This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What is the Menopause?

You have reached the menopause if six months have passed since your last period. Around this time, the ovaries stop producing eggs. As the ovaries close down, they produce smaller quantities of the hormones that had been building up the lining of the womb every month to make the body ready for pregnancy. As well as regulating periods and maintaining pregnancy, the hormone oestrogen triggers all the changes in the female body that begin at puberty. So, as oestrogen production declines, the body starts to change.

When does the menopause usually start?

Nowadays, the average age for a woman's last period is 51, though changes quite often begin in the early forties. Many women have menopause symptoms and irregular periods for several years before their periods finally stop altogether. This time in a woman's life is called the climacteric, or 'perimenopause', when the ovaries gradually stop their normal functioning.

The experience of menopause can vary a great deal. It might feel like a blessing to some women. For most, it just means fewer, more irregular, lighter periods, with maybe a few mild menopausal problems, which gradually stop after two to five years. But there can be downsides. Though the menopause isn't a disease - in fact it's a natural, inevitable phase of life - for some women it can be a real challenge.

There are emotional and psychological changes to adjust to, as well as physical ones. A woman's sense of who she is, and her place in the world, may be changing as well. For as many as 4 in 10 women, some menopausal changes are bothersome but only a few have unpleasant symptoms that last many years after their periods have stopped.

What problems are common at the menopause?

Hot flushes and night sweats
usually lasting for just a few minutes. Your face, neck and chest may go red and blotchy. You might start to sweat and feel your heartbeat get faster. When these flushes happen at night, they are known as night sweats. As a rule, hot flushes are at their worst for a year or so after the last period.

Sleep problems
Not surprisingly, night sweats can make it difficult to sleep. Some women also feel more anxious during the menopause, and this may also disturb sleep. Poor sleep can affect your mood, memory and concentration.

Vaginal dryness and soreness
Oestrogen is a sex hormone. When there is less of it in the blood, the vaginal lining gets thinner and doesn't produce as much fluid. When there is less lubricating fluid and the vagina gets drier, it may feel itchy and sore. This inflammation - called atrophic vaginitis - may also affect the bladder and urethra, and make you more likely to get cystitis and thrush.

Sexual issues
Sex hormones have a lot to do with sex drive. Yet some women find their interest in sex is unaffected; or even that, once free of periods and the chance of pregnancy, their sex drive and enjoyment get stronger. But more often, interest in sex and the need for it reduce around the menopause. And of course if vaginal dryness and urinary problems make having sex uncomfortable, this will reduce interest all the more. Together, these changes may make the stress and discomfort some women feel around the menopause even worse.

Medical treatment for menopause problems

According to NHS Choices around one-third of women experience some or all of the above symptoms shortly after the menopause, and slightly more women have them later on - more than 10 years after their final period. These problems can be treated by your GP. But if left untreated, they tend to continue or get worse.

HRT or not HRT? That was the question
For years Hormone Replacement Therapy (HRT) was the treatment of choice for the discomforts of menopause. It wasn't a perfect answer but at first it looked like a 'win-win' treatment. (As women get older, they face a growing risk of having heart disease and a stroke; HRT was thought to prevent these problems.) Then the Women's Health Initiative found the opposite - that women on HRT were more likely to have a heart attack or a stroke, and more prone to get breast cancer.

HRT today
Because of these safety fears, the number of women in the UK taking HRT fell from 2 million to fewer than 1 million between 2003 and 2007. But lately medical opinion has changed about the balance of benefit compared to risk. Doctors now seem to be moving back towards offering HRT to women whose hot flushes and atrophic vaginitis are persistent and moderate to severe. Research has shown that low-dose oestrogen is effective for many women, although some require larger doses to relieve hot flushes.

But because HRT is not risk free, doctors recommend that patients should take the lowest dose that relieves their symptoms (possibly using a vaginal cream rather than a pill), and for the shortest amount of time (depending on the problem). It is also best used by women early on in their menopause. HRT is not recommended for women with a high risk of stroke, heart disease, blood clots or breast cancer. And HRT users should be re-assessed by their GP at least once a year.

