Hormone replacement therapy vs non-hormonal menopause treatment

Hormone replacement therapy replaces oestrogen, with a progestogen added when needed to protect the womb lining. It can address hot flushes, night sweats and vaginal symptoms, and may also support bone health. Non-hormonal menopause treatment uses medicines, local products, behavioural measures or psychological approaches that do not supply systemic reproductive hormones. The right choice depends on symptoms, medical history, whether the womb is present, and personal priorities.

Hormone replacement therapy may be considered when menopause symptoms are frequent or affect sleep, work, relationships or daily comfort, especially when hot flushes and night sweats are prominent. It may also be useful when vaginal dryness or urinary discomfort needs treatment, although local options can sometimes be enough. A clinician will consider the type, route and dose rather than treating every person with the same regimen. Read more about [Hormone Replacement Therapy](/treatments/menopause-and-hormone-therapy/hormone-replacement-therapy/).

A non-hormonal approach may suit someone who prefers to avoid hormones, cannot use a particular hormone regimen, or wants treatment aimed at one symptom. Options can include prescription medicines for vasomotor symptoms, moisturisers or lubricants for vaginal discomfort, and structured support for sleep or mood. The treatment still needs a safety check because non-hormonal medicines can interact with other medicines or cause side effects. Explore [Non-Hormonal Menopause Treatment](/treatments/menopause-and-hormone-therapy/non-hormonal-menopause-treatment/).

Hormone treatment can cause breast tenderness, bleeding changes, bloating or headaches, and its suitability depends on individual history. Unexpected bleeding after treatment starts or after a symptom-free interval needs clinical assessment. Non-hormonal medicines may cause effects such as nausea, dizziness, dry mouth, sleepiness or changes in blood pressure, depending on the option. Herbal products are not automatically safer; their ingredients and interactions may be uncertain. Do not stop a prescribed medicine abruptly without advice.

Some symptoms need assessment before treatment is chosen. New vaginal bleeding, chest pain, severe breathlessness, one-sided leg swelling, fainting or a new breast change should be assessed promptly rather than self-treated as menopause. Vaginal or urinary symptoms may need examination for infection or another cause. Lifestyle adjustments, pelvic floor care, sleep support or treatment of an unrelated condition may be combined with either option.

The consultation usually starts by mapping symptoms, menstrual or surgical history, contraception needs, medicines and relevant personal or family history. The clinician then checks whether symptoms are consistent with menopause and discusses hormone and non-hormone choices, including route, timing, expected effects and follow-up. Mention migraine, clotting problems, liver disease, unexplained bleeding, breast or womb conditions, and cardiovascular history. Bring a symptom diary if patterns are difficult to describe.