Maybe you've been told you can't take HRT. Maybe you've had breast cancer, or you simply don't want to. Or perhaps you just want to know what else is out there before you decide. Whatever your reason, you're probably wondering whether going through menopause without HRT means just putting up with it.
It doesn't. You can go through menopause without HRT, and there are other options. The NHS says that if HRT doesn't work for you, you can't take it, or you don't want to, other types of treatment are available.
This guide sets out what UK guidance recognises, what the evidence looks like, and what to ask your GP. It's information to help you have that conversation, not advice to choose one thing over another.
See your GP if:
- you take HRT and are thinking of stopping or changing it. Please don't stop prescribed HRT on your own. Talk it through with your GP or menopause nurse first.
- you have any bleeding after 12 months with no period. The NHS says it needs checking. See bleeding after menopause.
Can you go through menopause without HRT?
Yes. HRT is a choice, not a requirement. NICE's menopause guideline (NG23), which UK doctors follow, says doctors should talk through the benefits and risks of each option with you.
It's worth being honest about where HRT stands, so you can decide with all the facts. Women's Health Concern, the patient arm of the British Menopause Society, calls HRT the most effective treatment for menopause symptoms and, for most, a low-risk option. NICE says doctors should offer it for hot flushes and night sweats.
But HRT isn't right for everyone. The British Menopause Society notes that some women can't take hormonal treatments, and that most guidelines treat oestrogen as unsuitable after breast cancer for now. It also says many women look for non-hormonal options first.
So the question isn't really "HRT or nothing". It's "what else is there, and what might suit me?"
What does NICE recommend instead of HRT?
NICE recommends several things doctors should consider if you can't take HRT or would rather not. Here they are in plain words.
Menopause-specific CBT
In 2024, NICE added menopause-specific cognitive behavioural therapy (CBT) as an option. It says doctors should consider it for:
- hot flushes and night sweats, on top of HRT or for women who can't take it or prefer not to
- sleep problems linked to night sweats, such as waking in the night
- low mood linked to hot flushes, when it isn't full depression
NICE says CBT can be face to face or remote, one to one or in a group, or a self-help option. We explain more about what it involves below.
Fezolinetant: a newer non-hormonal medicine
Fezolinetant is a non-hormonal tablet for hot flushes and night sweats. NICE's guidance on fezolinetant, published in March 2026, says it can be used for moderate to severe hot flushes when HRT is unsuitable.
The British Menopause Society says it works on the part of the brain involved in hot flushes, and that liver tests are advised before and during treatment. If you think it might be an option, ask your GP whether it would suit you.
Other prescription medicines
There are older non-hormonal medicines too. The NHS says that if CBT doesn't help with flushes and sweats, a doctor may suggest clonidine or an antidepressant. NICE says these shouldn't routinely be the first thing offered for hot flushes on their own.
The British Menopause Society lists several others that specialists sometimes use. Which one, if any, is right depends on your health and other medicines. That's a conversation for your GP or a menopause specialist. NICE suggests a referral to a specialist if you can't take HRT or it isn't clear what will suit you best.
Help for vaginal dryness
Vaginal dryness and soreness are common and often get worse with time. NICE says doctors should offer vaginal oestrogen (a cream, gel, tablet, pessary or ring) for these symptoms. This works in the vagina, and NICE says only a minimal amount is absorbed into the bloodstream compared with HRT.
If you'd rather not use any hormones, NICE says doctors should consider non-hormonal vaginal moisturisers and lubricants. If you've had breast cancer, NICE says these should be offered first. See our page on vaginal dryness for more.
What is CBT for menopause, and what does it involve?
CBT is a short talking therapy. Women's Health Concern's CBT factsheet describes it as a brief, non-medical approach that can help with stress, low mood, hot flushes, night sweats, sleep problems and tiredness. It can be used on its own or alongside HRT.
It looks at the links between your body, your thoughts, your feelings and what you do. For hot flushes, that might include:
- Paced breathing. Slow, even breathing from your stomach, used at the start of a flush.
- Calmer thoughts. Swapping "Everyone's looking at me" for "I notice my flushes more than other people do."
- Staying put. Where you can, staying in the situation rather than leaving, so you learn you can manage.
