When HRT isn't an option: what the research on non-hormonal supplements actually shows

By The Krevie Team  |  Last reviewed: April 2026

Several categories of options exist. Non-hormonal prescription medications have evidence for specific outcomes. Lifestyle approaches — particularly resistance training — have meaningful research support. Food supplements with research-backed ingredients provide a third category, working through nutritional and metabolic pathways. Your GP is the right person to map out which options fit your specific situation and medical history.

Approximately 85% of UK women going through menopause are not currently using HRT. Some cannot take it due to contraindications; others choose not to. In either case, the practical question is the same: what does the evidence say about the options that remain?

This article covers that landscape honestly. It does not position any supplement as a substitute for medical treatment. Krevie is a food company, not a medical one. What we can do is explain what each category of option looks like, what the research supports, and where food supplements fit within that picture.

One thing first: if HRT is off the table for you, the most important next step is a conversation with your GP or a menopause specialist. The options described in this article require different levels of medical input. Some are purely lifestyle. Some are prescription-only. And some — like food supplements — sit in their own separate category that does not require a GP visit but also does not replace one.

What HRT contraindications are — briefly

Common contraindications to oestrogen-containing HRT include a personal or close family history of hormone-receptor-positive breast cancer, a history of deep vein thrombosis or pulmonary embolism, active liver disease, and unexplained uterine bleeding. The picture is more nuanced than this — some women with some of these conditions can use specific low-risk formulations — which is precisely why this conversation belongs with a GP or menopause specialist rather than an online article.

What this article focuses on is the landscape of non-hormonal options, with attention to what the research actually supports for each one.

What the research shows

Non-hormonal prescription options

These are medicines, prescribed by a GP or specialist. They are not food supplements. They are not something Krevie produces, sells, or provides as an alternative. They are mentioned here because a genuinely useful overview of the landscape should not omit them.

SSRIs and SNRIs. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are used off-licence in UK menopause practice. Randomised trials report reductions in vasomotor event frequency. Venlafaxine (an SNRI) is among the most commonly prescribed in this context. An important note: paroxetine and fluoxetine should be avoided in women taking tamoxifen, as they inhibit the CYP2D6 enzyme needed to activate tamoxifen. These interactions make GP involvement essential, not optional.

Gabapentin. Originally developed for epilepsy, gabapentin has demonstrated reductions in vasomotor event frequency in multiple randomised placebo-controlled trials, with Level I evidence classification from the North American Menopause Society. It is a controlled drug in the UK, prescribed off-licence. Side effects including drowsiness and dizziness are dose-dependent considerations for a prescribing clinician to weigh.

Both categories require prescription and medical oversight. They work through neurotransmitter and receptor pathways — again, distinct from the nutritional pathways that food supplements use.

Lifestyle approaches with research support

Resistance training and bone density. Bone health is a particular concern when HRT is not an option, given the established bone-protective effects of oestrogen. The research on resistance training as a non-hormonal approach to bone mineral density is substantial.

A 2025 meta-analysis of randomised controlled trials (Huang et al., Journal of Orthopaedic Surgery and Research; PubMed 40420105) found that resistance training significantly improved bone mineral density at the lumbar spine (pooled SMD 0.88; p=0.01), femoral neck (SMD 0.89; p=0.0004), and total hip (SMD 0.30; p=0.003) in postmenopausal women. The subgroup analysis identified high-intensity protocols — at or above 70% of one-repetition maximum, three times per week — as producing the most consistent effects.

An earlier meta-analysis by Wolff et al. (Osteoporos Int, 2001; PubMed 11138958) came to a similar conclusion: resistance training had a positive effect on bone mineral density at the lumbar spine across pre- and postmenopausal women, and at the femur and radius sites for postmenopausal women specifically.

Resistance training is not a prescription item. It is something your GP would likely encourage regardless of your HRT status — and the bone density data suggests it deserves more prominence in conversations about non-hormonal options than it typically receives.

Sleep hygiene. Structured sleep hygiene practices — consistent sleep and wake times, limiting caffeine after midday, reducing artificial light exposure in the evening, and maintaining a cool sleeping environment — are backed by behavioural sleep research and are recommended across clinical guidance. These are low-risk and do not interact with any medical treatment. They are also frequently underestimated.

Research-backed food supplements

Food supplements are a third category, distinct from both prescription medicines and general lifestyle advice. They are regulated as food in the UK. They cannot make medical claims. They are not assessed against HRT in clinical trials. Their evidence base is built on their own RCTs, measuring their own outcomes through their own mechanisms.