To find out more about HRT treatment, visit Women's Health Concern

Looking on the bright side
Having hot flushes may cut your risk of developing breast cancer by as much as half, according to a recent US survey of 1,437 postmenopausal women. They were asked about various menopausal symptoms, including hot flushes, night sweats, insomnia, vaginal dryness, irregular or heavy menstrual bleeding, depression and anxiety. Those women who said they had suffered from hot flushes had the lowest risk of developing breast cancer.

Further information and advice

For more information visit:

When to see your doctor

Only 10% of women ask for medical advice during their menopause and many do not need treatment. But if your symptoms are severe and interfere with your daily life, your GP can suggest treatments that may help. For more information, visit NHS Choices.

If you have recently started taking new medication, speak to your pharmacist about whether this might be the cause of your problems.

Other information that might be helpful:

Spotting (light bleeding) after the menopause is not unusual. The cause is usually something minor but it occasionally it can be an early sign of a more serious problem, such as a tumour. Perhaps this is only the case in 5-10% of women who bleed after their periods have stopped but it is obviously important to see a doctor and find out the cause so it can be properly treated. Always seek medical advice if you notice spotting after periods have stopped.

simplechangesMake Some Simple Changes

pencil 12 Menopause diet tips

OverviewThere is still a lot more research to be done, but it looks as if the right foods could help reduce hot flushes and protect you from heart disease. This is important because after the menopause women become just as prone as men to heart disease.

Here are 12 dietary tips that may ease menopause symptoms:

1 Eat more phyto-oestrogens. These are plant chemicals, found in some fruit, vegetables, beans and seeds, which act like weak forms of oestrogen. They might ease menopausal symptoms slightly if you eat enough of them and eat them regularly.
2 Eat more fruit and vegetables. As well as phyto-oestrogens, they contain vital vitamins and minerals, including boron, which seems to help the body keep hold of oestrogen and calcium.
3 Eat tofu and other soy products. This is not because they help prevent hot flushes, or (as it used to be said) reduce 'bad' cholesterol, but because they are very healthy, low-fat, high protein foods. Soy products are rich in fibre, omega-3 oils, and essential protein. They have more vitamins and minerals than meat or dairy proteins, and contain 'good' (polyunsaturated) fats, which are healthier than the saturated fats found in meat, butter and cheese.
4 Eat beans and sprouted seeds. They are full of fibre, contain phyto-oestrogens, and may help keep your blood sugar at an even level. (Sudden rises in blood sugar may encourage hot flushes.)
5 Eat more of the right fats. Some fats are harmful. Some, such as omega-3 oils (found in oily fish like mackerel and olive oil), help prevent heart disease and cancer. But saturated fats and trans fatty acids (found in manufactured baked goods, and deep-fried foods such as chips) make us more prone to heart disease, diabetes and possibly prostate and breast cancer. So it makes sense to switch to olive oil, and eat more fish and less animal fat.
6 Reduce alcohol and caffeine. As well as cutting down on tea, coffee and alcohol, you should increase your intake of fruit juices and vegetable juices because they are rich in phyto-oestrogens and anti-oxidants
7 Snack, don't feast. Eat frequent small meals to keep your blood sugar level even. Don't miss breakfast - it gives you the energy boost you need first thing in the morning. Have light lunches and no late-night big meals when you're about to rest and your body will store the surplus as fat.
8 Eat calcium-rich foods. You can get calcium not just from milk products but also from seeds and grains. Taking in enough calcium helps maintain strong bones.
9 Shun foods that are high in fat and sugar. Preventing weight gain is important. Women don't just 'naturally' gain weight when their periods stop. Keeping your fat and sugar intake low will help you control your weight.
10 Add ground-up flaxseed to your food. This is one of the richest plant sources of phyto-oestrogen and also provides the vegetable version of the omega 3 oil that helps prevent harmful blood clots. But note that bottled flaxseed oil does not contain phyto-oestrogens.
11 Take vitamin D supplements if you need them. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. If your diet is poor and you don't get into the sun, ask your doctor about a vitamin D blood test. If it's normal, there's no point in taking vitamin D. If it's low, your GP will prescribe it for you.
12 Exercise so that your body burns fat faster. Exercising will help lower your blood cholesterol levels, improve your mood, reduce bone loss, boost your circulation and heart health, lower your risk of getting breast cancer and make your heart and lungs work better.

