Approaches

5-HTP

A naturally occurring amino acid and precursor to serotonin. Derived from the seeds of Griffonia simplicifolia. Used for mood support, sleep, and appetite regulation. Relevant to perimenopausal women experiencing low mood, anxiety, and sleep disturbance linked to declining oestrogen's effect on serotonin.

Acupuncture

A traditional Chinese medicine practice involving the insertion of fine needles at specific points on the body. Some clinical trials show modest benefit for menopausal vasomotor symptoms, although NICE notes the evidence is not conclusive enough to recommend it routinely. Used by many women as a complementary approach for hot flushes, sleep, anxiety, and pain.

Alendronic Acid

A bisphosphonate used to prevent and treat osteoporosis, particularly in postmenopausal women. First-line pharmacological treatment for osteoporosis alongside calcium and vitamin D. Reduces the risk of vertebral and hip fractures. Taken as a weekly oral tablet with specific administration requirements.

Anti-Inflammatory Diet

A dietary approach that emphasises whole foods, vegetables, fruits, fatty fish, nuts, seeds, and olive oil while reducing processed foods, refined sugar, red meat, and alcohol. Commonly explored by women with endometriosis, PCOS, and inflammatory symptoms.

Ashwagandha

An adaptogenic herb from Ayurvedic medicine. Used to reduce cortisol, improve stress resilience, support sleep, and enhance energy. Some evidence for improving thyroid function and reducing menopausal anxiety. Increasingly popular among perimenopausal women.

B-Complex

A combination of water-soluble B vitamins including B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), and B12 (cobalamin). Support energy metabolism, red blood cell production, nerve function, and mood. Particularly relevant to hormonal health via their roles in methylation, oestrogen metabolism, and neurotransmitter synthesis.

Bacopa Monnieri

An Ayurvedic herb used traditionally for cognitive enhancement. Studied for memory, attention, and information processing speed. Used by perimenopausal women for brain fog and cognitive decline associated with hormonal changes. Effects typically require 8–12 weeks of consistent use.

Berberine

A bioactive alkaloid found in several plants including goldenseal, barberry, and Oregon grape. Used for blood sugar management, metabolic health, and PCOS-related insulin resistance. Some research compares its glycaemic effects to metformin, though it is not a licensed medicine in the UK.

Black Cohosh

A herbal preparation from the root of the North American black cohosh plant. One of the most widely used herbal remedies for menopausal hot flushes and night sweats. Evidence is mixed; some trials show modest benefit for vasomotor symptoms. Not recommended alongside HRT.

Body-Identical HRT

Refers to HRT using hormones with a molecular structure identical to those produced by the human body — primarily 17β-estradiol and micronized progesterone. These are available as licensed products (patches, gels, Utrogestan) on the NHS and are distinct from unregulated 'compounded bioidentical HRT'. NICE and BMS endorse body-identical regulated HRT as the preferred approach.

Boron

A trace mineral involved in bone metabolism, oestrogen and vitamin D utilisation, and cognitive function. Some research suggests it may support bone mineral density and reduce urinary calcium excretion in postmenopausal women. Also proposed to influence oestrogen metabolism.

Calcium

An essential mineral for bone health, muscle function, and nerve signalling. Postmenopausal women are at increased risk of calcium deficiency and osteoporosis due to declining oestrogen. The UK RNI is 700mg/day, though many postmenopausal women require supplementation alongside vitamin D, particularly if dietary intake is low.

CBT for Insomnia

A structured psychological therapy for chronic insomnia, consisting of cognitive techniques (addressing unhelpful beliefs about sleep) and behavioural techniques (sleep restriction, stimulus control, sleep hygiene). Recommended by NICE as the first-line treatment for chronic insomnia in adults, including menopausal women.

Clonidine

A centrally acting alpha-2 adrenergic agonist originally developed for hypertension. Prescribed off-label in the UK for hot flushes in women who cannot take HRT. Evidence for efficacy is modest compared to HRT, but it remains an option for those with contraindications to hormonal treatments.

Cold Water Therapy

Deliberate exposure to cold water — via cold showers, outdoor swimming, or ice baths — to improve stress resilience, mood, and energy. Popular among perimenopausal women for managing fatigue, hot flushes, and mood changes. Evidence base is early-stage; most data comes from athletic recovery and mood studies.

