This is something that I talk about to my patients every day. The 2025 British Menopause Society (BMS) Conference placed strong emphasis on exploring options beyond hormone replacement therapy (HRT) for managing menopausal symptoms.

Globally, over one billion women are affected by the menopause. Symptoms last, on average, seven years, although for some women they may persist anywhere between four and fourteen years. Over 80% of women experience vasomotor symptoms such as hot flushes and night sweats, but in total, more than 100 different symptoms have been described. These range from sleep disturbances, anxiety, mood changes, brain fog, fatigue, and joint pain to urogenital symptoms such as vaginal dryness and urinary discomfort.

Menopause is a critical tipping point in a woman’s life that not only affects day-to-day wellbeing but also has long-term implications for health. I feel very passionaltely about this. The menopause transition often coincides with the early development of chronic conditions such as cardiovascular disease, osteoporosis, and dementia—conditions that are more prevalent in women than men. For example, dementia affects twice as many women as men, and research is increasingly linking this to hormonal changes.

The economic impact of menopause is also substantial. Many female-dominated professions—such as those in the NHS, social care, and education—feel this most acutely. Women struggling with unmanaged symptoms may reduce their hours, leave their jobs, or face diminished productivity.

As a healthcare provider, I see this phase not just as a challenge but as a vital opportunity to support women metabolically, mentally, and socially.

Beyond HRT and CBT: What Are the Alternatives?

While HRT remains the most effective treatment for many women and cognitive behavioural therapy (CBT) can be helpful—especially for mood and sleep disturbances—there are several other evidence-based strategies worth considering.

The Lancet recently published the ‘Top Ten Research Priorities’ for menopause, with diet and lifestyle changes highlighted as essential areas for investigation and support.

1. Improving Sleep

Sleep disturbances are among the most common and disruptive menopausal symptoms. Poor sleep can affect mood, concentration, weight, and overall quality of life. Sleep hygiene, mindfulness techniques, relaxation practices, and CBT for insomnia (CBT-I) are all non-pharmaceutical strategies worth exploring.

2. Gut Health and the Microbiome

Emerging research is exploring how the gut microbiome influences overall health, including brain function and hormonal metabolism. A healthy microbiome may impact how oestrogen is broken down and used in the body. Probiotics, prebiotics, and a diet rich in fibre and fermented foods may be beneficial, although more clinical evidence is needed. I do recommend these.

3. Diet and Nutritional Supplements

Omega-3 fatty acids, found in oily fish and flaxseeds, have been linked to improved brain function, reduced inflammation, and potential modulation of hormonal balance. Phytoestrogens—plant-based compounds with mild oestrogen-like activity—such as isoflavones (found in soy products), black cohosh, and St John’s Wort are popular complementary therapies. Some women find these help manage vasomotor symptoms, although evidence is mixed, and safety—particularly with St John’s Wort, which can interact with other medications—should always be reviewed with a healthcare provider.

A growing number of women are seeking bespoke nutritional advice. Tailored diets that address hormonal changes, support bone health, and help manage weight can be highly effective, especially when guided by a registered dietitian or qualified nutritional therapist with menopause expertise. I have a fantastic nutritionist and she is helping many of my patients.

4. Weight Management

Weight gain is a common and frustrating issue during menopause. Women typically gain an average of 1.5 kg per year during this phase, largely due to declining oestrogen levels, which impact metabolism, fat distribution, and appetite regulation. This can also lead to an increased risk of type 2 diabetes and cardiovascular disease.

Weight loss leads to improvement of menopausal symptoms!

We now understand that managing weight during the menopause is more than just about appearance—it’s about health.

GLP-1 receptor agonists such as Mounjaro (tirzepatide) and Wegovy (semaglutide)—originally developed for diabetes and weight loss—are being evaluated in the context of menopausal weight gain. For some women with obesity or significant weight-related health risks, these may be considered under medical supervision in the clinic.

5. Planning Ahead

The reality is that many women enter perimenopause and menopause unprepared. They are not informed about what to expect, what is “normal,” and what treatment or lifestyle options are available to them. We need to empower women to anticipate these changes—much like we do during pregnancy—and proactively manage symptoms before they impact careers, relationships, and long-term health. I see this all of the time.

So, What Can Women Do Now?

While HRT remains an important and often underutilised tool, it’s not suitable or desired by everyone. Women should be offered a holistic approach that includes:

• Evidence-based lifestyle advice
• Access to mental health and sleep support
• Nutritional and dietary guidance
• Consideration of supplements and complementary therapies
• Support for managing weight and metabolic health
• Education and resources to prepare for menopause early

Currently, the options beyond HRT and CBT remain limited and not consistently offered or well-integrated into mainstream care. However, awareness is growing, and with more research, education, and policy support, this is beginning to change.

In the meantime I will continue to support women and give up to date advice regarding this vital part of management of the menopause.