pencil Cutting down caffeine

OverviewIt can be tempting to reach for stimulating drinks like tea, coffee, colas or so-called 'energy drinks' if you're tired and need a boost. They can give you a quick lift, but if you rely on them for long they only keep you going until your energy stores run down further. We didn't find any good studies linking caffeine and hot flushes, but since they both affect sleep it makes sense to avoid caffeine later in the day.

pencilTreatment Options:

simplechanges Cutting down on alcohol and stopping smoking

OverviewSince smoking and excessive drinking undermine your overall health (and can affect how tired you feel), there is every reason to cut down on them or, better still, cut out smoking completely.

Red wine contains a substance called resveratrol, which is a phyto-oestrogen and has oestrogen-like effects. One small glass a day may be good for the heart. But alcohol pushes calcium out of the body, and three or more glasses of wine per day increases the risk of getting osteoporosis. And the more alcohol you drink, the greater your risk of developing breast cancer. Women who have 2 to 5 drinks a day have 1-2 times the risk of women who drink no alcohol.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.
EvidenceIt does seem that alcohol and smoking may make hot flushes worse. A survey of 28,000 women in France found that smokers and drinkers were more likely to get menopausal symptoms.
SafetyThere are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you're cutting down.
CostThere are no costs. In fact you will save money.
Find out moreFor more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.
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simplechanges Exercise

OverviewTaking exercise does more than keep you fit. It makes your heart and lungs work better, tones your muscles, strengthens bones and joints. It also stimulates circulation to your brain and internal organs and boosts the immune system. It helps protect against osteoporosis, burns up body fat, triggers brain chemicals that lift your mood and can generate a glowing sensation of well-being.

A researcher who studied the effects of exercise on women after menopause said, 'It doesn't always have to be sports! In our calculations we have also taken account of activities such as gardening, cycling or walking to the shops. Our advice to all women is therefore to stay or become physically active in the second half of your life. You will not only reduce your risk of breast cancer, but it has been proven that your bones, heart and brain also benefit from it.'

Dr A. Heather Eliassen and her colleagues monitored the weight gain of 87,000 American women for 26 years. Based on their research, they calculated that gaining 22 pounds (10 kg) after the menopause increased the risk of developing breast cancer by 18%, but losing 22 pounds (10 kg) after the menopause reduced the risk by 57%.

Note: Exercise training can include aerobic forms such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretches for flexibility. Other popular types of exercise are Tai Chi, Qigong and yoga.
EvidenceWhile exercise has huge benefits on general health and wellbeing, there has not been enough research to decide whether it helps to prevent hot flushes. But physical activity has been shown to improve all sorts of health problems. It reduces the risk of hormone-dependent breast cancer (the commonest kind after the menopause) and helps prevent heart disease. For mild to moderate depression, it can be as effective as anti-depressant medication.
SafetyIf you're not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise.
CostNo costs are involved if you are exercising at home, although you should get advice on the best exercises to do from a trainer or fitness professional first. There may be a small cost if you join an organised exercise programme.
Find out moreNatural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.
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simplechanges Healthy Diet

OverviewIt is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Your diet should also be low in fat, sugar and salt. Improving your diet could help with your mood.

When your periods stop and your oestrogen levels go right down, your total cholesterol level rises. Research has shown that one type of cholesterol is bad for the body, while another type protects health. During the menopause, 'bad' cholesterol rises, while 'good' cholesterol levels fall.