Collagen Peptides

Hydrolysed collagen protein broken into small bioactive peptides for absorption. Used for skin elasticity, joint health, and bone support. Relevant to menopausal women because oestrogen decline accelerates collagen loss (approximately 30% in the first 5 years post-menopause), affecting skin, joints, and connective tissue.

Combined HRT

Preparations combining oestrogen and a progestogen in a single product, available in sequential (mimicking a cycle) or continuous combined (no bleed) formulations. Suitable for women with a uterus who need both oestrogen and progestogen.

Conjugated Estrogens

A mixture of oestrogen compounds derived from the urine of pregnant mares. One of the most widely studied oestrogen preparations, though largely replaced in the UK by body-identical options. Still prescribed in some cases, including for women post-hysterectomy.

CoQ10

A fat-soluble antioxidant naturally produced by the body, with levels declining with age. CoQ10 is involved in mitochondrial energy production and has been explored for fertility support, cardiovascular health, and as an adjunct in statin therapy.

D-Chiro-Inositol

A stereoisomer of inositol often used alongside myo-inositol for PCOS management. Plays a distinct role in insulin signalling, particularly in non-ovarian tissues. Typically combined with myo-inositol in a 40:1 ratio. Excessive D-chiro-inositol alone may impair oocyte quality.

Denosumab

A monoclonal antibody biologic used for the treatment of osteoporosis in postmenopausal women at high risk of fracture, and for those who cannot tolerate bisphosphonates. Administered as a subcutaneous injection every six months by a healthcare professional.

DHEA

A precursor hormone produced naturally by the adrenal glands. Available as an oral supplement or vaginal pessary (Intrarosa, licensed for vaginal atrophy). Used to support oestrogen and testosterone levels, particularly in women with adrenal insufficiency or premature ovarian insufficiency.

DIM

A compound derived from the digestion of indole-3-carbinol, found naturally in cruciferous vegetables such as broccoli and cabbage. Used to support oestrogen metabolism, particularly to promote conversion to less potent oestrogen metabolites. Popular for PMS, hormonal acne, and oestrogen dominance.

Dydrogesterone

A synthetic progestogen used as the progestogen component in Femoston combined HRT. Structurally similar to natural progesterone and considered to have a more favourable side-effect profile than older synthetic progestogens. Does not have androgenic activity.

Estradiol Gel

Transdermal oestrogen in gel form, applied daily to the skin of the arm or thigh. Oestrogel is the most widely used brand in the UK. Dose can be adjusted by the number of pumps used.

Estradiol Patch

Transdermal oestrogen delivered via a patch applied to the skin, changed every 3–4 days. One of the most common HRT delivery methods in the UK.

Estradiol Tablets

Oral oestrogen tablets taken daily. Widely available and convenient but subject to first-pass liver metabolism, which can affect clotting factors and triglycerides more than transdermal routes.

Evening Primrose Oil

An oil extracted from the seeds of the evening primrose plant, rich in gamma-linolenic acid (GLA). Traditionally used for breast pain (mastalgia), PMS, and menopausal hot flushes. Evidence for hot flush reduction is modest. Also used for skin health and inflammation.

Fezolinetant

A non-hormonal oral treatment for moderate to severe vasomotor symptoms (hot flushes and night sweats) associated with menopause. Fezolinetant is a neurokinin 3 (NK3) receptor antagonist, approved by NICE in 2024. It offers an alternative for women who cannot or prefer not to take HRT.

Holy Basil

An adaptogenic herb from Ayurvedic medicine. Used for stress management, cortisol modulation, blood sugar regulation, and immune support. Some clinical trials show benefit for generalised anxiety and stress-related symptoms. Consumed as a tea or supplement.

Inositol

A naturally occurring carbohydrate with vitamin-like properties. Myo-inositol is widely studied for PCOS, supporting insulin sensitivity, ovarian function, and reducing androgen levels. Also used for anxiety and OCD in higher doses. Relevant to hormonal health throughout the reproductive years.

Intermittent Fasting

A dietary pattern alternating between periods of eating and fasting. Common protocols include 16:8 (16 hours fasting, 8-hour eating window) and 5:2 (two days per week at 500–600 calories). Used for weight management, metabolic health, and insulin sensitivity. Evidence in perimenopausal women is mixed; some practitioners advise caution regarding cortisol and HPA axis effects.

