturize. I buy organic sunscreen when it’s available. Plain old vinegar makes an excellent household cleaner. All this helps to keep any hormone influencing toxins as limited as I feasibly can.

4. Try to lower your stress or improve how you deal with it. Hormone fluctuations are exacerbated by stress. Reduce levels of stress in your life, maybe adopt a meditation practice or do some restorative yoga. Both of these will help you lower stress levels overall and potentially reduce menopause symptoms, especially the anxiety that seems to affect many of us around this time.

5. Get a handle on your weight, if you think it’s an issue. If you’re significantly overweight in midlife, that will cause problems down the line. And women who are overweight are known to have more of an issue with hot flushes in particular.

Yes, you can take a supplement or try other things here that will help. But if you are, hand on heart, overweight and suffering badly with menopause symptoms, consider trying to do something about it rather than just accepting it as a natural aspect of getting older. It’s not. Click here for help on maintaining a healthy weight.

6. Up your exercise. As we age we need more exercise not less and many women swear by exercise to help them manage menopause symptoms. I know regular yoga and running certainly help me. Running is also excellent for building and maintaining bone density.

Any weight-bearing exercise helps to maintain strong bones. Also actually lifting weights helps to maintain our muscle mass which naturally decreases as we age, slowing our metabolism which then leads to weight-gain. Midlife muffin top? Not necessarily menopause. Lift weights and do lots of cardio exercise!

7. Try acupuncture. Acupuncture is great for restoring balance to the body so it makes sense that it can help us during menopause when we are out of balance. I tried it for a nasty facial scar but also for general balance and I felt amazing afterwards.

Hot flushes/flashes and night sweats

The most common of menopause symptoms is hot flushes/flashes and their night-time equivalent night sweats. These are also the most common reason for a prescription of hormone therapy. But how can hot flushes be managed in menopause without HRT?

1.First, think of them as power surges! If you think of them like that, rather than seeing them as a problem or something shameful, they become less of an issue. They’re great when it’s chilly!

This may sound simplistic and naïve, especially if you’re coping with being drenched in sweat, but it’s worth a go. Mindset can be very powerful. A BBC documentary on menopause found that when women used CBT techniques to lessen feelings of shame around hot flushes, their hot flushes became fewer and less intense.

2. Keep a diary of when you have hot flushes and the triggers for them. Is stress bringing them on? Caffeine? Sugar? Alcohol? Chilli? All these are known to exacerbate hot flushes. If you know the triggers, you can tackle the symptoms. Keep an eye on your weight too. If you’re significantly overweight you’re likely to suffer worse from hot flushes.

3. Reduce your stress if you find that this triggers a hot flush. I often used to find that when I was under pressure was exactly when my body would start to heat up. If you’re in a meeting and it happens, don’t be embarrassed to step outside until it subsides. It takes courage to be honest about what’s going on, but a little humor and honesty might be just the ticket and also help others. But if honesty is not possible, just make your excuses and step outside for some air.

4. Try avoiding or reducing caffeine. For many women caffeine brings on a hot flush. Personally I haven’t had any caffeine since I went through early menopause at 41 which is over a decade ago. I was advised by Dr Marilyn Glenville to give up caffeine and I haven’t missed it in years. I love not being dependent on caffeine to get myself going in the morning or after lunch.

menopause without HRT

5. Cut back on sugar especially refined. I was also advised by Dr Glenville to give up sugar or at least reduce my consumption of it. Refined sugar products, in particular, are known to cause hot flushes. I try not to overdo it on the sugar front but I do love my chocolate. The mini hot flush I occasionally get after I’ve had some chocolate is worth it. It’s just my little power surge!

6. If you find alcohol a trigger for hot flushes, consider reducing your intake of that also. Unfortunately it’s many of the things we love that contribute to our power surges. But you may consider it a price worth paying. That’s up to you. But better to be informed so you can make that decision. Again, remember it may be your body telling you what you’ve done in the past, may not be what you need for long term future health. Bummer!

7. Learn to regulate your temperature with ease. Wear layers and if you’re a fan of polo necks and sweaters, consider alternatives. I’ve given up wearing polo necks because I don’t want to run the risk of being caught having a hot flush and then being unable to do anything about it! Instead I’ve become a committed wearer of scarves and I regulate my temperature by just taking them on and off.

Similarly, although they may not be the most sophisticated item of clothing, I’m a big fan of the humble cardigan. I can wear a cardigan, jacket, or zip-up fleece either open or closed. Unfortunately the same cannot be said for a sweater. So I think about the environment in which I’ll be wearing a sweater and whether I’d be comfortable taking it off!

Avoid synthetic fibers and carry a pocket foldout fan especially in summer. I’m also usually to be found with a hair band on my wrist. I have long hair and my hair band helps regulate my temperature.

I actually really feel the cold and can’t imagine ever having my hair cut short now. I would just be too chilly! But being able to put it up in summer (or if flushing) is fab. Drink plenty of water and check whether spicy food brings on a flush. If so, consider avoiding that curry or decide it’s a price worth paying!

8. Spirulina and maca powders, added to smoothies for example, may also help reduce hot flushes.

9. If night sweats are the biggest issue, make sure you are wearing and sleeping in natural fabrics. Make sure the room is well-ventilated and consider sleeping separately for a while if your partner likes it warmer than you. Avoid alcohol in particular as this can really cause night-time sweats. Consider meditating before bed to clear your head of any stress. All of the other hormone balancing tips will also help to reduce night sweats.

