HRT can undoubtedly be transformative for those who take it, but not everyone needs — or wants — a treatment based on hormones.

Breast cancer survivors, those with blood clots at-risk, and women who have had liver disease or a family history may be advised to avoid it.

Other women might prefer non-medical intervention and choose to not take HRT.

In the third section of the essential guide we’ve enlisted experts to help us evaluate the alternative options.

Women with a history of breast cancer, as well as those at risk of blood clots or who have liver disease, may be advised against it or restricted to certain types

Breast cancer history, blood clot risk, or liver disease may all affect women.

You can find natural solutions (see the right), as well drugs for specific purposes, like clonidine, which is a blood pressure medication.

Clonidine can dilate blood vessels. It may also help relieve hot flushes, night sweats, and other symptoms in women. Sid Dajani is a pharmacist from Bishopstoke near Southampton.

Side effects include dry or drowsy mouth and dry eyes.

Gabapentin is a medication that’s used to treat seizures and nerve pain. It can also be used for hot flushes. It can also cause sleepiness and dependence.

A new class of drugs called neurokinin-3 receptor antagonists (NK3R), is being studied by researchers. By reducing the activity of neurokinin 3, receptor, these drugs can reduce hot flushes as well as night sweats. These drugs can be taken as an oral tablet or capsule and work by binding to receptors and blocking them.

A study found that NK3R antagonists decreased hot flushes following four weeks of treatment. The hot flush frequency and severity in the treatment group had decreased by 72 percent by day 3.

A team investigating these drugs includes Dr Nick Panay (a consultant gynaecologist who is interested in menopause, and other menstrual issues). While he concedes the treatment won’t be better than oestrogen therapies, he adds, “It will hopefully offer an option for women who have contraindications to HRT or those who aren’t willing to use it.”

Dr Panay says that there is evidence to suggest the therapy may also improve sleep quality, mood, and quality of living. She is located at The Chelsea and Westminster Hospital in London as well as The Women’s Wellness Centre.

Advanced clinical trials in several countries are underway, and treatment might be possible in the next year. However, drugs may not be for everybody. Non-medical options are important in controlling menopause symptoms. Kathy Abernethy is the ex-chair of the British Menopause Society, as well as the author of Menopause. The One-Stop Guide to Menopause.

She adds that a lot of women desire to be able to deal with the menopause naturally.

While some people find meditation and mindfulness beneficial, the evidence is not conclusive.

The Journal of Psychosomatic Research published a comprehensive review of research last year that found mindfulness could improve quality of living, however, it was not shown to reduce menopause symptoms, such as hot flushes.

However, cognitive behavioural therapy (CBT) has been clinically shown to reduce vasomotor symptoms (hot flushes/night sweats), anxiety and low mood.

One study showed that NK3R antagonists reduced hot flushes after four weeks of treatment. By day three, hot flush frequency in the group taking the medication had already reduced by 72 per cent, and severity was down by 38 per cent, compared with those given a placebo

After four weeks, NK3R antagonists showed a reduction in hot flushes. The hot flush frequency and severity in the treatment group had decreased by 72% by day 3 compared to those receiving a placebo.

Myra Hunter is an emeritus professor in clinical psychology at King’s College London and has created a special form of CBT for treating symptoms associated with the menopause.

Her publications include studies published in The Lancet Oncology and Menopause. These papers demonstrate its efficacy for treating vasomotor symptoms, as well as for patients with breast cancer.

Face-to-face sessions are possible, as well as audio and booklet guidance over the phone and the internet. The therapy focuses on changing the negative beliefs that lead to hot flushes at work or in public. For example, ‘everyone’s looking at me’. This increases distress for psychological reasons and can make hot flushes more severe.

This helps women to develop strategies for coping with stress and reducing it.

Professor Hunter says that CBT to treat menopause symptoms has been well researched and is supported by strong academic research. You can use it to treat poor sleep which is frequently associated with menopause symptoms.

Dr. Hunter has found that CBT is most effective for women who are able to learn it in groups. However, self-help, books, and other online resources can also be very helpful. She says that it can be extremely empowering to learn CBT in a group with people who can support and guide you.

“The group can help spread the message that normal menopause symptoms exist and we should not be ashamed about having them.”