Iodine

An essential trace element required for thyroid hormone synthesis. The UK RNI is 140mcg/day. Iodine deficiency can impair thyroid function and is common in some UK populations, particularly those who do not consume dairy or fish. However, excess iodine can worsen autoimmune thyroid conditions including Hashimoto's thyroiditis.

Iron

An essential mineral for red blood cell production and oxygen transport. Iron deficiency and iron deficiency anaemia are common in women of reproductive age due to menstrual blood loss, and in perimenopause when cycles may become heavier. Symptoms overlap significantly with menopausal symptoms, including fatigue, brain fog, and mood changes.

L-Theanine

An amino acid found naturally in green tea. Used for promoting relaxation without sedation, reducing anxiety, and supporting sleep quality. Popular with perimenopausal women experiencing anxiety, racing thoughts, and sleep-onset difficulty.

Levothyroxine

Synthetic thyroxine (T4) used as the standard treatment for hypothyroidism. The most commonly prescribed thyroid medication in the UK. Dose is titrated based on TSH levels. Many perimenopausal women have co-existing thyroid conditions, and thyroid symptoms can overlap significantly with menopausal symptoms.

Licorice Root

A herbal preparation from the root of Glycyrrhiza glabra. Used traditionally for adrenal support, digestive health, and inflammation. Contains glycyrrhizin, which inhibits cortisol metabolism. DGL (deglycyrrhizinated licorice) has the glycyrrhizin removed and is used specifically for digestive support without blood pressure effects.

Lion's Mane Mushroom

A medicinal mushroom used traditionally in East Asian medicine for cognitive support and nerve health. Increasingly used by perimenopausal women experiencing brain fog, poor concentration, and memory difficulties. Available as a powder, capsule, or tincture.

Liothyronine

Synthetic triiodothyronine (T3), the active thyroid hormone. Sometimes added to levothyroxine (T4) in patients who do not feel well on T4 alone, though this combination therapy is not routinely recommended by NICE or the BTA. Increasingly sought privately by patients who report persistent symptoms on levothyroxine monotherapy.

Low-Carb Diet

A dietary approach reducing carbohydrate intake, typically to below 130g/day (moderate low-carb) or below 50g/day (ketogenic). Used for weight management, blood glucose control, and reduction of menopausal weight gain and insulin resistance. Some evidence for benefit in PCOS and type 2 diabetes.

Low-FODMAP Diet

A structured dietary approach developed at Monash University for managing irritable bowel syndrome (IBS). Involves eliminating then systematically reintroducing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Relevant to perimenopausal women because gut symptoms often worsen during hormonal transitions.

Maca Root

A Peruvian root vegetable used traditionally as an adaptogen. Marketed for energy, libido, and hormonal balance. Some small trials suggest benefit for menopausal symptoms and sexual function. Not oestrogen-based and considered safe for women who cannot take HRT, though evidence is limited.

Magnesium Glycinate

A highly bioavailable form of magnesium bound to glycine. Supports sleep quality, mood, muscle relaxation, and bone health. Commonly used by women to ease perimenopause symptoms including insomnia, anxiety, and restless legs. Better tolerated than magnesium oxide with less laxative effect.

Mediterranean Diet

A dietary pattern emphasising vegetables, fruit, legumes, whole grains, fish, olive oil, and moderate red wine. Associated with reduced cardiovascular disease risk, improved cognitive function, and lower rates of depression. Particularly relevant for postmenopausal women given increased cardiovascular risk and metabolic changes after menopause.

Melatonin

A hormone produced by the pineal gland that regulates the sleep-wake cycle. Available on prescription in the UK (Circadin for adults over 55) and as an unlicensed supplement. Used for sleep-onset difficulty, jet lag, and circadian rhythm disruption. Melatonin production declines with age and may be further disrupted during perimenopause.

Micronized Progesterone

Body-identical progesterone derived from plant sources and micronized for absorption. Used to protect the uterine lining in women taking oestrogen HRT. Can be taken orally or vaginally and is associated with better sleep and fewer side effects than synthetic progestogens.

Mindfulness Meditation

A formal practice of directing attention to present-moment experience with non-judgmental awareness. Mindfulness-Based Stress Reduction (MBSR) is an 8-week programme with strong evidence for reducing anxiety, depression, and stress. NICE recommends mindfulness for recurrent depression. Used by menopausal women to manage anxiety, sleep disturbance, and perceived hot flush severity.

