How to offer holistic, evidence-based menopause care

GP educator and executive coach Dr Farnaaz Sharief explains how reframing menopause as a natural stage of life can shift the focus beyond hormone replacement therapy as the sole option for symptom management, and outlines practical, holistic and evidence-based approaches that support women to optimise their health through the transition

Menopause is often spoken about in hushed tones, as something to endure, to get through or even to fear. But this narrative does women a disservice.

Menopause is not a failure of the body but rather a natural biological transition and a privilege of longevity. Not every woman reaches this stage of life. For those who do, it offers something rarely acknowledged: a powerful opportunity to reset, to recalibrate and to build a stronger foundation for the decades ahead.

Hormone replacement therapy (HRT) remains the most effective treatment for many menopausal symptoms. But guidance from the British Menopause Society and NICE is clear: menopause care should be holistic.

Alongside HRT, or instead of it, there are powerful, evidence-based lifestyle strategies that every woman should be considering, not just to manage symptoms, but to optimise long-term health.

The most impactful changes are often the simplest and they sit within how we nourish, restore, and move our bodies.

Nutritional advice: focus on protein and whole foods

Nutrition becomes more important than ever during menopause. This is not just a hormonal shift; it is a metabolic one. Declining oestrogen affects muscle mass, bone density, cardiovascular health and insulin sensitivity. Yet many women continue to eat in ways that no longer support their changing physiology.

One of the most important and commonly missed priorities is protein. Muscle mass naturally declines with age, and this accelerates during menopause. Without adequate protein intake, women are more likely to experience fatigue, reduced strength, slower metabolism and increased long-term frailty. Guidance from the British Heart Foundation¹ supports spreading protein intake evenly across the day to optimise muscle protein synthesis and metabolic health. In practice, this could translate to aiming for approximately 20 g of protein per meal from foods such as eggs, Greek yoghurt, chicken, fish or lentils to help preserve muscle mass and maintain steady energy during menopause.

Alongside this, a focus on whole, unprocessed foods supports cardiovascular health, while consistent hydration improves both energy and cognitive clarity. Even small changes in habits, such as taking a short walkafter meals, can significantly improve glucose regulation and reduce energy crashes.

Bone health also requires attention. Calcium and vitamin D support bone health in postmenopausal women, but fracture prevention benefits from supplementation are inconsistent and mainly seen in frail older populations, while risks (e.g. kidney stones) should be considered. The British Menopause Society recommends intake of around 1,000 mg calcium and 1000 IU vitamin D daily.² This can be achieved through foods such as dairy products (milk, yoghurt, cheese), fortified plant-based alternatives (such as fortified soy or almond milk), leafy green vegetables (kale, broccoli) and tinned fish with bones (such as sardines or salmon). These are not abstract targets, they are investments in maintaining independence, mobility and strength later in life.

Optimising sleep is vital

If nutrition is how we fuel the body, then sleep is how we restore it. And for many women, this is where things begin to unravel.

Hormonal changes, night sweats and heightened stress responses disrupt sleep patterns, leaving women exhausted but unable to rest deeply. The impact is far-reaching: poor sleep amplifies anxiety, weight gain, cardiovascular risk and cognitive dysfunction.

What matters most with sleep is consistency.³ The final 30 to 60 minutes of the day hold disproportionate power. When this time is intentionally slowed down, with reduced stimulation, a cool and comfortable environment and consistent sleep and wake times, the nervous system begins to feel safe enough to switch off. Gentle additions such as chamomile tea^4,5 can promote relaxation, while magnesium⁶ supports the ‘calming’ neural pathways and may improve sleep quality.

Where sleep difficulties persist, menopause-specific cognitive behavioural therapy is recommended, although access across England can be limited. In practice, many women benefit from more accessible tools such as mindfulness, breathwork or yoga.  These offer simple practices that help regulate the stress response and restore a sense of control.

Exercise – centre the physical and mental benefits

Movement is the third pillar and perhaps one of the most misunderstood. Exercise is often framed narrowly as a tool for weight management, when in reality it is one of the most powerful interventions available for menopausal health.

Regular movement preserves bone density, maintains muscle mass, improves cardiovascular function, and enhances mood and cognition. Strength training, in particular, is essential in counteracting age-related muscle loss.⁷ When combined with adequate protein intake, it supports the development and maintenance of lean muscle.

Cardiovascular fitness also plays a key role. Short bursts of higher-intensity exercise, such as interval training, can improve heart health, insulin sensitivity and overall fitness in a time-efficient way.

Beyond the physical benefits, movement has profound effects on brain chemistry. Activities that involve progression, challenge or goal-setting stimulate dopamine,⁸ enhancing motivation, focus and productivity.

Meanwhile, rhythmic or enjoyable movement, whether that is walking, dancing or exercising helps improve mood,⁹ reduce stress and increase resilience. Even simple, human experiences such as laughter or physical connection can amplify this effect.