CBT does require some effort and commitment — it takes around eight hours in total (either two hours a week for four weeks, or one-and-a-half-hour sessions over six weeks).

According to Professor Hunter, women report improvement after only a few sessions. [showed]Six months later, improvements were made.

Lifestyle changes can alleviate menopause symptoms, too — especially regular exercise. Although the results of many research studies are not conclusive, Maturitas 2012 published research that showed aerobic exercise could help improve sleep quality and reduce hot flushes.

Kathryn Freeland, personal fitness instructor, states that although it isn’t known why, exercise regularly can improve your health, weight and quality of life.

For the best results, incorporate exercise daily into your day before you reach menopause.

“If you’re just starting out, I recommend that you start slowly with ten minutes of walking, cycling, swimming per day,” she advises.

The expert advises women going through menopause to choose an activity they love and increase intensity over time by around 10% per week.

She says, “Perseverance matters if you’re perimenopausal and/or post-menopausal as results take longer to come.”

According to her, as we age, our muscle mass decreases, which slows down the metabolism, making it more difficult for us to keep a healthy weight.

Aerobic exercise like swimming and cycling can help women with sore joints or who have been overweight.

A non-medical option to alleviate symptoms associated with menopause, is diet.

Marcela Fiuza from the British Dietetic Association, a specialist on women’s health and the menopause, says, “A lot of women that I see in clinic experience a range of undesirable symptoms they cannot control. But their diet is something which they can control.”

According to her, “The better you feel and the healthier you look, the easier it will be for you to cope with all the changes happening in your life,” she said.

In the last part of the series, next week we’ll take a close look at what foods are best (and which to avoid).

Expert guide on what works, from maca root to the sage leaves

Popular alternative treatments are because they can be found naturally and thus safer.

The truth is somewhat more complex, because alternative treatments have not always been examined as closely as traditional medicines.

In 2010, the Royal College of Obstetricians and Gynaecologists reported that not enough research had been done on herbal remedies. Alternative remedies may be able to reduce symptoms by between 50-60%, far lower than HRT which can decrease symptoms by 80-90 percent.

“If you’re going to try an alternative treatment, make sure to check with your doctor first. This is a good idea, advises Dr Heather Currie (a former chair of British Menopause Society).

Look for products that are marked with the Traditional Herbal Registration symbol (THR), or product license number. While this does not guarantee its safety or efficacy it is a confirmation that it has what it claims.

This article will discuss some alternative options that are very popular. 

Black cohosh can be used as an oral supplement made from the root of North American plants. The capsules, pills, or powders are taken 2 to 3 times per day. It may reduce the severity of hot flushes in some women, according to The Royal College of Obstetrics and Gynaecologists.

Dr Currie says that black cohosh may be able to help with hot flushes for some women. However, it is not as efficient as HRT. It is best to avoid if your liver has problems. You should not take it if you have heart disease, breast cancer or epilepsy.

Possible side effects include stomach upset and headaches.

St John’s Wort is a European herb that has been used to treat low moods. However, studies show that St John’s Wort can also improve low sex drives that may accompany menopause. This herb is believed to control moods by increasing brain levels of chemical messengers.

Dr Currie states that St John’s wort may be helpful in reducing hot flushes or night sweats. Some women also find it useful for low moods. But, the evidence is weak.

You should consult your doctor before you take the remedy.

Red clover capsules: Or powdered, they are made from red clover, which comes from an African and Asian plant. They contain phytoestrogen (a plant hormone similar to estrogen) and can be taken as capsules.

One study that was published in PLoS One 2017 suggested that menopausal bone losses can be prevented by fermented clover extract.

However, the researchers were cautious about saying red clover works — it could be the fermentation process used to produce it that makes the difference, they said, as it allows the body to access the oestrogen-like compounds in red clover.

Dr Currie states that some women may find it helpful in treating hot flushes. But again, evidence is scarce. Women with hormone sensitive cancer like breast cancer should not use this product. 

Evening primrose oil is an oil extracted from seeds of the plant that is native to North America. It is high in gamma–Linolenic Acid, an essential fatty acids involved in the creation of prostaglandin-like substances. The menopause is associated with hormonal changes that can be countered by boosting prostaglandins.

Although there isn’t much evidence supporting its efficacy, Dr Currie says that some women do find it to be beneficial for breast tenderness.