How to handle the menopause without HRT by changing your diet and routine

The prospect of the menopause can seem daunting. Increasing numbers of women are sharing tales of hot flushes, brain fog, mood swings, crashing libido, dry eyes, aching joints, sleeplessness and weight gain. And thanks to a new openness around "the change" – and campaigning by celebrities such as Davina McCall, Meg Mathews and Penny Lancaster – more women than ever are asking for hormone replacement therapy (HRT).

For many, it's a life-saver enabling them to conquer sometimes debilitating symptoms or to simply sleep through the night. But others – including breast, ovarian and uterine cancer survivors – feel excluded as they’re unable to take HRT because it's not safe. Women with untreated high blood pressure or those prone to blood clots are also advised by the NHS to steer clear.

Meanwhile, other women try HRT expecting miracles, only to be left feeling disappointed. "HRT doesn't work for some women," says Professor Annice Mukherjee, consultant endocrinologist and honorary professor at Coventry University. "It can cause side effects such as weight gain and breast lumps. Paradoxically, it can sometimes worsen sleep and anxiety.

"When it works, I want to prescribe it to everyone," she stresses. "There are some women who want to take it for ever. They don't want to stop and they shouldn't have to. But some women come back to me saying, ‘this is supposed to be a miracle cure, why aren't I feeling better?’ There's a sense of FOMO for those who can't take HRT."

Menopause symptoms can last between two and 10 years, with the average of seven years, but Professor Mukherjee says that only 25 percent of women will experience them severely. These include hot flushes and night sweats (vasomotor symptoms), lack of sleep, irritability, anger, weight gain and vaginal issues such as dryness, itching and soreness.

"Some women don't get any symptoms at all, and some unlucky women will continue to have them life long, particularly the vasomotor symptoms. It's very individual," she says. "The primary role of HRT is to manage menopause symptoms caused by their changing hormone levels and the lack of balance between oestrogen and progesterone."

So why doesn't it work for everyone? "HRT doesn't give hormones back in the same way that we produce them naturally," she says. And some women seem to see HRT as a cure for being overstretched and stressed."Weight gain, insomnia, anxiety and fatigue are arising across society from the demands of modern life," says Prof Mukherjee.

"Women in midlife are under a lot of pressure. They have teenage children, they’re caring for elderly parents and holding down demanding jobs. And there is a lot of pressure on them to continue with their busy lives."

Fortunately other treatments can help. "Vaginal oestrogen suits most women and there are medications that can stabilise an overactive bladder," she says. "There's evidence that CBT can be very helpful with a range of symptoms, particularly insomnia, as it helps reframe your perspective. A new medication, fezolinetant, that works on hot flushes and night sweats by targeting a brain neurone receptor that's been identified as the origin of the vasomotor symptoms rather than low oestrogen, should be coming to the UK in the next year or so."

But underpinning it all is the need for a healthy diet and regular exercise. "Lifestyle is crucial for healthy ageing," says Professor Mukherjee. "We also know that a healthy lifestyle is the best way to reduce the risk of dementia and heart disease. Smoking makes symptoms worse and alcohol increases fatigue and health risks."

HRT can be an important part of your toolkit but there's not enough discussion about how other things like food and movement can help balance hormones.

Nutritionist Karen Newby, author of The Natural Menopause Method, shares the changes women can make to their diets to ease symptoms: "I want to help women get back in control, and that means listening to your body, understanding it and working with it."

Have a big protein-rich breakfast such as eggs, or full fat yoghurt with high protein granola, blueberries (flavonoids for your brain) and ground flaxseed (phytoestrogen to help smooth your oestrogen levels), giving the body micronutrients and energy at the beginning of the day, rather than at the end.

Follow with a good lunch made up of 25 per cent of protein (including oily fish, white fish, organic meat, legumes, pulses, tempeh or quinoa), 40 per cent vegetables (including sauerkraut and kimchi and brassicas such as broccoli), 10 per cent wholegrains, 10 per cent healthy fats (nuts, seeds, olive oil, avocados and kefir), 10 per cent whole fruit and five per cent herbs and spices. Buddha bowls are easy options with pulses, hummus, sauerkraut, falafel, avocado, leaves, tomatoes, leftover chicken, smoked mackerel or tofu.

Supper should be earlier than most of us eat in the evening – around 6pm or 6.30pm. Simple and quick plant-based dishes work well – think ramen, or spicy Thai soup, cod and spinach curry, roasted miso veg or veggie traybakes. Leave a 12 to 14-hour fasting window overnight.

Have your first coffee or tea of the day with food. Having caffeine without food – particularly when you’re stressed – will make you feel jangly and need more.

Our modern diet is laced with sugar and the body can't deal with it. Increase the protein, essential fatty acids, especially Omega-3 and opt for complex carbohydrates, such as wholegrains, over refined carbs, and aim to eat 30-plus unique plants a week. Your diet will shift to being high in protein, essential fats, fibre and contain a tsunami of nutrients.

Increase your antioxidant-rich plants to help with brain fog such as blueberries, pomegranates, plums, cherries, kale and broccoli. We’re often low in magnesium so incorporate pumpkin, sunflower and sesame seeds, cashews, oats, spinach and black-eyed beans.

Cut back on meat and dairy which are pro-inflammatory.

Phytoestrogens – found in a huge range of plants including tofu, tempeh, miso and edamame, ground flaxseed and alfalfa – have a mild oestrogenic effect on the body and can blunt the rollercoaster of unopposed oestrogen which causes heightened PMT, rage, breast tenderness and heavy periods as well as drops of oestrogen that can trigger migraines and hot flushes.

When oestrogen is low phytoestrogens bind to receptor sites, and when oestrogen is too high they can block it. There is also research showing they’re protective post breast cancer and for oestrogen sensitive conditions such as fibroids.

Omega-3 fatty acids are anti-inflammatory and can help with low mood, slow mental processing, cracked heels, dry skin and morning stiffness. Eat salmon, sardines, trout, mackerel, nuts and seeds such as flaxseed. A teaspoon of flaxseed oil a day can also help with cholesterol, which can increase at menopause.

Clare Fone, physiotherapist and co-founder of Westminster Physio (@clarefone_lifestylephysio) says the foundations of a healthy body and mind are nutrition, movement, sleep, mental fitness and connection, but they’re so easy to ignore at this time of life when stress is at its height.

"The body is made to move – so go for a walk, swim or do yoga. I offer physical and online classes called PhysioYogaLates, which incorporates biomechanics, yoga, Pilates, ballet, tai chi and qi gong. Strength training is important too as we lose muscle mass as we age and it helps strengthen our bones.

"The normal activities of daily living such as housework, gardening, carrying shopping and cleaning the car all count. Consider exercising with resistance bands, which are more controlled than free weights."

But Professor Mukherjee reassures that for most women this is a phase that will come to an end. "As your hormones drift downwards your body acclimates to the new level of oestrogen. After menopause, you still produce oestrogen but in smaller amounts from your adrenal glands, fat cells and ovaries, if you still have them. You’re reaching a new lower level. It's stable and when the body adjusts to that the symptoms disappear for most."