A woman’s experience of the menopause transition is individual to her – from the age she starts to go through the perimenopause, how long it lasts, the symptoms she’ll experience and the intensity and duration of these. That’s why management of menopause symptoms is not one size fits all and you should navigate through the menopause transition in your own way – the way that works best for you.
While HRT is the most effective way to manage menopause symptoms, some women choose not to take it, others have been advised that because of their medical history it may be too risky for them, and others would like to take something alongside their HRT to help them manage their symptoms.
The good news is that there are a range of different options. Knowledge is power – the key is to know what they are and then make choices that are right for you.
Alternative forms of management aim to reduce the impact of the symptoms of the menopause transition, but may also have a part to play in helping to reduce the long term health consequence of the menopause – osteoporosis, heart disease and, particularly for women who go through menopause under the age of 40 (known as POI – premature ovarian insufficiency) dementia.
Look at your lifestyle
The menopause is a good time to take stock of your health and make any tweaks that can help you lead a healthier life.
Caffeine, alcohol, and spicy food can make hot flushes worse. Caffeine can also have a negative impact on your bladder, making you want to pass urine more often and with greater urgency. Caffeine can also increase anxiety along with palpitations and also effect sleep, keeping you awake at night – with all the knock on effects of this. Some find reducing the intake of caffeine and alcohol helping. For others, the switch to decaffeinated tea and coffee or alcohol-free alternatives makes a huge difference.
Many women drink alcohol in an attempt to help them deal with sleep and anxiety. Although it may help you feel better at the time, it’s only temporary, as alcohol acts as a depressant on the brain. Alcohol induced sleep can be of poorer quality, increasing night time wakening. In the long run, cutting down or switching to alcohol-free alternatives can really help you feel better as well as supporting weight loss.
Smoking adds to the risk of heart disease and osteoporosis, and increases the risk of dementia. Stopping reduces the risk of these and can help manage hot flushes.
Weight gain is something that troubles lots of women, and losing weight can be a real challenge during the menopause. That’s because of changes to how your body handles carbohydrates and processes calories. Small and sustainable changes to your diet, addressing the balance of carbohydrates and protein, can turn into dramatic and positive changes in your body.
There is no one best ‘menopause diet.’ The Mediterranean diet is associated with lower risks of heart disease. This is a diet rich in vegetables, fruits, beans, wholegrain cereals and cereal products and unsaturated fats such as olive oil. It also contains moderate amounts of fish, white meat and some low-fat dairy, nuts and smaller amounts of red meat and sweet desserts. This diet, rich in calcium and vitamin D, will help keep bones healthy as well.
Exercise is so beneficial, helping weight gain, reducing the risk of heart disease. Weight bearing and muscle gaining exercise can help reduce the risk of osteoporosis. Exercise can also help mood, reduce anxiety and help reduce brain fog. You don’t have to run a marathon – just start with small achievable targets and work from there, e.g. a brisk walk in the morning or evening, take the stairs instead of the lift, walk to the next bus stop – trust me, it’ll all add up!
Exploring alternative remedies
There are alternative remedies and herbal medicines that may help women. But don’t forget that not all supplements are completely safe for everyone. Speaking to a practitioner, pharmacist or doctor with knowledge of herbal medicine is recommended. And it’s important to know that some herbal medicines can interfere with medicines that are prescribed by doctors.
If you are investigating herbal solutions, always look for the THR mark on the box. The Traditional Herbal Registration certification means the product has been registered by the Medicines and Healthcare products Regulatory Agency under the UK Traditional Herbal Registration Scheme.
Phyto-oestrogens are weaker plant-based oestrogens which are similar to, but not the same, as those found in HRT. It is believed that for some women they can help ease hot flushes, night sweats, fatigue, anxiety, vaginal dryness and impaired sleep.
You can increase your intake of these by eating a diet rich in phytoestrogens in foods such as soy and flax seed, pulses and beans and some vegetables, or by taking supplements such as red clover, soy or sage.
There is a lack of evidence confirming safety of phytoestrogen supplements for women who have had hormone dependent cancers for example breast cancer.
There are other types of herbal remedies that can help with symptoms – for example agnus castus can help premenstrual syndrome type symptoms and St Johns Wort may be beneficial in helping treat anxiety and depression. The latter can interact with many prescription medications, so care should be taken and always check with a pharmacists before starting. Oil of evening primrose can help breast tenderness.
Any supplement taken for the menopause can have a significant placebo effect, and for many supplements there is a lack of evidence that they work effectively. However, this does not mean that you shouldn’t try taking herbal remedies or supplements and many women feel that they help their symptoms. Recommended supplements include vitamin D and calcium.
Vitamin D supplements are recommended for everyone during the winter months, but are particularly important for women in the menopause and post-menopause, to help reduce the risk of osteoporosis and fractures. If your diet is low in calcium, adding a calcium supplement can also be useful to help protect bones.
Talking therapies and counselling can be so beneficial in helping tackle the physical psychological, cognitive symptoms of the menopause as well as helping tackle hot flushes and night sweats – cognitive behaviour therapy (CBT) – is a non-medical intervention that has been shown to help physical and psychological symptoms of the menopause. CBT challenges the links between thoughts, feeling, behaviours and physical symptoms, as the embarrassment and anxiety about hot flushes n public can make them feel worse.
Breathing techniques can also help quieten a frazzled mind and diminish the severity of hot flushes.
There are medicines available on prescription that can also help manage symptoms of the menopause. Clonidine is a tablet that is usually used for the treatment of blood pressure, but there is evidence that it can be helpful in reducing hot flushes and night sweats.
Some antidepressants can be used to help manage these symptoms also, as well as helping psychological symptoms of anxiety and depression. They have an important part to play for women suffering with more severe anxiety and depression. There are other medicines that can be prescribed by doctors to help manage menopause symptoms.
Lubricants and vaginal moisturisers are non-hormonal and can help vaginal dryness, discomfort and pain during sex. A moisturiser is used when needed to help keep the moisture in the vagina. Vaginal and vulval tissue can become more delicate and sensitive and washing with soap free wash may help prevent further dryness and irritation.
As you can see, there are many alternatives and additions to HRT that can help you manage your symptoms and you may find that a combination of these is what works best for you. Seize control and talk to your healthcare professional about options and the right combination for you.
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