Hormone Replacement Therapy (HRT) is one of the most talked-about aspects of menopause care, but it’s not the only option, and it’s not right for everyone.
In this episode, Catriona is joined by Dr. Jacqueline Radley, GP and menopause specialist, to explore what happens when HRT isn’t suitable, isn’t wanted, or simply isn’t the first choice.
Top 5 highlights from the conversation
1. Most women ask about HRT — but it’s not always suitable
Many women seek HRT after trying other approaches, often when symptoms become more disruptive.
However, some women:
- Can’t take HRT (e.g. certain breast cancer treatments or unexplained bleeding)
- Prefer not to take hormones
- Feel uncertain due to what they’ve heard or read
The important message is simple: there are other ways to manage menopause.
2. Menopause symptoms can be confusing, especially alongside other conditions
Symptoms like fatigue, low mood, joint pain, or brain fog are often mistaken for:
- Depression
- Ageing
- Existing chronic conditions
Dr. Radley describes menopause care as a bit of a “detective process”, often using symptom questionnaires to build a full picture.
Sometimes, a trial of HRT is used to help confirm whether symptoms are hormone-related.
3. If not HRT, treatment becomes more targeted
Unlike HRT, which replaces hormones and can help a wide range of symptoms, non-hormonal approaches tend to focus on individual symptoms, such as:
- Sleep problems
- Hot flushes and night sweats
- Anxiety or low mood
This means treatment is often a combination approach, rather than one single solution.
4. There are effective non-hormonal medical options
For women who cannot or do not want HRT, there are several alternatives:
- Certain antidepressants (used at low doses)
- Help reduce hot flushes and night sweats
- Can also support mood and sleep
- Oxybutynin
- Originally for bladder symptoms
- Can also reduce hot flushes (not always suitable for older women)
- Clonidine
- Used for blood pressure and migraines
- Some benefit for hot flushes
- Gabapentin / Pregabalin
- Used more cautiously due to dependency risks
There is also a newer medication:
- Fezolinetant (Veoza)
- Works on temperature regulation in the brain
- Currently available privately in the UK
5. Lifestyle is the foundation, with or without HRT
One of the strongest messages from this conversation is that lifestyle matters hugely.
As oestrogen drops, the body undergoes metabolic changes:
- Loss of muscle mass
- Increased fat storage (especially around the middle)
- Slower metabolism
Key areas to focus on:
- Strength training (at least twice weekly)
- Protein intake with each meal
- Mediterranean-style diet
- Vitamin D and calcium for bone health
- Weight-bearing exercise
These changes don’t just help symptoms, they support long-term health, including:
- Bone strength
- Heart health
- Brain health
A Note on Supplements
Many women try herbal or natural remedies.
The reality:
- Some (like black cohosh and red clover) may help
- Evidence is limited compared to prescribed treatments
- They are not risk-free, especially for women with a history of breast cancer
Always check with a healthcare professional before starting anything new.
About the expert
Dr Jacqueline Radley is a GP and British Menopause Society Accredited Menopause Specialist
Dr Jacqueline Radley is the founder of The Birmingham Menopause Clinic. She provides personalised care across perimenopause, menopause and postmenopause, integrating hormonal and non-hormonal therapies to support long-term health.
Her interests include complex menopause, neurodiversity, testosterone therapy and the mental health impact of hormonal change. With postgraduate training in lifestyle medicine and medical education, she blends clinical expertise with a holistic approach to help people understand their symptoms and make informed choices.
Jackie is committed to breaking taboos around vaginal atrophy, libido and mood, and to delivering clear information and truly individualised care.
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Medical disclaimer
This content is for general information only and is not a substitute for professional medical advice. Always consult your GP or a qualified healthcare professional if you have any concerns about your health.