Mirena IUS

A hormonal intrauterine system (coil) that releases a low dose of levonorgestrel locally into the uterus. In the context of HRT, it is used as the progestogen component to protect the uterine lining when combined with systemic oestrogen. Also functions as contraception.

Myo-Inositol

The most abundant stereoisomer of inositol, widely studied for PCOS and insulin resistance. Acts as an insulin-sensitising agent, supporting ovarian function and metabolic health. Often used in combination with D-chiro-inositol in a 40:1 ratio reflecting physiological levels.

NAC

A sulphur-containing amino acid derivative and precursor to glutathione, the body's primary intracellular antioxidant. Studied for PCOS (insulin sensitisation, ovulation support), endometriosis (inflammation reduction), and liver health. Also used as a mucolytic and in paracetamol overdose treatment.

Norethisterone

A synthetic progestogen used as the progestogen component in some combined HRT preparations and as a standalone treatment to delay menstruation or manage heavy periods. Has androgenic properties and is associated with more side effects than micronized progesterone in some women.

Omega-3

Polyunsaturated fatty acids including EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) from fish oil, or ALA from plant sources. Support cardiovascular health, brain function, inflammation, joint health, and mood. Evidence for benefit in menopausal depression and cardiovascular risk reduction.

Pelvic Floor Exercises

Exercises to strengthen the muscles of the pelvic floor. Recommended as first-line treatment for stress urinary incontinence and urge incontinence, which affect many peri- and postmenopausal women. Also supports sexual function and pelvic organ prolapse management.

Pelvic Floor Physiotherapy

Specialist physiotherapy focused on assessment and rehabilitation of pelvic floor muscles. Treats urinary incontinence, pelvic organ prolapse, pelvic pain, and sexual dysfunction. Involves internal and external assessment, individualised exercise programmes, biofeedback, and education. Available on the NHS via GP or self-referral in many areas.

Phosphatidylserine

A phospholipid found in high concentrations in brain cell membranes. Used for cognitive support, cortisol modulation, and stress resilience. Some evidence for blunting the cortisol response to exercise and psychological stress. Used by perimenopausal women for brain fog and HPA axis support.

Probiotics

Live microorganisms intended to confer a health benefit. Different strains have different evidence profiles. Relevant to hormonal health via the gut-hormone axis (oestrobolome), with the gut microbiome playing a role in oestrogen metabolism, immune regulation, mood (gut-brain axis), and metabolic health.

Red Clover

A herbal supplement containing isoflavones (formononetin, biochanin A, daidzein, genistein) that have weak oestrogen-like activity. Used for menopausal hot flushes and bone health support. Some evidence for modest reduction in hot flush frequency.

Rhodiola Rosea

An adaptogenic herb traditionally used in Scandinavian and Russian folk medicine for fatigue, stress resilience, and cognitive function. Some clinical evidence for improving stress-related fatigue and mild depression. Used by perimenopausal women for burnout, energy, and stress adaptation.

Saffron Extract

A standardised extract from the stigma of Crocus sativus. Used for mood support, with several RCTs showing benefit for mild to moderate depression comparable to some SSRIs. Also studied for PMS, appetite control, and libido. Relevant to perimenopausal women experiencing mood fluctuations.

Sage

An herbal remedy derived from the sage plant. Used traditionally and in some clinical studies to reduce hot flushes and night sweats in menopausal women. Available as a tea, tincture, or standardised extract (e.g., Menoforce). One of the few herbal options with some clinical trial evidence specifically for hot flushes.

Seed Cycling

A practice involving the consumption of specific seeds during the follicular and luteal phases of the menstrual cycle. Flaxseeds and pumpkin seeds are eaten in the follicular phase; sesame seeds and sunflower seeds in the luteal phase. Claimed to support hormonal balance via lignans and fatty acids. Evidence is anecdotal; no clinical trials exist to date.

Selenium

An essential trace mineral important for thyroid function, immune health, and antioxidant defence. The UK RNI is 60mcg/day for women. Particularly relevant for women with thyroid conditions, as selenium is required for the conversion of T4 to active T3. Some evidence for reducing thyroid antibodies in Hashimoto's thyroiditis.

Sleep Hygiene Protocol

A set of behavioural and environmental recommendations to improve sleep quality. Typically includes consistent sleep and wake times, reducing caffeine and alcohol, minimising screen light before bed, optimising bedroom temperature, and limiting daytime napping. Often the starting point before CBT-I for menopausal insomnia.

