Many women reach midlife wanting to understand their options, especially when hormone therapy isn’t suitable, accessible, or something they feel ready for.
In this episode of All About You, Dr Shauna Watts explores what people often mean when they talk about “managing menopause naturally,” where lifestyle and non-hormonal supports can play a role, and where misinformation can quietly creep in.
This conversation isn’t about quick fixes or doing it alone. It’s about understanding physiology, knowing what can help some symptoms, and recognising when medical support may still be important, even if HRT isn’t part of your plan right now.
If you’ve ever felt overwhelmed by conflicting advice or unsure who to trust, this episode is designed to bring clarity and calm.
Transcript
Definitely, while I do love HRT for the right person, it is not for everyone. I would never make anyone, or try to talk anyone, into taking it. It’s absolutely your decision. I just want you to know that you can still have real control over your health moving forward, and I’m here to help you do that.
Today’s episode is for the women out there who can’t, or don’t want to, take hormone replacement therapy. The reason I wanted to make this episode came after a really upsetting consultation I had about a week ago.
I’d been looking after a beautiful woman for about six months. She came to see me because she really wanted to start hormone replacement therapy. After working through whether it was appropriate, we got her started. Unfortunately, we tried multiple types and doses, and she was one of those people who just kept getting side effects.
On the whole, a lot of women feel much better on hormone replacement therapy. But this woman didn’t. It actually made her feel worse.
She’s incredibly intelligent, has a PhD, and is very well read. She was in tears because she’d been doing a lot of reading and listening to podcasts and Instagram content, hearing all about the incredible benefits of hormones.
Through tears she said, “What am I going to do? I’m going to end up with osteoporosis.”
She has a strong family history of heart disease and was very worried about that. She has struggled with her weight for a long time. To add to that, she is caring for her mum who has dementia. She had been reading about the potential protective effects of hormone replacement therapy on the brain.
Why many women ask about managing menopause without HRT
I know there are many women out there who may be having treatment for breast cancer, or for various reasons can’t, or simply don’t want to, take hormone replacement therapy. I also understand that all the conversation around HRT and its benefits can feel exclusionary.
That’s why I wanted to address some of the things you can be doing, with good evidence behind them, to help relieve symptoms of perimenopause and support your health long term.
This isn’t about just surviving the next phase of life. It’s about thriving.
What people usually mean by “balancing hormones naturally”
I want to reassure you that there are things you can reasonably and realistically bring into your life that will go a long way toward supporting your health.
I also want to be very clear about something important: it is not a foregone conclusion that if you don’t take HRT you will definitely get osteoporosis, or that if you do take HRT you definitely won’t. It is not that black and white.
Lifestyle factors that can support symptoms
One of the most important things is building muscle.
For many women of my generation, exercise in our teens, twenties and thirties was all about cardio, aerobics, step classes, running, and trying to be slim. Women rarely went near the weights area of the gym. It felt intimidating, and many worried about “getting bulky”.
The reality is, it is very hard to get bulky. Building muscle takes a huge amount of work.
Why is muscle so important? During this phase of life, we lose a significant amount of muscle mass. Muscle burns energy. If you have less muscle, your resting metabolic rate is lower, meaning you burn fewer calories, which can contribute to weight gain.
Muscle is also critical for joint stability and mobility. We often assume frailty is inevitable with ageing, but it isn’t. I recently watched a 102-year-old run 100 metres. It completely changes how we should think about ageing.
The key to staying mobile and independent later in life
If you want to stay mobile and independent into later life, you need to maintain muscle mass. Strength training is essential. Even if you have osteopenia or osteoporosis, supervised strength training is not only safe, it’s recommended. Putting load through muscles and bones helps them strengthen.
Strength training also releases endorphins, improves mood, provides structure, and can be social.
Sleep is another major pillar. Sleep disruption is one of the most debilitating symptoms of perimenopause and menopause. Many women fall asleep easily but wake at one or two in the morning, wide awake, sometimes anxious, sometimes not.
Poor sleep raises cortisol, contributes to weight gain, worsens food choices, and impacts brain health. Sleep is when the brain clears waste products. Without it, that process is impaired.
Your bedroom should be cooler than you think. You need to drop your body temperature by about one degree to fall and stay asleep. Cool bedding like cotton or bamboo can help. Phones do not belong in the bedroom. Regular routines matter. Women often need more sleep than previously thought, ideally eight to nine hours.
Sleep hygiene helps: winding down, avoiding stressful conversations at night, journaling, warm (not hot) showers. Magnesium and melatonin can help some women, but if sleep is poor, speak to your doctor.
How your nutrition needs change
Nutrition also matters. Protein needs increase in midlife to support muscle mass. Fibre is equally important. Gut health changes during menopause, insulin resistance can increase, and the gut microbiome shifts.
Aim to eat a wide variety of fruits and vegetables. Research suggests variety matters more than repetition. Frozen options are fine. Include beans, legumes and whole foods. Minimise ultra-processed foods, things you couldn’t reasonably make in your own kitchen.
Logging food for a week can be eye-opening and help identify gaps.
Alcohol is another big factor. Many women drink to cope with anxiety or sleep, then struggle with weight, poor sleep and decision-making. Alcohol is metabolised differently in midlife, often worsening sleep and anxiety.
Taking a break from alcohol can be transformative. Many women report better sleep, improved energy, weight loss and better choices overall. Alcohol is also clearly associated with increased cancer risk, including breast cancer.
Staying socially connected is crucial. Many women withdraw socially during this phase due to fatigue, confidence changes, or caring responsibilities. Yet long-living populations consistently show strong social connection as a key factor.
This doesn’t mean huge social commitments. It might be joining a class, a sport, or a creative group. Social connection supports mental health, confidence and resilience.
The limits of non-hormonal approaches
Lifestyle changes are powerful, but they have limits. They may not fully address severe symptoms for everyone, and they are not a replacement for medical care when it’s needed.
When medical support may still be needed
There are non-hormonal medications that can help with hot flushes, anxiety, and sleep. Medically supervised weight management may also be appropriate for some women.
Vaginal hormone therapy can be very helpful for vaginal and urinary symptoms and is often suitable even when systemic HRT is not.
Understanding risk, safety, and individual decision-making
Every decision about menopause care is individual. Risk, family history, symptoms and personal values all matter. There is no single “right” choice.
Why there is no one-size-fits-all menopause plan
Everything I’ve discussed is helpful whether or not you take HRT. I never want anyone to feel excluded, left behind, or unsupported.
HRT can be life-changing for the right person, but it is not for everyone. You still have agency, options, and support available to you.
You can have real control over your health moving forward, and you don’t have to do it alone.
If you have questions, you can reach out on Instagram or via our website.
This podcast and any information, advice, opinions or statements within it do not constitute medical or professional advice. Information is provided for educational and entertainment purposes only. If you have health concerns, always consult your doctor.
Menopause Health Assessment Medicare rebates
Many women aren’t aware that, from 1 July 2025, Medicare rebates are available for menopause and perimenopause health assessments.
These items support a structured, doctor-led assessment to help understand the physiological changes that can occur during this stage of life, including changes in menstrual cycles, sleep, mood, energy, and overall wellbeing.
An assessment doesn’t treat symptoms on its own. Its role is to support an evidence-informed conversation with a clinician and improve access to appropriate care and guidance.
You’re not broken. This is physiology, not a personal failure. And understanding what’s happening in your body can be a helpful first step toward clarity and reassurance.