Creatine HCl — CONCRET-MENOPA (Forbes et al., J Am Nutr Assoc, 2025; PubMed 40854087). This randomised double-blind placebo-controlled trial in 36 perimenopausal and menopausal women tested creatine HCl at 750mg, 1,500mg, and in combination over eight weeks. The 1,500mg group showed a 6.6% improvement in reaction time versus 1.2% in placebo (p<0.01) and a 16.4% increase in frontal brain creatine levels versus 0.9% in placebo (p<0.01). The mechanism is cellular energy metabolism via the phosphocreatine system — not hormonal. HRT status was not an exclusion criterion in this trial.

pine bark — Yang et al. (Acta Obstet Gynecol Scand, 2007; PubMed 17653885). A randomised double-blind placebo-controlled trial in 155 perimenopausal women using 200mg pine bark daily. All measured climacteric scores improved relative to placebo. Antioxidative status increased and the LDL/HDL ratio improved. No side effects were reported. The mechanism involves nitric oxide synthesis and antioxidant pathways — not oestrogen replacement.

pine bark — Luzzi et al. (Minerva Ginecol, 2017; PubMed 28116886). In 35 perimenopausal women using 100mg/day over eight weeks, plasma free radicals dropped 22%, homocysteine decreased 43%, and CRP decreased 60% (all p<0.05). These cardiovascular markers are independent of hormonal status.

saffron extract — Lopresti and Smith (J Menopausal Med, 2021; PubMed 34463070). A 12-week randomised double-blind placebo-controlled trial in 86 perimenopausal women using 14mg saffron extract twice daily (28mg total). The saffron group showed a 33% reduction on the psychological subscale items of the Greene Climacteric Scale and a 32% reduction on the corresponding mood subscale from baseline to week 12, both significantly greater than placebo (p=0.032). The measured outcomes on those subscales are validated clinical measures — a pathway distinct from both hormonal replacement and the energy metabolism pathways of creatine and citicoline.

Citicoline (as citicoline) — Silveri, Dikan, Ross et al. (NMR in Biomedicine, 2008; PubMed 18816480). Six weeks of citicolineat 500mg produced a 7% increase in phosphocreatine and a 14% increase in brain ATP in 16 healthy adults aged around 47. Citicoline is a precursor to phosphatidylcholine, a structural component of cell membranes. This is a nutritional pathway with no hormonal mechanism.

How this relates to Krevie

All five ingredients described above are present in The Krevie Routine, at doses that match the published research: citicoline as citicoline (500mg), pine bark (200mg), saffron extract (28mg daily), vitamin D3 (2,000 IU), and vitamin K2 as MK-7 (100mcg) in The Foundation, plus creatine HCl at 1,500mg in Creatine Companion.

These ingredients work through nutritional and metabolic pathways that are completely independent of hormonal status. They do not interact with oestrogen receptors. They are not alternatives to HRT. Whether or not HRT is part of your picture is irrelevant to whether these specific ingredients, at these specific research-matched doses, have evidence for the outcomes measured in their respective trials.

For women who cannot or choose not to use HRT, The Krevie Routine sits alongside a full picture that should also include GP conversations about non-hormonal prescription options (where appropriate) and lifestyle practices like resistance training. All of these categories are complementary. None replaces the others.

The Krevie Routine is priced at £49 for the first month, £75 recurring.

Important: This article provides general educational information about a range of options. It is not medical advice. Your GP is the right person to help you map out options for your specific situation — including medical history, current medications, and individual risk factors. Food supplements are not medicine and cannot substitute for that conversation.

Frequently asked questions

Further reading

• Can a supplement replace HRT? The honest research answer
• Taking creatine alongside HRT: what the research says about combining them
• What "clinically dosed" actually means — and how to check

References

1. Huang X et al. Optimal resistance training parameters for improving bone mineral density in postmenopausal women. J Orthop Surg Res. 2025. PubMed 40420105
2. Wolff I, van Croonenborg JJ, Kemper HC, et al. The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int. 1999. PubMed 11138958
3. Korovljev D, Ostojic J, Panic J, et al. The Effects of 8-Week Creatine Hydrochloride and Creatine Ethyl Ester Supplementation on Cognition, Clinical Outcomes, and Brain Creatine Levels in Perimenopausal and Menopausal Women (CONCRET-MENOPA). J Am Nutr Assoc. 2025. PubMed 40854087
4. Yang HM, Liao MF, Zhu SY, Liao MN, Rohdewald P. A randomised, double-blind, placebo-controlled trial on the effect of pine bark on the climacteric syndrome in peri-menopausal women. Acta Obstet Gynecol Scand. 2007;86(8):978–85. PubMed 17653885
5. Luzzi R, Belcaro G, Hosoi M, et al. Normalization of cardiovascular risk factors in peri-menopausal women with pine bark. Minerva Ginecol. 2017. PubMed 28116886
6. Lopresti AL, Smith SJ. The Effects of a Saffron Extract on Menopausal Symptoms in Women during Perimenopause. J Menopausal Med. 2021. PubMed 34463070
7. Silveri MM, Dikan J, Ross AJ, et al. Citicoline enhances frontal lobe bioenergetics as measured by phosphorus magnetic resonance spectroscopy. NMR Biomed. 2008;21(10):1066–75. PubMed 18816480