patient information // menopause TREATMENT
Menopause treatment options – from HRT to lifestyle support
An evidence-based guide to the treatments available for menopause and perimenopause symptoms, including HRT, testosterone therapy, and non-hormonal alternatives – to help you understand your options before your consultation.
your options
What treatments are available for menopause?
There's no one-size-fits-all approach to managing menopause. The right treatment depends on your symptoms, your medical history, and your preferences. Here's an overview of the main options – which you can explore in detail further down the page.
HRT
The most effective treatment for most menopause symptoms. Replaces the hormones your body is no longer producing.
Testosterone
For symptoms like low energy, brain fog, and reduced libido that HRT alone may not fully address. Often not prescribed by GPs.
Non-Hormonal
For women who can’t or prefer not to take HRT. Includes prescribed medications, CBT, and supplements.
Lifestyle
Includes improvements to diet, exercise, sleep, and stress management. Works alongside medical treatment, not instead of it.
Hormone replacement therapy
HRT for menopause – the most effective treatment
HRT replaces the oestrogen your body is no longer producing in sufficient amounts. It's recommended by NICE and the British Menopause Society as the first-line treatment for menopausal symptoms in most women.
What can HRT help with?
HRT is effective for a wide range of menopause symptoms, including hot flushes and night sweats, sleep disruption, mood changes and anxiety, brain fog and concentration difficulties, joint pain and muscle aches, and vaginal dryness. It also offers long-term protective benefits for bone density, and there is growing evidence for cardiovascular and cognitive benefits when started around the time of menopause.
What HRT may not address on its own
Some symptoms – particularly low libido – may not fully respond to oestrogen replacement alone. This can be related to declining testosterone levels, which is why testosterone therapy is sometimes recommended alongside HRT. Dr Radley will discuss this with you if it's relevant to your symptoms.
Who is HRT suitable for?
For most women experiencing menopause symptoms, the benefits of HRT outweigh the risks. There's no need to wait until your periods stop – HRT can be started as soon as perimenopause symptoms begin. Your suitability depends on your individual medical history, which is why a specialist assessment matters.
types & delivery
Types of HRT – how it's delivered
HRT comes in many different forms. The right choice depends on your symptoms, medical history, and personal preference. Here's an at-a-glance overview of how the main delivery methods compare.
Oestrogen delivery methods
Traditionally, oestrogen was taken as a tablet, similarly to the hormonal contraceptive pill. However, this delivery method carries an increased risk of blood clots, since the medication needs to be processed by your liver.
Transdermal delivery methods are now the most popular - and safest choice. They are absorbed directly into your bloodstream through the skin. As a result, they carry no increased risk of blood clots.
TRANSDERMAL
Patches
Applied to your skin and changed once or twice weekly. Delivers a steady dose of oestrogen.
Brands
Estradot, Evorel, FemSeven
Benefits
Steady hormone levels, no need for daily application
TRANSDERMAL
Gel
Applied daily to your skin, usually on your upper arm or thigh. Dose can be easily adjusted.
Brands
Oestrogel, Sandrena
Benefits
Flexible dosing, easy to adjust
TRANSDERMAL
Spray
A daily spray applied to the inside of your forearm. Quick-drying and discreet.
Brands
Lenzetto
Benefits
Quick application, dries quickly
ORAL
Tablets
Taken daily by mouth. The longest-established form of HRT, still widely prescribed.
Brands
Elleste, Zumenon, Progynova, Bijuve
Benefits
Familiar daily routine
TRANSDERMAL
Patches
Applied to your skin and changed once or twice weekly. Delivers a steady dose of oestrogen.
Brands
Estradot, Evorel, FemSeven
Benefits
Steady hormone levels, no need for daily application
TRANSDERMAL
Gel
Applied daily to your skin, usually on your upper arm or thigh. Dose can be easily adjusted.
Brands
Oestrogel, Sandrena
Benefits
Flexible dosing, easy to adjust
TRANSDERMAL
Spray
A daily spray applied to the inside of your forearm. Quick-drying and discreet.
Brands
Lenzetto
Benefits
Quick application, dries quickly
ORAL
Tablets
Taken daily by mouth. The longest-established form of HRT, still widely prescribed.
Brands
Elleste, Zumenon, Progynova, Bijuve
Benefits
Familiar daily routine
Transdermal HRT (patches, gel, or spray) carries no increased risk of blood clots, whereas oral delivery (tablets) carry an increased risk. This is one of the reasons transdermal options are often preferred, particularly for women with a higher baseline clot risk. Dr Radley will discuss which delivery method is most appropriate for you and ensure you are fully informed of the risks and benefits of each.
