If I have menopausal symptoms but cannot take HRT what other options are there?

At one time many women were advised that they could not take HRT for a variety of reasons that are no longer considered to be contraindications. Diabetes, high blood-pressure, heart disease and obesity were regarded as medical reasons for avoiding HRT but this is no longer the case. Nowadays, there are very few, if any, absolute contra-indications to HRT.

Some women have anxieties about interfering with hormones or cannot find an HRT preparation that suits them. For those with hot flushes, hot flashes, night sweats, clonidine (Dixarit -Boehringer), ethamsylate (Dicynene – Delandale) or progestogens (Q 24.17B) such as Provera 10 – 30 mg daily may help.

If the problems relate to vaginal dryness, including discomfort or dyspareunia (pain during intercourse) topical vaginal oestrogen preparations that are poorly absorbed may be considered for vaginal symptoms (2).

Tamoxifen is frequently prescribed for several years following a diagnosis of breast cancer (Q32.42). This drug has anti-oestrogenic activity, which is probably its mode of action on the breast tumour. Paradoxically, tamoxifen also has some oestrogenic activity on the genital tract so postmenopausal women taking it seem to be less prone to vaginal symptoms


A thirty-one year old lady presented with pelvic discomfort, which was related to fibroids. She came to hysterectomy and her ovaries were removed. The fibroids were benign under the microscope but they had a tendency to recur (an extremely rare situation). When she was given HRT more fibroids appeared (an extremely rare condition called benign metastasising leiomyomata) but they regressed when the HRT was withdrawn. For the last thirteen years she has been taking tamoxifen. The fibroids have not recurred and there have been no problems with menopausal symptoms.

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