Soy Isoflavones

Plant-derived compounds from soybeans with weak oestrogen-like activity. Consumed through diet (tofu, soya milk, edamame) or in concentrated supplement form. Studied for reduction of hot flushes, bone density support, and cardiovascular health in menopausal women.

Spearmint Tea

Spearmint (Mentha spicata) consumed as a tea or extract. Studied for its anti-androgenic properties in women with PCOS, hirsutism, and hormonal acne. Two cups of spearmint tea daily has been associated with reduced free testosterone levels in small clinical trials.

Strength Training

Structured exercise using resistance (bodyweight, free weights, or machines) to build and maintain muscle mass and bone density. Particularly beneficial during perimenopause and post-menopause when oestrogen decline accelerates muscle loss (sarcopenia) and bone density reduction. Also supports metabolic health, insulin sensitivity, and mood.

TENS Machine

A portable device that delivers low-voltage electrical impulses through electrode pads placed on the skin. Used for pain management including dysmenorrhoea, pelvic pain, musculoskeletal pain, and endometriosis-related pain. Available over the counter in the UK without a prescription.

Testosterone Cream

Topical testosterone applied to the skin in small doses to address low libido and fatigue in women. In the UK, no testosterone product is licensed for women; use is off-label or via compounding pharmacies. Recommended by NICE and BMS as a treatment for hypoactive sexual desire disorder (HSDD) in menopausal women.

Tibolone

A synthetic steroid with oestrogenic, progestogenic, and weak androgenic activity. Used as a continuous combined HRT option in postmenopausal women. Typically causes no withdrawal bleed and may also benefit libido.

Turmeric / Curcumin

Curcumin is the primary active compound in turmeric. It has anti-inflammatory and antioxidant properties and has been explored for joint pain, endometriosis-related inflammation, and general inflammatory symptoms associated with hormonal conditions.

Vaginal Estrogen

Low-dose oestrogen applied directly to the vagina as a pessary, cream, or ring. Treats local symptoms of genitourinary syndrome of menopause (GSM) including vaginal dryness, discomfort, and recurrent UTIs. Does not significantly raise systemic oestrogen levels and is safe for most women, including many with a history of breast cancer.

Venlafaxine

A serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressant. Used off-label at low doses for the management of menopausal vasomotor symptoms (hot flushes and night sweats) in women who cannot take HRT. Also prescribed for depression and anxiety, which commonly co-occur with perimenopause.

Vitamin C

A water-soluble vitamin with antioxidant properties. Essential for collagen synthesis, immune function, and iron absorption. The adrenal glands contain some of the highest vitamin C concentrations in the body, and levels are depleted during chronic stress. Some practitioners use higher-dose vitamin C for adrenal support, though evidence for this specific indication is limited.

Vitamin D3

The most biologically active supplemental form of Vitamin D. Essential for calcium absorption, bone health, immune function, and mood regulation. The NHS recommends all adults consider supplementing, particularly in autumn and winter. Especially important for perimenopausal and postmenopausal women given the role in bone density.

Vitamin K2

A fat-soluble vitamin that plays a role in calcium metabolism, directing calcium into bones and teeth rather than soft tissues and arteries. Often taken alongside vitamin D3 and calcium for bone health. Increasingly recognised for cardiovascular health in postmenopausal women.

Vitex

An herbal extract from the chaste tree berry. One of the most studied herbal remedies for PMS, cyclical breast pain, and irregular menstruation. Has dopaminergic activity and is thought to lower prolactin levels. Not recommended for use during HRT or pregnancy.

Walking Programme

A structured walking programme, typically involving brisk walking for 30-60 minutes most days. Walking is one of the most accessible forms of exercise and has been studied for cardiovascular health, mood, weight management, and menopausal symptoms.

Yoga

A mind-body practice combining physical postures, breathing exercises (pranayama), and meditation. Used to manage menopausal symptoms including stress, anxiety, sleep disturbance, and musculoskeletal pain. Evidence from RCTs supports modest benefit for hot flush frequency, mood, and quality of life.

Zinc

An essential trace mineral involved in over 300 enzymatic reactions. Supports immune function, wound healing, thyroid hormone production, and reproductive health. Relevant to PCOS (androgen metabolism), thyroid function (T4 to T3 conversion), and skin health (acne). The UK RNI for women is 7mg/day.