You asked..here are the answers

This is a big topic and a question that comes up a lot. HRT remains the most effective way of managing the root cause of perimenopause and menopause symptoms. However, there are additional and alternative things to consider alongside or in place of HRT. These are particularly important for women who are unable to use HRT for safety reasons.

Anti-anxiety and anti-depressant medications such as “SSRI” fluoxetine, paroxetine, escitalopram or “SNRI” venlafaxine can be a real ray of hope for women struggling with mental health issues and hot flushes and can be taken alongside or instead of HRT. There are new drugs in development on the horizon too. Calcium, Vitamin D and bisphosphonate medications are important for bone health particularly for women who cannot safely use HRT.

Specialist Women’s Health and Pelvic Physiotherapists are a valuable resource to consider for Musculo-skeletal and pelvic health problems.

I like to consider “4 pillars” that are relevant to non-hormonal health too:

Nutrition: broadly, aim for stable blood sugar levels and a diverse gut microbiome by eating a high-fibre, whole-food and plant-rich diet with plenty of omega-3’s and calcium. We get very little vitamin D in the diet so I would suggest a supplement at 1000iu daily unless you are deficient. Cut down or cut out alcohol – it really doesn’t help with symptoms or health and well-being in the long term. The supplement industry is BIG and aimed at selling things. If you have a healthy varied diet you are likely to get enough of the micronutrients that you need but if you are looking for supplements consider one that as well as Vitamin D contains B6 and b12, magnesium and maybe collagen. There is no strong research evidence supporting the use of specific herbal supplements.

NICE (National Institute of Clinical and Health Excellence) are clear in their 2015 guidance that to ensure safety approval look for herbal remedies that carry the THR logo. St Johns Wort and Black Cohosh interact with other drugs so do not start these without medical advice. St Johns Wort also makes Tamoxifen ineffective. Isoflavones, red clover and black cohosh are not safe for survivors or women with breast cancer.

Movement & Exercise: move as much and often as possible and try to introduce a variety of activities to challenge the body in broader ways. Pilates, yoga, Strength and weight-training, conditioning, steady-state cardiovascular exercise and low-intensity movement such as walking are all important to consider.

Sleep: prioritise it. Avoid late night blue-light. Increase early morning and daytime daylight to naturally improve melatonin levels. Avoid caffeine after lunch and avoid alcohol which disrupts sleep. Get regular exercise and arm yourself with some relaxation and mindfulness techniques. Consider guided online CBT for insomnia such as Sleepful or Sleepio or invest in 1:1 CBT for insomnia.

Stress- management: Notice thoughts and feelings and how they affect your body and breath. Learn some breathing, relaxation and mindfulness exercises to help down-regulate your stress response. Recognise your warning signs and take pre-emptive action. Snatch moments of mindfulness, sprinkle in and micro-dose with acts of self-care. Share and cultivate nourishing relationships in which you can be honest. Be kind to yourself and approach challenges with Curiosity. Learn to say no, set boundaries, and stick to them. CBT, ACT or coaching can be a worthwhile investment as can complementary therapies to help sooth, calm and nourish such as reflexology and acupuncture.