Previous research suggested that soy products could help lower cholesterol and so prevent heart disease. But later research has indicated that this might not be the case; at least not if you only eat 25 g of soy protein a day. Nevertheless, soy products (such as tofu, soy butter, soy nuts and some soy burgers) are healthy foods because of their polyunsaturated fats, fibre, vitamins, minerals and low saturated fat. Eating less animal protein (which contains saturated fat and cholesterol) and substituting soy foods should therefore be good for the health of your heart.
EvidenceIt seems that some foods can make hot flushes worse. For instance, a survey of 28,000 women in France found that those who ate sugary snacks were more likely to get menopausal symptoms.
SafetyIf you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
CostEating a healthy diet and reducing or excluding some foods need not cost you anything. This is especially true if you prepare your own healthy meals, rather than buying costly ready-meals, which often contain a lot of hidden fats, salt and sugar. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice.
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simplechanges Phytoestrogen-rich foods

OverviewSome plants contain substances called phyto-oestrogens, which act in a similar way to oestrogen and may help to ease menopausal symptoms. But these foods have a much weaker effect on the body than oestrogen, and some may even have an 'anti-oestrogenic' effect. So it is difficult to predict which ones will be helpful. There are three kinds of phyto-oestrogens:

1 Isoflavones - good sources are soy products and pulses (such as lima beans and lentils).
2 Lignans - good sources are fruit, vegetables, grains and oilseeds (such as linseed).
3 Coumestans - good sources are sprouting seeds (such as alfalfa).

Many women now eat soy products as part of their everyday diet. The available evidence suggests that if you eat enough of them they might help mild to moderate hot flushes in early natural menopause. However, unlike synthetic HRT, none of the compounds researched so far seems to protect against breast cancer, bone fracture or heart disease.

Though phyto-oestrogens might help ease menopausal symptoms if you eat enough of them regularly, we don't yet know how much is needed or how often. In fact the research to date has not proved that phyto-oestrogen foods or supplements are good for menopausal problem. Nevertheless, whole grains, ground flax and soy proteins are still great health-supporting foods, whether or not they have special benefits during the menopause.
EvidenceThere have been lots of small studies of how different sorts of phyto-oestrogens affect menopausal symptoms. The results have been rather mixed, so we can't firmly recommend adding them to your diet. But they are definitely safe, inexpensive, low-fat, high-protein food items.
SafetyEating normal quantities of phyto-oestrogen-rich foods is unlikely to have any harmful effects. in fact these foods are generally very healthy.
CostNo extra costs are involved if you prepare your own healthy meals using tofu, soy milk, pulses, whole grains, seeds, vegetables and fruit, rather than buying costly ready-meals, which often contain hidden fats, salt and sugar.
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simplechanges Relaxation techniques

OverviewRelaxation will help with sleep problems, and with managing stress and coping with the tension or anxiety that women experiencing hot flushes and other menopausal symptoms often feel. Relaxation techniques are useful during rest periods or for helping you sleep.
EvidenceRelaxation techniques have been found to help reduce hot flushes in several research studies.
SafetyThese techniques are generally safe unless you have a severe or long-standing mental health problem. For more on this, see our leaflet on Stress and Anxiety.
CostYou may need to buy a tape or book but this will be a one-off cost.
Find out moreRelaxation techniques can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book. See the information about yoga in the Classes section and our leaflet on Stress and Anxiety. Visit The British Holistic Medical Association for podcasts and leaflets.
Cost: Safety:

buysomethingBuy Something

pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

pencil Complementary and alternative treatments for hot flushes

OverviewGiven the debate about the risks of HRT, it is not surprising that many women look for alternatives. Several surveys have shown that women are particularly likely to try complementary and alternative treatments during the menopause. Many of these therapies might be worthwhile but, if no clinical trials have been carried out, we can't be sure whether they really work.

Many of these products may not always be manufactured as strictly as standard medical products. For example, there are some concerns about liver damage from black cohosh (see below). It appears that this this sort of liver damage is linked to inferior and possibly dangerous substitutes for black cohosh. Recent market surveys have shown that one-third of black cohosh products do not contain the real herb. This is an important reminder that you should only to buy products that have been independently certified as coming from reliable suppliers.

Very large research projects have been carried out on HRT, so we know a lot about its side-effects. But some herbs may have side-effects too. Generally, it's best to be cautious. Treatments such as ginseng, black cohosh and red clover are supposed to be oestrogen-like in their effects. Although we do not know how they actually work, they ought not be used in women who need to avoid oestrogen (such as women with breast cancer). Nor are we clear about their long-term effects on the breast and uterus.