Progesterone: protecting your womb
In addition to oestrogen levels declining through perimenopause and into menopause, your body's progesterone levels also fall. This means that if you still have your uterus, you'll need to replace this by taking a progestogen – a group of hormones that include your body's naturally-occurring progesterone – to protect the lining of your womb. The type of progestogen you take matters – it affects both your experience and your risk profile.
Micronised progesterone (Utrogestan) is body-identical – chemically identical to the progesterone your body produces naturally. It's associated with a lower breast cancer risk than synthetic progestogens, as well as carrying a lower incidence of side effects. It can be taken orally or vaginally.
The Mirena coil (IUS) is another popular delivery method. It releases a synthetic progestogen – levonorgestrel – which is delivered directly to the womb, which means less circulates in your bloodstream. It's a good option for women who want contraception alongside HRT, or who experience side effects from taking a progestogen orally.
Synthetic progestogens (such as norethisterone or medroxyprogesterone) are still widely used, but body-identical options are increasingly preferred based on the evidence around risks and side effects.
As well as the delivery method, the way HRT is taken – the "regimen" – depends on where you are in your menopause journey.
HRT regimen types
Sequential
(cyclical) HRT
For women who are still having periods (perimenopausal). You take oestrogen continuously and add progesterone for 14 days of each cycle. You'll usually have a monthly withdrawal bleed.
Continuous
combined HRT
For women who are postmenopausal (no period for 12+ months). You take oestrogen and progestogen every day with no break. No monthly bleed – which many women prefer.
Oestrogen-only
HRT
For women who've had a hysterectomy. Because the uterus has been removed, there's no need for progestogen – oestrogen alone is sufficient and simpler.
body-identical HRT
Body-identical HRT – what it means and why it matters
Not all HRT is the same. Body-identical hormones are now widely regarded as the preferred option – recommended by the British Menopause Society and NICE. Understanding the difference between body-identical and older synthetic options can help you make a more informed choice.
What is body-identical HRT?
Body-identical hormones are chemically identical to the hormones your body produces naturally – specifically oestradiol (a form of oestrogen) and micronised progesterone. They're derived from plant sources (yams and soy), manufactured to pharmaceutical standards, regulated by the MHRA, and available on the NHS.
This is different from traditional synthetic HRT, which uses hormones that are structurally similar to your own but not identical. Synthetic oestrogens (such as conjugated equine oestrogens) and synthetic progestogens (such as norethisterone or medroxyprogesterone) have been used for decades and are still prescribed, but the evidence increasingly favours body-identical options.
Body-identical versus synthetic HRT
body-identical
Oestradiol + micronised progesterone
Chemically identical to your natural hormones. Transdermal oestradiol (patches, gel, spray) carries no increased blood clot risk. Micronised progesterone (Utrogestan) is associated with a lower breast cancer risk than synthetic progestogens, and many women find it easier to tolerate with fewer side effects. This is the combination recommended by the BMS as the preferred approach.
traditional synthetic
Conjugated oestrogens + synthetic progestogens
Structurally similar but not identical to your natural hormones. Oral synthetic oestrogens carry a higher blood clot risk than transdermal body-identical options. Synthetic progestogens are associated with a higher breast cancer risk with long-term use, and some women experience more side effects including bloating, mood changes, and breast tenderness.
When patients ask about "natural HRT" or "plant-based HRT," they usually mean body-identical. The term "natural" can be misleading, so Dr Radley always uses the clinically accurate term and explains exactly what you're being prescribed and why.
Dr Radley prescribes body-identical HRT as standard. This means oestradiol delivered through the skin (patches, gel, or spray) alongside micronised progesterone (Utrogestan) where needed. This is in line with current BMS and NICE recommendations and carries the most favourable risk profile.
A note on compounded ‘bioidentical’ HRT
You may also come across "bioidentical" or "compounded bioidentical" HRT – custom-made hormone preparations from specialist pharmacies. Despite the similar name, these are not the same as regulated body-identical HRT.
The risks of compounded ‘bioidentical’ HRT
not regulated by the MHRA
not subject to the same quality controls as licensed medicines
not recommended by the BMS, NICE, or the NHS
long-term safety data is limited
potency can vary - meaning each batch may give you a different dose
testosterone therapy
Testosterone for women
Testosterone isn't just a male hormone. Women produce it naturally throughout their lives – just in smaller amounts than men. When levels decline during menopause, it can cause symptoms that oestrogen replacement alone won't resolve.
