HRT is rarely out of the news. But whether you’re starting with the odd hot flush or already experiencing the full tidal wave of menopause symptoms, news of shortages of hormone replacement therapy (HRT) will be most unwelcome.

The crisis in the UK over supplies of HRT – thought to have begun after China forced some manufacturers to stop producing HRT patches – is reportedly seeing some British women flying abroad, with warnings they could struggle to get hold of patches for nearly a year. It’s thought that two thirds of HRT products have been affected.

[Smoking is bad, but it’s even worse during menopause]

To make matters worse, a report published recently revived the debate over whether HRT raises women’s risk of breast cancer. The study published in The Lancet found a small increased risk for all types of HRT except topical vaginal oestrogens, and that for some, the risk remains for more than a decade after use stops.

Around one in 10 women going through the menopause are prescribed HRT – which restores falling levels of hormones – amounting to around 200,000 women in the UK. But worries over supplies, and a new breast cancer scare, will no doubt add to growing interest in alternative ways to manage the symptoms of the menopause. ‘This is an ideal time to look at all the latest ways to take care of yourself as you approach and go through the menopause,’ says Dr Louise Newson, a GP and menopause specialist based in Stratford-upon-Avon. For those who want to cut their reliance on HRT or try coming off it completely, a number of alternative methods are gaining attention.

Herbal solutions

If you’re considering coming off HRT, Dr Marilyn Glenville, who specialises in women’s health and hormonal balance, recommends gradual weaning, and trying herbal remedies to ease the symptoms. ‘Stopping HRT suddenly can cause withdrawal symptoms. If you need extra help then you can use herbs like black cohosh, agnus castus, dong quai and sage, which have been shown to help with the symptoms of the menopause.’ She recommends NHP’s Black Cohosh Plus.

Apps and mindfulness

Increasingly, experts are showing that changing your psychological response to menopausal symptoms can reduce their impact. Research on 140 women by Prof Myra Hunter, a psychiatrist at King’s College London, found that after four sessions of CBT – where women were helped to replace negative thoughts about the menopause with positive ones – 65 per cent reported reductions in flushes and night sweats, compared with 12 per cent in a control group. They continued to experience fewer symptoms six months after they finished the treatment. Prof Hunter found women responded just as well from a self-help CD and book as they did to therapy sessions.

Apps such as mySysters, which tracks symptoms and offers support network for women going through perimenopause or menopause, or one of the meditation apps like Headspace, may also prove useful.

Many experts argue that simply raising awareness around the menopause helps women feel less embarrassed about it, and thus perceive the symptoms differently. MPs recently called for workplaces to have “menopause policies” and allow female employees time off or changes to their shifts when necessary.

Gadgets and cosmetics

One symptom getting more attention presently is vaginal atrophy: menopause causes skin in this intimate area to dry out and become painful. New products such as internal moisturisers like YES VM, which rejuvenate the dry or damaged tissues, are proving popular.

Dr Newson, author of the Haynes Menopause Manual, recommends YES, Sylk and Regelle but warns against shopping for scented moisturisers or using KY Jelly, which has no lasting effect. ‘You can also get a vaginal oestrogen,’ she says, ‘which is not HRT and is safe for most women to use’.

For fans of complementary therapy, the LadyCare Plus+ is an updated version of this popular, discreet magnetic product (about the size of a small coin) that attaches to underwear in the pelvic area to be worn day and night. Fans say it is useful for mood stabilising.

Diet and exercise

A study in the journal Menopause in 2016 found women with sedentary lifestyles had significantly worse menopausal symptoms, including hot flushes, joint pain and anxiety. ‘Pick an exercise that works for you whether that is running or walking the dog. Especially if it helps strengthen the pelvic floor like yoga,’ says Newsom.

Diet matters, too, but while many women try to up their intake of soya and chickpeas, which are high in phytoestrogens – compounds which mimic the effect of oestrogen in the body – ‘there is little evidence they work’. Instead, she advises to ‘cut back on added sugars and processed food and make sure you get adequate calcium to support bone strength.

Think about improving your gut bacteria diversity as that’s important for serotonin levels, to help stabilise and improve your mood’. Cutting down on alcohol and caffeine can also help with insomnia and low mood.

The Daily Telegraph