What becomes clear is that these lifestyle factors do not operate in isolation. They reinforce each other – better sleep improves nutritional choices; better nutrition fuels movement; and movement enhances mood and sleep. Over time, this creates momentum, shifting women from a cycle of depletion to one of strength and capability.

Non-HRT medication can be helpful for hot flushes, night sweats

Of course, lifestyle strategies are not always sufficient on their own. For women who require additional support, if HRT is unsuitable or declined, non-hormonal medical treatments play an important role. Medications such as SSRIs and SNRIs, including citalopram or venlafaxine, can reduce the frequency and severity of hot flushes, particularly where anxiety or low mood are also present. Gabapentin may be helpful for night sweats and sleep disturbance, while clonidine can offer modest benefit for vasomotor symptoms, although its use may be limited by side effects.

More recently, fezolinetant has emerged as a non-hormonal option, acting on neural pathways that trigger hot flushes and night sweats. It is not recommended for women with active breast cancer, other oestrogen dependent cancers or liver disease. It may be used cautiously in those with a history of breast or oestrogen dependent cancers, after specialist input and an individualised risk-benefit assessment has been carried out. Liver function monitoring is required before starting treatment and regularly thereafter. Although recently recommended by NICE, access across the UK remains variable as it is gradually being incorporated into local formularies and care pathways.

Be cautious with herbal or dietary supplements

Some women explore herbal or ‘natural’ remedies such as black cohosh, red clover, or soy isoflavones. However, the evidence for their effectiveness is limited and inconsistent, with only small or variable effects seen in studies. Major guidelines, including NICE and the British Menopause Society, do not recommend them as routine treatments due to uncertainty around efficacy, variability in product quality and dosing, and potential safety and interaction concerns.

Genitourinary symptoms – hormonal and non-hormonal options can be offered

Women’s genitourinary health requires careful attention, as symptoms such as vaginal dryness, discomfort, urinary urgency and recurrent urinary tract infections are very common during and after the menopausal transition. These symptoms are typically driven by local oestrogen deficiency and are frequently under-recognised, despite being highly treatable.

For most women without a history of hormone-sensitive cancer, vaginal oestrogen is first-line treatment and can be used long term with regular review. It has minimal systemic absorption and is considered safe for extended use. NHS-available preparations include estradiol pessaries or tablets (for example 10 mcg pessaries used daily for two weeks, then typically twice weekly), estriol creams and vaginal oestrogen rings. Choice of preparation is guided mainly by preference, ease of use and symptom pattern.

For women with a history of breast cancer or other oestrogen-dependent cancers, management should be individualised and ideally discussed with oncology or specialist menopause services. Non-hormonal options are first-line, including regular use of vaginal moisturisers (such as hyaluronic acid-based products), lubricants during sexual activity and ongoing symptom monitoring.

Alongside medical treatments, simple lifestyle measures can significantly improve symptoms. Reducing exposure to products such as perfumed soaps, shower gels, bubble baths, deodorants, and avoiding over-washing often helps. Bland emollient soap substitutes (e.g. Doublebase Gel, E45, Dermol) can be used instead. Breathable cotton underwear and avoiding prolonged damp clothing after exercise or swimming can also help reduce irritation and recurrent infections.

In summary, when women begin to work with their biology, by nourishing their bodies, protecting their sleep, moving with intention and accessing the right treatments when needed, they do not just ‘manage’ menopause. They build strength, resilience and a future where health is no longer an afterthought, but a priority.

Dr Farnaaz Sharief is a GP educator and executive coach with an interest in women’s health

References

1. British Heart Foundation. Protein: how much do you need? Updated October 2025
2. BMS Consensus statement. Prevention and treatment of osteoporosis in post-menopausal women. Reviewed October 2022
3. Chaput J et al. Sleep timing, sleep consistency, and health in adults: a systematic review.Appl Physiol Nutr Metab 2020;45(10 (Suppl. 2)): S232-47
4. Chang S, Chen C. Effects of an intervention with drinking chamomile tea on sleep quality and depression in postpartum women. J Adv Nurs 2016; 72(2):306-15
5. Amsterdam J et al. Chamomile (Matricaria recutita) may have anxiolytic activity via GABAergic mechanisms. Phytomedicine 2009–2012 programme of studies.
6. Boyle N, Lawton C, Dye L. The effects of magnesium supplementation on subjective anxiety and stress – a systematic review. Nutrients 2017;9:429
7. Escriche-Escuder A et al. Effects of exercise on muscle mass, strength, and physical performance in older adults with sarcopenia. Exp Gerontol 2021;151: 111420
8. Schultz W. Predictive reward signal of dopamine neurons. J Neurophysiol 1998
9. Rebar A et al. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev 2015;9(3):366–78