Q&A with Dr Reena Virdi (General Practitioner and Well Women Clinic GP)

Welcome to our Doctor’s Q&A corner!
It’s our second edition and we’re thrilled to launch this brand-new section, featuring insights from Dr. Virdi.

Remember, if you’ve got general questions about perimenopause or menopause symptoms, management tips, or lifestyle advice, send them our way! Submit yours for the next edition!

Question: "Should I start hormone therapy, or is it too risky? Are natural supplements safe and effective instead of HRT?"
Answer: For most women, perimenopause and menopause typically occur between the ages of 45 and 55. During this time, hormone replacement therapy (HRT) is usually considered after lifestyle factors have been optimised as much as possible.

These include maintaining a healthy weight (ideally a BMI under 25), exercising at least three times per week for around 45 minutes (including strength training), not smoking, limiting alcohol intake to under 14 units per week, and avoiding excessive caffeine. Optimising these factors can significantly improve symptoms and reduce long-term health risks.

If symptoms such as hot flushes, sleep disturbance, low mood, or vaginal dryness persist despite these measures, HRT may be considered. The decision is highly individual and should always involve a discussion with a healthcare professional, as personal risk factors need to be reviewed.

Lifestyle factors such as smoking, physical inactivity, excess alcohol intake, and being overweight already increase the risk of conditions like breast cancer, endometrial cancer, cardiovascular disease, and osteoporosis. HRT carries a small relative risk for some of these conditions, depending on the type used and individual health history. Therefore, overall risk depends on the full picture — personal health, family history, and the type of HRT prescribed.

HRT consists of oestrogen and progesterone. However, women who no longer have a uterus typically require oestrogen only. Importantly, HRT also offers significant benefits. These include effective relief of menopausal symptoms, improved bone health and reduced osteoporosis risk, potential cardiovascular protection when started at the appropriate time, reduced colorectal cancer risk, and possible cognitive benefits in some women.

Regarding natural supplements, some women prefer to try these before considering HRT. It is important to choose reputable, regulated over-the-counter options rather than unregulated or compounded “bioidentical” hormones, which may not meet safety standards.

Common supplements include:

Magnesium (for sleep and mood support)

Calcium and vitamin D (for bone health)

B vitamins (for energy and cognitive support)

Black cohosh and red clover (sometimes used for hot flushes)

Evening primrose oil (often used for hormonal balance)

While many of these supplements are generally safe when taken appropriately, the scientific evidence for their effectiveness is mixed, and they are not as well regulated or studied as prescribed HRT. Additionally, supplements can still interact with medications or have side effects.

In summary, HRT is not automatically “too risky” — for many healthy women within 10 years of menopause onset, the benefits outweigh the risks. However, it is a personal decision that should be made in partnership with a doctor who can assess your individual risk profile and help you choose the safest and most suitable option.