- Spotting triggers. Keeping a short diary of what happened just before each flush.
For night sweats and sleep, it adds good sleep habits and ways to stay calm when you wake. We've written more about this in our guides to CBT for menopause and waking at 3am.
Lifestyle changes: what the NHS suggests
None of these are a replacement for treatment if you need it. But the NHS suggests a number of everyday things that can make symptoms easier to live with.
For hot flushes and night sweats:
- wear light layers and keep your bedroom cool at night
- take a cool shower, use a fan or have a cold drink
- notice and cut back on triggers such as spicy food, caffeine, hot drinks, smoking and alcohol
For your health more generally:
- exercise regularly, including weight-bearing exercise for your bones
- eat a balanced diet, with calcium-rich foods like milk, yoghurt and kale
- keep to a regular sleep routine
- try relaxing things such as yoga, tai chi or meditation
- talk to other women going through the same thing
- don't smoke, and keep alcohol within the recommended limits
Women's Health Concern adds a target of 150 minutes of exercise a week, and fewer than 14 units of alcohol with at least two alcohol-free days.
To be honest about the evidence: a 2023 review by The Menopause Society, a large North American body for menopause doctors, did not recommend cooling tips, avoiding triggers, exercise, yoga or relaxation on their own as treatments for hot flushes. The evidence that they change how often flushes happen is limited or mixed. These habits are still good for your health, sleep and bones.
Herbal remedies and supplements
Many women try these first, so it's worth knowing what the guidance says. We don't recommend any particular product.
- NICE says the safety, quality and contents of unregulated products may be unknown. It says there's some evidence for isoflavones (from soya) and black cohosh, but products vary, their safety is uncertain, and they can interact with other medicines.
- The NHS says there's very little evidence on how well or how safely red clover and black cohosh work.
- St John's wort: NICE warns women who have had breast cancer that it can interact seriously with some medicines, including tamoxifen and blood thinners.
- The British Menopause Society points out that in menopause studies, the placebo effect alone can be as large as 30 to 50%.
The NHS advice is simple: talk to a doctor or pharmacist before taking herbal supplements or complementary medicines, especially if you take anything else.
What research has looked at for clinical hypnosis
Clinical hypnosis has been studied for hot flushes, mostly by one research team in the US.
One of the main trials, published in 2013, included 187 women after menopause with frequent hot flushes. They had five weekly sessions of either clinical hypnosis with a trained therapist or a comparison programme without hypnosis. After 12 weeks, the women in the hypnosis group reported about 74% fewer hot flushes, against about 17% fewer in the comparison group.
The Menopause Society's 2023 review recommended clinical hypnosis for hot flushes, alongside CBT and some prescription medicines. The British Menopause Society lists CBT with self-hypnosis among the self-help approaches that have been used. NICE's guideline does not mention hypnosis.
The research has real limits. The studies are fairly small, and most come from a single team. We've set out the trials and their limits in detail in hypnotherapy for menopause: what the research says.
Thinking about stopping HRT?
If you're already on HRT and want to come off it, that's your choice to make, but please make it with your GP.
NICE says that if you stop, you should be offered the choice of cutting down gradually or stopping straight away. It says cutting down gradually may stop symptoms coming back as much in the short term, but it makes no difference in the longer term. NICE also says your doctor should explain that symptoms may return when you stop, and that you can restart if you need to.
Don't stop or change any prescribed medicine without talking to your GP or pharmacist first.
When to see your GP
See your GP or practice nurse if:
- symptoms are affecting your sleep, work, relationships or mood
- you can't take HRT and want to know your other options
- you're on HRT and want to stop, change or review it
- you have any bleeding after 12 months with no period
- you feel low most of the time, or anxious in a way that's new for you
It may help to bring a list of your symptoms. Our perimenopause symptoms page can help you put one together.
Where relaxation fits in
Whatever you decide about treatment, it can help to have something calming to turn to when hot flushes leave you feeling flustered. Cool and Calm, our hypnosis download for menopause hot flushes, is a gentle relaxation with cooling imagery, to help you unwind and feel calmer. It's also part of The Calm Change, our set of menopause hypnosis MP3s, which includes recordings for sleep, anxious moments and foggy days. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.
Related: hot flushes, menopause mood swings and how long does menopause last.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