10. Finally, consider these natural remedies too, which some women find helpful:

  • Black cohosh
  • Sage – as a supplement of just as a tea
  • Evening primrose
  • Chamomile tea
  • Dong Quai – a Chinese herb
  • Foods rich in vitamin E like sweet potatoes, hazelnuts, almonds and avocados are thought to be able to help, particularly to decrease night sweats.


1. Try all or any of the above to get your hormones balanced better.
2. Try a regular meditation practice with some mindfulness. This really helps ground me and bring me back to the moment. Remember your thoughts are just your thoughts. Just because you think something doesn’t make it true. Good apps to try are HeadspaceBuddify and Insight Timer which is free.
3. Exercise and being outdoors are great for anxiety. Go for a walk in the park (or a forest if you can find one) and take some calming deep breaths.
4. Take big belly breaths. Many of us breath very shallowly in our upper chest. This doesn’t help at all when we’re feeling anxious. So slow things down and breath deep down into your belly. Do it 10 times and assess whether you feel less anxious.
5. Remember that menopause doesn’t make you any less of who you are. You are still the fabulous woman you’ve always been. You know the same stuff and can do the same things. Believe in yourself and your power.

Click here for more help with menopause anxiety.


Sleeplessness can be an issue in the menopause years but remember it will get better once the hormonal fluctuations stop. If it continues after menopause then you need to seek help because it has become a habit. Start by trying everything above to get your hormones more in balance.

If restless legs are keeping you awake, try taking a magnesium supplement. Practice good sleep hygiene: make it dark and quiet where you sleep, no screens an hour before bed, a soothing routine to get you ready for bed (think bathtime for babies – we need routine too), if you’re lying awake, try using it as an opportunity to meditate or listen to a sleep meditation on your phone – try Insight Timer.

Try not to get up but stay resting in bed. If thoughts are keeping you awake, set yourself some boundaries about what you allow your mind to think about when it’s sleep time. You can choose to ignore your thoughts.

menopause without HRT

I’ve also learned about EFT (Emotional Freedom Technique) tapping to help with insomnia. Doing it regularly before you go to sleep can really help apparently (and this is from a woman who went through surgical menopause). Here is the recommended free Tapping Solution app  and there are free meditations on it as well as paid.  (You may think it’s just a placebo effect but if it works, so what!) Click here for more help with sleep.

Lack of libido and vaginal dryness

I’ve put these together as I think they’re very linked. If one isn’t working so well, the other probably won’t either!

1. Don’t assume it’s menopause! You might just be bored!
2. Start investing in your relationship if you’ve let it slide. John Gottman’s 7 Principles For Making Marriage Work is brilliant for reconnecting with a distant partner. Do the exercises in the book and see if anything changes.
3. Take sex back to pleasure. We have a whole workshop in our Membership on this (and on intimacy) and it’s so important. Take the pressure off. Sex doesn’t have to always be PIV (penis in vagina). Outercourse can be a lot of fun! Take turns to give non-sexual pleasure to each other. Make it about giving and see what happens.
4. Invest in a good lubricant. My current favorite is Pjur silicon lubricant. I used to insist on organic and liked Yes products and even coconut oil which can be great. But because Pjur stays on the skin and isn’t absorbed, it’s great and lasts!
5. Invest in sex toys. If getting going is an issue, a small but powerful egg vibrator may get your bits responding if they’re not performing as you want them to. Similarly they can help us have fabulous orgasms. They’re fun with or without a partner. Not particularly natural? Well it’s not drugs huh!
6. Have fun and practice with yourself. Self-play is particularly important. It keeps blood flowing to the vulval area and keeps us able to respond sexually. There is some truth to use it or lose it. So keep using it even if you don’t have a partner.
7. Sea buckthorn tablets taken as a supplement can be very helpful for maintaining the health of our vaginal tissue.
8. Moisturize your vagina as you would your face. Coconut oil can be very good for this and there are organic vaginal moisturizers around. But, also consider non-systemic, vaginal estrogen if nothing else works. This form of HRT is considered to be almost completely risk free.

Listen to my podcast on Midlife Sex with Dr Sonia Wright or read a transcription of the interview.

Urinary incontinence

Lastly a brief word about incontinence. One in three women will suffer from stress incontinence – when we laugh, cough or sneeze – or bounce around on a trampoline, for example. Often this starts after childbirth.

And it can start or get worse in menopause as estrogen levels drop, affecting the tissue in our vulval area. But incontinence is common NOT normal. So go and see your doctor, get a referral to a pelvic physiotherapist and get treatment.

84% of women with stress incontinence are cured after just 6 sessions. And it all comes down to pelvic floor exercises. So don’t suffer. Get help. Do the exercises religiously. And get better. Your orgasms will improve too! Double whammy! I recorded a fabulous podcast episode with the amazing pelvic physio and stand up comedian Elaine Miller which you can listen to below.

Listen to pelvic health physio Elaine Miller talking about incontinence solutions on the Magnificent Midlife Podcast

menopause without HRT

So that just about covers everything when it comes to menopause without HRT. There is so much to try. A word of caution though. Don’t assume any one of these is going to fix everything.

Often it is a package of things that will do the trick. For me it is soy, ground flax seeds daily, no dairy milk, no caffeine, trying to limit sugar, alcohol and processed foods, running, yoga, meditation, a great lubricant and my friends. Having good friends you can fall back on makes all the difference! It helps to remember none of us is alone! Women all go through menopause – if we’re lucky enough to live this long!


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