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buysomething Black cohosh (Cimicifuga racemosa or Actaea racemosa)

OverviewThis herbal medicine from North America is also known as Squaw Root. It contains a plant oestrogen, but studies have shown mixed results.
EvidenceSome research suggests that black cohosh may help with hot flushes but not all studies show this. Researchers have also found that black cohosh in combination with other herbs (including St John's wort) appeared more effective than black cohosh alone. Evidence for side-effects was uncertain.
SafetyThere have been a few reports of liver disorders among women using black cohosh. Though these reactions in the liver appear to be rare, women taking black cohosh should be aware of this possible risk and take special care to use only high-quality black cohosh products from reputable suppliers.
Cost: Safety:

buysomething Dong quai (Angelica sinensis)

OverviewThis traditional Chinese herbal 'tonic' for women has been promoted as a treatment for hot flushes but there is no supporting evidence for its effectiveness.
EvidenceResearchers have not found that dong quai helps hot flushes or other menopausal symptoms.
SafetyDo not take it if you are on blood-thinning drugs such as warfarin.
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buysomething Evening primrose oil (EPO)

OverviewEvening primrose is a yellow, flowering plant that blooms in the evening. It contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can't make GLA so we need to get it from our food.
EvidenceThere is some evidence suggesting that evening primrose oil may help breast pain associated with the menstrual cycle, and premenstrual syndrome (PMS). But it does not appear to help menopausal problems.
SafetyEPO is generally safe in recommended doses. Reported side-effects are rare and mild. Stomach pain and loose stools may mean you are taking too much.

If you get seizures (e.g. epileptic fits) be careful with omega-6 supplements such as EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.
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buysomething Red clover (Trifolium pratense)

OverviewResearch findings on how supplements made from red clover extracts affect hot flushes are mixed. Most studies say that taking them for up to a year does not help hot flushes or night sweats. There is also no evidence that taking red clover supplements for three months to a year will reduce 'bad' cholesterol or increase 'good' cholesterol or increase bone strength in women.
EvidenceAccording to two reviews of research, red clover supplements may produce a slight to modest reduction in the number of daily hot flushes.
SafetyPhyto-oestrogen supplements may contain far more phyto-oestrogens than foods. Long-term use of these supplements might possibly affect the risk of getting some types of cancer, particularly breast cancer.
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buysomething Soya-based supplements

OverviewThe active ingredients in soy are called isoflavones. Supplements containing concentrated isoflavones are available in pharmacies and health food shops. But there is no guarantee that the content shown on the label is accurate.
EvidenceA review of research compared women on HRT with women taking soy-based supplements. Women on HRT had 24 fewer hot flushes per month. Women on soy supplements had 12 fewer, and all had fewer than those who took a 'dummy pill'. The study did not look at whether eating soy rich foods has the same effect on hot flushes
SafetySoy supplements may contain far more phyto-oestrogens than foods. Long-term use of these supplements might possibly affect the risk of getting some types of cancer, particularly breast cancer. Some women get nausea, bloating, and constipation when they take soy supplements.
CostA month's supply costs about ten pounds.
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buysomething Wild yam (Dioscorea villosa)

OverviewWild yam creams are advertised as a natural form of HRT to be rubbed into the skin. But, despite such claims, this plant does not contain any progesterone-like ingredient. The root and the bulb of the plant are used in laboratories to make progesterone and the contraceptive pill. Although wild yam (like black cohosh) contains oestrogen-like substances, the human body cannot convert them into female hormones.
EvidenceAccording to research carried out to date, using wild yam cream for three months doesn't help with hot flushes or night sweats.
SafetySome commercial herbal wild yam products, especially those bought from Internet retailers, may contain illegal prescription progesterones.
Cost: Safety:

attendvisitAttend Classes / Visit Practitioner

pencil Dealing with psychological problems

OverviewMany women don't have mood problems during the years around menopause. But for others it can be a time of mood swings, sadness, irritability, unpredictability or anxiety and depression. It can sometimes be difficult to know whether these feelings are due to the menopause or to other changes occurring in your life.
Feelings about ageingHow do you feel about becoming an older woman? It can be hard to come to terms with ageing in a society that puts such a high value on youthfulness. Leaving fertility and child-bearing behind can feel like a real loss too. And your body may be changing in ways you don't like very much. But if getting older leaves you feeling sad or angry, it could be more about your attitude to aging than about hormonal changes. We are all living longer these days. If 'sixty is the new forty' there will certainly be life after the menopause - possibly for several more decades. Think about what you need to do to move forward, accept what's changed and explore new possibilities. Getting older may bring new opportunities as well as challenges.
Hormonal irritability?Some women are very sensitive to changes in hormone levels. Problems such as premenstrual tension and post-partum depression aren't all in the mind; they may be linked to falling oestrogen levels. If you've been sensitive to hormone dips in the past then this may happen again around the menopause. Oestrogen also helps regulate production of serotonin, a brain chemical that helps stabilise mood. When your oestrogen levels start to drop, so might your supplies of mood-smoothing serotonin. If you think this might apply to you, ask your doctor about possible treatments including the possibility of trying HRT.
Poor sleep?Night sweats can deprive you of refreshing sleep. And if you snore, sleep apnoea might be stopping you from getting as much sleep as you need. In addition, during the menopause years you are more likely to feel anxious or depressed, and this will disturb your sleep. Tiredness and irritability go hand in hand but these problems can be diagnosed and treated.
Too much going on?Mid-life is often the busiest time of life. Changes are inevitable and they can feel stressful. House moves, children leaving, job changes, marital issues or loss of a partner, ageing parents; the list goes on. There may be no escaping major shifts in your life, but you can still learn to calm your body and mind down. Getting support, learning to relax and manage your time, and choosing a healthy lifestyle, will all help make you more resilient.

pencil Previous depression

OverviewIf you have been treated for depression before, then you're more likely to feel this way again during the menopause. If you suspect that you are not just feeling low, but may be depressed, get advice from your GP or counsellor at an early stage.

Symptoms of depression include:

- sadness throughout the day, nearly every day
- loss of interest in or enjoyment of your favourite activities
- feelings of worthlessness
- excessive or inappropriate feelings of guilt
- thoughts of death or suicide
- trouble making decisions
- fatigue or lack of energy
- sleeping too much or too little
- change in appetite or weight
- trouble concentrating
- feelings of restlessness or being slowed down.

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attendvisit Acupuncture

OverviewAcupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.
EvidenceSome studies suggest that acupuncture can help, but all the studies have been small and only a few have been carried out. The results overall don’t prove that acupuncture helps with hot flushes.
SafetyAcupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit Homeopathy

OverviewThe basic principle of homeopathy is that 'like cures like'. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body's self-healing processes into action. Homeopathy has been called 'unscientific' because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains.
EvidenceA large study carried out in eight countries seemed to show that treatment with homeopathy helped women with hot flushes. But the study did not prove this fully because homeopathy was not tested against another treatment. Homeopathy does not seem to be effective for flushes experienced by women being treated for breast cancer.
SafetyHomeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms at first but this generally only lasts a short time.
CostThe monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £20-£50.
Find out moreIt is important to find a practitioner who is registered with one of the following professional organisations:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths
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attendvisit Massage

OverviewThere are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils that practitioners believe have special healing properties.
EvidenceWe could not find any useful research on the effectiveness of massage or aromatherapy for hot flushes.
SafetyMassage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Finding a practitionerIt is important to find a qualified practitioner such as someone registered
The General Council for Massage Therapies
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attendvisit Psychological therapies

OverviewWhen people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

CBT is effective for depression, but it also appears to help women with hot flushes.
EvidencePsychological treatment may help symptoms of menopause. But women included in some of the studies also took medication so it is difficult to be certain.
SafetyThese techniques are safe in most people if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Finding out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises and some types are much more strenuous than others. Others focus more on meditation, breathing and relaxation.
EvidenceIt is not clear whether yoga will help with hot flushes but many yoga classes include relaxation, which is likely to be helpful.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
CostOnce you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services.
To find a qualified teacher near you see also the The British Council for Yoga Therapy and the The British Wheel of Yoga
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