How testosterone is prescribed
Testosterone for women is prescribed as a cream or gel applied to the skin daily – at much lower doses than for men. Until recently, there was no testosterone product licensed specifically for women in the UK, meaning specialists prescribed male preparations at adjusted doses (off-label).
Currently, the only menopause symptom it is licensed to treat is low libido. Menopause specialists sometimes prescribe it for other symptoms that may be linked to low testosterone where HRT alone has not improved these symptoms.
Symptoms of low testosterone in women
Reduced libido
Loss of interest in sex or reduced arousal. Testosterone’s strongest clinical evidence is for treating low libido, and this is the only symptom it is specifically licensed for.
Persistent low energy & fatigue
Tiredness that doesn't improve with sleep or oestrogen replacement. Often described as a deep, motivational fatigue.
Brain fog & poor concentration
Difficulty thinking clearly, word-finding problems, and reduced mental sharpness that persist despite HRT.
Low mood & reduced motivation
A general flatness or loss of drive that doesn't respond fully to oestrogen or standard treatments for low mood.
AndroFeme - testosterone developed for women
AndroFeme is the first testosterone cream specifically developed and licensed for women and received MHRA approval in 2025. This is a significant development, as it provides a regulated, accurately dosed product designed for female physiology.
This does not mean that traditional ‘male preparations’ of testosterone replacement are no longer safe or effective when prescribed in correct doses by a specialist and monitored appropriately, but represents a positive step towards closing the women’s health gap.
Dr Radley can discuss whether testosterone therapy is appropriate for your symptoms.
Most GPs can't prescribe testosterone for women, because using it to treat menopausal symptoms takes specialist knowledge and monitoring: keeping up to date with the evidence, assessing blood levels, and adjusting the dose. This falls outside standard GP training, which is one of the main reasons women seek private menopause care.
vaginal & topical treatments
Vaginal oestrogen – a treatment in its own right
Vaginal oestrogen is a low-dose, local treatment that's separate from systemic HRT. It's highly effective for vaginal dryness, discomfort during sex, and recurrent urinary tract infections – and it's safe for almost all women, including many who can't take systemic HRT.
What makes vaginal oestrogen different?
Unlike systemic HRT (patches, gel, tablets), vaginal oestrogen works locally – which means it acts on the specific area it’s applied with very little being absorbed into the blood stream. It can treat vaginal symptoms directly, without carrying the risks of systemic HRT, making it a safe option for most women, including those with a history of breast cancer (with specialist guidance). It can also be used alongside systemic HRT for women who need both.
What vaginal oestrogen can treat
Vaginal oestrogen is used to treat genitourinary syndrome of menopause (GSM) – formerly referred to as vaginal atrophy – which is where the tissues of the vaginal walls and urinary tract become thinner, dryer, and sometimes inflamed, as a result of declining oestrogen levels. GSM can be lead to the following symptoms:
Vaginal dryness, irritation, and discomfort
Pain or discomfort during sex
Recurrent urinary tract infections (UTIs)
Urinary urgency and frequency (incontinence)
Vaginal oestrogen delivery methods
Vaginal oestrogen comes in several forms – pessaries, creams, gels, and vaginal rings. Until very recently, vaginal oestrogen was only available with a prescription. However, Gina, a vaginal oestrogen tablet, became available over the counter in pharmacies in 2024 – meaning you can buy it without a prescription for vaginal dryness, and Ovesse, a newer vaginal oestrogen cream, has also recently become available over-the-counter.
Your pharmacist can help you understand whether over-the-counter vaginal oestrogen medications may be helpful for your symptoms, and offer advice on using them safely and effectively.
It's important to remember that vaginal oestrogen medications are for vaginal and urinary symptoms only – they won't help with systemic symptoms like hot flushes, brain fog, or mood changes. If you're experiencing both, you may benefit from systemic HRT as well.
Dr Radley has specific experience supporting women who can't take HRT – including those with a history of breast cancer, blood clots, or other conditions where certain hormonal treatments may not be suitable. A specialist consultation can help you understand all the options available to you.
non-hormonal treatments
Alternatives to HRT – non-hormonal options
If you can't take HRT – for example, because you have a history of breast cancer and the risks have been assessed by a specialist – or if you'd prefer not to, there are effective non-hormonal treatments available. Dr Radley works with women in all situations to find an approach that's safe, evidence-based, and right for you.
Prescribed non-hormonal medications
Fezolinetant (Veoza) is a newer non-hormonal medication that works directly on the brain's temperature control centre to reduce hot flushes and night sweats, without using any oestrogen. Because it is non-hormonal, it is of particular interest for women with a history of hormone-sensitive breast cancer. While it is not currently licensed for use in this situation, it can considered on an individual, case-by-case basis. Dr Radley can discuss whether it may be a good option for you.
