HRT is not the only way to treat hormonal symptoms associated with the menopause. There are non-prescription products and therapy based approaches which can help too. This summarises some other treatments you can consider.
95% of women said they would try alternative therapies before HRT because they think they are more natural and because they are worried about health risks of HRT - Women's Health Concern, the patient arm of the British Menopause Society 
Many women do not want to take HRT to manage menopause. This is a very valid choice. Some women have health conditions making HRT out the question; whilst others may prefer a non-hormonal route. There are plenty of alternative treatments to help you with menopause which you might want to try. One warning though is that these can be quite expensive.
There are different herbal supplements that claim to help ease menopause. It's important to consider the evidence for each before spending your hard earned cash on them.
This herbal remedy is often suggested to help women with hot flushes and night sweats. There are some clinical studies  which show it to be effective - whilst other studies show no impact. There's a need for more research to help identify whether black cohosh really helps.
Black cohosh has not been shown to help with mental health symtpoms including anxiety or low mood.
St John’s Wort has been shown to help with hot flushes and night sweats. It's particularly useful for women with a history of, or at high risk of breast cancer. Women on tamoxifen for breast cancer treatment must not take St John’s Wort because it interferes with the treatment.
Dong quai is a plant used in traditional chinese medicine to reduce hormonal symptoms. Though many women say they find it helpful, clinical trials suggest it has no impact. If you are on the blood medication warfarin you should not try Dong Quai.
Evening primrose oil is claimed to help with lots of different medical conditions. This is because it is high in the anti-inflammatory compound gamma-linolenic acid (GLA). Current evidence from clinical trials does not suggest it helps with menopausal symptoms.
This herb is considered to improve cognitive symptoms associated with menopause - like brain fog and memory changes. There are short term studies have shown Gingko biloba to help; but there's not much long term evidence for it's effects out there.
Other common herbal remedies suggested to be helpful are sage, wild yam and liquorice root. There's no clinical evidence for these helping with menopausal symptoms. But, if you are taking herbal remedies and they are helping you then that's great.
Don't stop things which are working for you, unless you're advised by a doctor. Some herbal treatments do interfear with prescription medications, so make sure your doctor is aware of what you are trying. In general, these herbs are unlikely to cause you harm if you follow the instructions on the packet.
There's a lot of press (good and bad) about the use of bioidentical hormones to treat menopause. It can actually be very confusing to understand what bioidentical hormones are, and how they are different to HRT. So we'll try and explain that briefly here.
Bioidentical means that the hormones have the same chemical structure as the hormones which your body makes itself. Because of this same structure, these hormones can be considered more 'natural' than man-made HRT.
The main problem with bioidentical hormones is that they are poorly regulated. There are conventional forms of HRT which use hormones that are identical to those in the body which are regulated. So the current medical advice is to use the regulated products, not the unregulated 'bioidentical hormones'.
If you are under the care of a medical professional they may be able to explain to you clearly why bioidentical or synthetic HRT is the best option for your specific needs.
Rather than focussing on curing a single symptom, therapeutic approaches look to improve the health of the whole mind and body. Some therapies include:
-Cognitive behavioural therapy (CBT)
There are a few studies that show acupuncture can help with symptoms. And there's currently a lot of research looking at CBT to help manage menopause and in particular hot flushes. We're very excited that CBT can offer a really effective, non-hormonal way to manage common menopausal symptoms for women. CBT is helpful for anyone suffering with anxiety, low mood and depression separate to menopause too. So if these are your symptoms then CBT might be worth trying.
Certain plants have chemicals in which act very similar to estrogen in the body. The most important of these chemicals are isoflavones and lignans. Isoflavones come from foods like soybeans, chickpeas and other legumes. Lignans are in flaxseeds, some whole cereals, vegetables and fruit.
The evidence for eating diets rich in phytoestrogens might help with some menopausal symptoms. A systematic review concluded that there are some trials that show a small reduction in hot flushes - but there were not many studies of high enough quality to be included in the review . As ever - more research is needed! NICE - an organisation whcih advises doctors on providing care to patients - suggests that isoflavones in particular may help with hot flushes and night sweats . But, it does also note that the products available containing plant based estrogens vary in quality so always read the label.
You may try many different things to ease your menopause symptoms. And sadly, it might take some time to find the things which work for you. Don't give up though - things will get easier. Just make sure that you track your symptoms to understand whether each thing you try is working - we wouldn't want you wasting money on things which aren't actually making you feel better.
1 Women's Health Concern Website. Complementary/alternative therapies for menopausal women. Retried 28 December 2019 from [https://www.womens-health-concern.org/help-and-advice/factsheets/complementaryalternative-therapies-menopausal-women/]
2 Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007244. DOI: 10.1002/14651858.CD007244.pub2.
3 Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub4.
4 National Institute for Health and Care Excellence. Menopause: Diagnosis and Management. London: NICE; 2015.
5 Hillard T., et al. (2017). Management of the menopause. 6th edn. British Menopause Society. UK.
6 National Health Services Website (2018). *Treatment - menopause * Retrieved 16 October 2019 from [https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/].