Doctor Guide: Menopause

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Doctor Guide: Menopause

Written by BePurer's medical advisory team. For educational purposes only — always consult your GP or a menopause specialist for personalised advice.

The evidence on HRT: setting the record straight

Hormone replacement therapy (HRT) is the most effective treatment for menopause symptoms and has been shown to reduce the risk of osteoporosis, cardiovascular disease, and type 2 diabetes when started within 10 years of menopause or before age 60.

The 2002 WHI study caused widespread abandonment of HRT based on findings that have since been significantly recontextualised. That study used older synthetic hormones in women who were significantly older than typical HRT users. Current evidence, including the NICE menopause guidelines (2015, updated 2019), strongly supports HRT for most women under 60 or within 10 years of menopause.

Types of HRT

  • Body-identical HRT: Oestradiol (patches, gel, or spray) + micronised progesterone (Utrogestan). This is the preferred form — it has the best safety profile and is chemically identical to the hormones your body produces.
  • Synthetic HRT: Older formulations using synthetic progestogens. Associated with slightly higher breast cancer risk than body-identical HRT.
  • Local oestrogen: Vaginal oestrogen for genitourinary symptoms only. Minimal systemic absorption. Safe for long-term use.

Who can use HRT?

Most women can use HRT. Absolute contraindications are rare and include unexplained vaginal bleeding, active liver disease, and some hormone-sensitive cancers. Women with a history of breast cancer should discuss with their oncologist — local oestrogen is generally considered safe even in this group.

Lifestyle medicine for menopause

Exercise

  • Weight-bearing exercise (walking, running, dancing): protects bone density
  • Resistance training (weights, resistance bands): preserves muscle mass and supports metabolic health
  • Aerobic exercise (swimming, cycling): supports cardiovascular health and mood
  • Yoga and Pilates: support flexibility, balance, and stress management

Aim for 150 minutes of moderate aerobic activity and 2 sessions of resistance training per week.

Nutrition

  • Mediterranean-style diet: vegetables, legumes, whole grains, oily fish, olive oil, nuts
  • Adequate protein (1.2–1.6g per kg body weight) to preserve muscle mass
  • Calcium-rich foods: dairy, fortified plant milks, leafy greens, sardines
  • Limit alcohol (increases hot flush frequency and breast cancer risk)
  • Limit ultra-processed foods and refined carbohydrates
  • Phytoestrogen-rich foods: soy, flaxseed, chickpeas

Sleep hygiene

  • Consistent sleep and wake times
  • Cool, dark bedroom
  • Limit screens 1 hour before bed
  • Avoid alcohol and caffeine in the evening
  • Address night sweats (cooling mattress topper, moisture-wicking bedding)

Stress management

Chronic stress elevates cortisol, which can worsen hormonal imbalance, disrupt sleep, and increase hot flush frequency. Mindfulness, breathwork, therapy, and social connection all have evidence for stress reduction in menopause.

Evidence-based supplement protocol for menopause

  • Magnesium glycinate: 300–400mg daily (evening) — sleep, mood, bone health
  • Vitamin D3 + K2: 1,000–2,000 IU D3 + 90–200mcg K2 daily — bone density, immune function
  • Omega-3 (EPA + DHA): 1,000–2,000mg daily — cardiovascular health, inflammation, mood, cognition
  • Marine collagen: 5–10g daily with vitamin C — skin, joints, bone
  • Phytoestrogens: 40–80mg soy isoflavones daily — hot flush frequency and severity
  • B-complex: Daily — energy, mood, cardiovascular health
  • CoQ10: 100–300mg daily — energy, cardiovascular support

Navigating the healthcare system

Many women struggle to access adequate menopause care through the NHS. Key tips:

  • Request a GP appointment specifically for menopause — be explicit about your symptoms
  • Use the Menopause Society’s symptom checklist before your appointment
  • Ask specifically about body-identical HRT (oestradiol + micronised progesterone)
  • If your GP is not menopause-trained, ask for a referral to a menopause clinic
  • Private menopause specialists (e.g. via the British Menopause Society directory) can be accessed without a GP referral

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