Elinzanetant (Lynkuet) is another new non-hormonal option which can help with hot flushes and night sweats, alongside the disturbed sleep that often accompanies them. Importantly, it is now licensed specifically for hot flushes and night sweats caused by breast cancer hormone treatments such as tamoxifen and aromatase inhibitors, the first medicine in the UK licensed for this use. However, it has not yet been appraised by NICE for NHS funding, so it is currently available on private prescription only.
If you have a history of breast cancer, treatment options are covered in more detail in our Menopause after breast cancer guide.
SSRIs and SNRIs (certain antidepressants such as escitalopram and venlafaxine) are recommended by NICE as an alternative to HRT for managing hot flushes and mood symptoms. They're prescribed at lower doses than for depression.
Gabapentin can help with hot flushes and may also improve sleep. Clonidine is sometimes used but tends to be less effective than the other options.
Note that HRT remains the most effective treatment because it directly addresses the root cause of symptoms – fluctuating and declining hormone levels – whereas non-hormonal medications tend to target individual symptoms, or clusters of symptoms (such as vasomotor symptoms). Dr Radley can help you understand the safest, most effective treatment options for you, based on your medical history and preferences.
CBT for menopause
Cognitive behavioural therapy (CBT) is recommended by NICE specifically for managing hot flushes and sleep disruption during menopause. It's not "just talking therapy" – it's a structured, evidence-based approach that helps you change the way you respond to symptoms. Research shows it can reduce the impact of hot flushes even when their frequency doesn't change.
Supplements and herbal remedies
Many women try over-the-counter supplements and herbal products for menopause symptoms. The evidence for most is limited, but some women do find them helpful. Dr Radley can give you an honest, evidence-based assessment of what's available.
Products commonly used include black cohosh (some evidence for hot flushes, but a risk of liver toxicity – should not be taken without medical guidance), red clover, evening primrose oil, and soy isoflavones. It's important to know that "natural" doesn't mean risk-free – herbal remedies can interact with other medications and aren't subject to the same regulation as prescribed treatments.
LIFESTYLE & WELLBEING
Lifestyle changes that support your treatment
Lifestyle adjustments work alongside medical treatment – not instead of it. The right changes can help manage symptoms, protect your long-term health, and improve how you feel day to day.
Exercise
Weight-bearing exercise protects bone density. Resistance training helps maintain muscle mass and metabolism. Regular movement also improves mood, sleep, and cardiovascular health. Even moderate activity makes a difference.
Nutrition
A diet rich in whole foods, healthy fats, and lean protein supports overall health during menopause. Calcium and vitamin D are particularly important for bone health. Moderating processed foods and sugar can help manage weight and energy.
Sleep & Stress
Good sleep hygiene – consistent bedtime, cool bedroom, reduced screen time – can help with menopause-related insomnia. Stress management through mindfulness, breathing techniques, or CBT can reduce the intensity of both mood and vasomotor symptoms.
Dr Radley takes a holistic approach to menopause care – your treatment plan may include lifestyle recommendations alongside medical treatment, tailored to your individual circumstances and goals.
Frequently asked questions
Common questions about menopause treatment
These are the questions patients ask most often – about safety, side effects, costs, and how treatment works in practice. If you have more questions, a consultation with BMS Registered Menopause Specialist Dr Jacqueline Radley is the best way to get answers and a treatment plan that’s personalised to you – whether that includes HRT or not.
Side effects are not common, and when they do occur they're usually mild and settle within the first few months. They can include breast tenderness, irregular bleeding, headaches, and fluid retention. Most side effects can be resolved by adjusting the dose, changing the delivery method, or switching the type of progestogen. Dr Radley works with you to find the right balance, and adjustments can always be made at follow up appointments.
Uncommon, usually mild, and manageable with adjustment
HRT tablets carry a small increased risk of blood clots. However, transdermal HRT – patches, gel, or spray – carries no increased clot risk. This is why transdermal delivery is often preferred, particularly for women with a higher baseline clot risk, a higher BMI, or who are smokers.
Key: transdermal HRT has no increased clot risk
You can start HRT as soon as perimenopause symptoms begin – there's no need to wait until your periods stop. Starting earlier may offer additional protective benefits for bone and cardiovascular health. Equally, if you're wondering whether you've left it too late – you almost certainly haven't. Women can start HRT at any age if the benefits outweigh the risks for their individual situation. Even women in their 60s and beyond may benefit, particularly from vaginal oestrogen.
As soon as symptoms begin – no need to wait.
