Modern menopause treatment: what are the options?

Menopause care has changed considerably over recent years.

For some women, the conversation may once have been reduced to hot flushes and whether or not to take hormone replacement therapy (HRT). Today, menopause management can involve a much wider discussion about symptoms, quality of life, individual risk factors, treatment preferences and different ways of accessing specialist care.

NICE recommends that menopause management should be tailored to the individual, with the benefits and risks of different options discussed as part of shared decision-making.

That means modern menopause treatment isn’t simply about finding a treatment.

It is about understanding which options may be appropriate for the individual woman.

HRT remains an important treatment option

Hormone replacement therapy is still a major part of menopause treatment.

Oestrogen can be given in different forms, including tablets, patches, gels and sprays. For women who have a uterus, progestogen is generally needed alongside systemic oestrogen to protect the lining of the womb.

There are also different preparations and treatment approaches, meaning HRT isn’t necessarily a single standard prescription.

NICE recommends discussing factors including:

• oestrogen-only versus combined HRT
• oral versus transdermal treatment
• different oestrogen and progestogen preparations
• sequential versus continuous combined HRT
• dose and duration

These decisions should take account of the woman’s individual circumstances and potential risk factors.

This is one reason why a detailed consultation can be valuable when a woman is considering starting HRT, changing treatment or trying to understand why her current treatment isn’t working as expected.

Vaginal oestrogen can be important too

Menopause symptoms aren’t restricted to hot flushes and night sweats.

Some women experience vaginal dryness, discomfort, pain during sex or urinary symptoms. NICE recommends offering vaginal oestrogen for genitourinary symptoms associated with menopause, including for people who are already using systemic HRT.

Vaginal oestrogen is a local treatment, and NICE notes that only a minimal amount is absorbed into the bloodstream compared with systemic HRT.

For some women, this can therefore be an important part of menopause care that is easily overlooked when conversations focus solely on hot flushes.

What about testosterone?

Testosterone is another treatment that is increasingly discussed in menopause care.

NICE recommends considering testosterone supplementation for people experiencing low sexual desire associated with menopause when HRT alone has not been effective.

The NHS also notes that testosterone gel or cream may help improve low libido for some women and may be prescribed by a menopause specialist.

However, testosterone isn’t a general-purpose treatment for every menopause symptom. A specialist assessment can help determine whether it is appropriate.

Menopause treatment doesn’t always have to involve hormones

HRT isn’t suitable or preferred for everyone.

There are also non-hormonal approaches.

NICE recommends menopause-specific cognitive behavioural therapy as an option for some people experiencing vasomotor symptoms, including hot flushes and night sweats, and also for certain sleep and depressive symptoms associated with menopause. It can be used alongside HRT or where HRT is unsuitable or not preferred.

There are also non-hormonal medicines that may be considered in specific circumstances.

One of the most significant recent developments is fezolinetant.

In March 2026, NICE recommended fezolinetant as an option for treating moderate to severe menopause-related hot flushes and night sweats when HRT is unsuitable. It is a non-hormonal medicine and represents an additional treatment option for women who cannot or do not want to use HRT.

This is a good example of how menopause care is continuing to develop.

What about “natural” or bioidentical hormones?

There is an important distinction between regulated body-identical hormones and compounded “bioidentical” hormone preparations.

The NHS explains that regulated body-identical hormones are different from unregulated compounded bioidentical preparations. The latter are not recommended because their safety, effectiveness and quality are not established in the same way as regulated medicines.

This is particularly important because the language used around menopause treatments can be confusing.

“Natural” doesn’t automatically mean safer, and “bioidentical” doesn’t automatically mean better.

A qualified clinician should be able to explain what a treatment actually contains, what evidence supports it and what its potential benefits and risks are.

Do you need a blood test to diagnose menopause?

This is another area where modern menopause care can be different from what many women expect.

For otherwise healthy women aged 45 or over experiencing typical menopause-associated symptoms, NICE recommends identifying perimenopause or menopause clinically rather than routinely relying on laboratory tests.

That doesn’t mean blood tests are never appropriate.

There are circumstances where investigations may be useful, particularly where the clinical picture is less straightforward or another condition needs to be considered.

This is why a consultation should look at the overall picture rather than relying on a single hormone result.

What happens during a menopause consultation?

A good menopause consultation should be about much more than ticking off a list of symptoms.

A clinician may discuss your symptoms, menstrual history, medical and surgical history, medication, relevant family history and previous treatments.

You should also have the opportunity to explain what is actually troubling you.

Is it your sleep?

Your mood?

Your periods?

Hot flushes?

Sexual health?

Brain fog?

Urinary symptoms?

Or simply the fact that you don’t feel like yourself anymore?

Current specialist menopause services commonly use a combination of symptom history, medical assessment, treatment discussion and individualised planning.

Can a menopause consultation be done online?

Increasingly, yes — where it is clinically appropriate.

Online consultations can allow women to discuss their symptoms and treatment options with a menopause specialist without having to travel to a clinic.

For MenopauseCare Online, virtual appointments involve discussing symptoms, medical and surgical history, medication and relevant family history, with treatment options and next steps then discussed during the consultation. Face-to-face appointments are also available where required or preferred.

This isn’t about replacing face-to-face medicine.

Sometimes examination or investigation is necessary. Ultrasound, for example, may require a separate pathway.

Instead, online consultations provide another way of accessing specialist menopause advice when a physical examination isn’t required.

Interestingly, this approach is also becoming part of the wider NHS landscape. NHS England says menopause and menstrual problems are among the initial areas being prioritised for the planned NHS Online service from 2027, including online consultations where appropriate.

The most important part of modern menopause care

Modern menopause treatment isn’t about finding the latest medication and assuming it will work for everyone.

It’s about personalised care.

One woman may benefit from HRT.

Another may need local vaginal treatment.

Another may need a non-hormonal approach.

Someone else may need a combination of treatments, lifestyle changes and further investigation.

And sometimes the most useful first step is simply talking to a clinician who understands menopause and can help make sense of what’s happening.

There are now more treatment options and more ways of accessing specialist advice than many women realise.

The challenge is knowing which options are appropriate for you.

A final note from Kavita

“Every woman’s menopause experience is different. My role is to listen carefully, understand what you are experiencing and help you understand the treatment and support options available to you, so that we can make an informed plan together.”

MenopauseCare Online offers online and face-to-face consultations with Miss Kavita Verma, Consultant Gynaecologist and menopause specialist. A free 15-minute discovery call is also available for women who are unsure whether a full consultation is right for them.