Blood tests are not usually required to start HRT – for most women over 45, your symptoms are enough to make a clinical diagnosis and begin treatment. However, blood tests can be useful in some situations: to check hormone levels if you're under 45 (to investigate early menopause), to monitor testosterone levels if you're on testosterone therapy, or to assess your overall health including thyroid function, cholesterol, and vitamin D. Dr Radley will recommend tests if they're appropriate for your situation.
Only needed in specific scenarios
This is an active area of research without a clear answer yet. Some studies suggest HRT started around the time of menopause may have a protective effect on cognitive function, while others show no significant impact. Dr Radley can discuss the latest evidence with you in the context of your individual health.
Active research – no definitive answer yet but early research suggesting a positive effect on cognitive function
This is one of the most common concerns, but the evidence is reassuring. HRT does not cause weight gain. Menopause itself is associated with changes in body composition – including increased abdominal fat – but HRT is not the cause, and may in fact help maintain a healthier body composition and reduce menopause-related weight gain.
Evidence: HRT does not cause weight gain
This depends on the type and duration. Combined HRT (oestrogen + progestogen) is associated with a small increase in risk with long-term use, though body-identical progesterone carries a lower risk than synthetic progestogens. Oestrogen-only HRT shows little or no increased risk. For most women, the benefits outweigh the risks.
Nuanced: depends on type, duration, and individual factors
There is no arbitrary time limit for taking HRT. The BMS and NICE recommend that HRT should be reviewed annually, but the decision to continue is individual – based on your ongoing symptoms, health profile, and personal preference. Many women take HRT well into their 60s and beyond.
No set limit – individualised annual review recommended
Yes – GPs can and do prescribe HRT. However, many GPs have limited training in menopause care, and some may be less familiar with body-identical options, testosterone therapy, or managing complex cases. If your GP is unable to help, or if you'd prefer specialist input from the start, a private menopause consultation can provide a treatment plan. In many cases, GPs can take over prescribing ongoing HRT following a menopause specialist’s recommendations.
GPs can prescribe, but specialist input often helps, especially in complex cases
If your GP prescribes HRT on the NHS, you'll pay the standard NHS prescription charge of £9.90 per item – or £19.80 per year with an HRT prepayment certificate, which covers unlimited HRT items.
If you're prescribed HRT privately, costs vary: standard HRT typically costs £10–£35 per month, and testosterone (AndroFeme) costs £99 for a three month supply. Blood tests, if recommended, are an additional cost.
NHS: £19.80/year with HRT prepayment certificate
Bone
health
Oestrogen plays a key role in maintaining bone density. After menopause, bone loss accelerates – increasing the risk of osteoporosis and fractures. HRT is one of the most effective ways to protect bone density, and is particularly important for women who experience early menopause.
Cardiovascular
health
There is growing evidence that HRT started around the time of menopause may offer cardiovascular benefits – helping to maintain healthy blood vessel function and cholesterol levels. The timing of starting HRT matters: the earlier it's started relative to menopause, the greater the potential benefit.
Urinary & vaginal
health
Oestrogen helps maintain the health of your urinary tract and vaginal tissues. HRT – particularly vaginal oestrogen – can reduce the risk of recurrent UTIs, improve vaginal comfort, and support bladder function long after other menopause symptoms have eased.
Treatment isn't just about how you feel today. Dr Radley takes a long-term view of your health – considering not just your current symptoms, but how the right treatment now can protect you in the years ahead.
long-term benefits
The benefits of HRT beyond menopause symptom relief
The conversation about HRT often focuses on risks. But for most women, the benefits extend well beyond managing day-to-day symptoms; HRT can also play an important role in protecting your long-term health. Here’s a quick overview of the benefits of HRT outside of symptom relief:
For women who experience early or premature menopause, HRT is recommended at least until the average age of natural menopause (51) to protect bone, cardiovascular, and brain health over the longer term. This recommendation isn’t about optional symptom relief – it's an important part of managing the health implications of an extended period without oestrogen.
choosing the right treatment
How to choose the right menopause treatment
This page has covered a lot of ground, and we understand that the range of treatment options can seem confusing at first. Our aim, however, isn't to overwhelm you with information – it's to demonstrate that menopause treatment isn't one-size-fits-all, and that the right approach depends on your symptoms, your stage of menopause, your medical history, and what matters most to you.
A menopause specialist can help you by reviewing your full symptom picture and medical history, explaining your options in the context of your individual situation, recommending a treatment plan and adjusting it over time, and monitoring your health with regular reviews.
You don't need to have all the answers before you book. Dr Radley will take the time to listen, explain your options clearly, and help you make an informed decision that's right for you.
