Why I Haven’t Needed HRT, and What I’m Doing Instead

A pair of 15-pound hexagonal dumbbells placed on a plain white background, perfect for building strength and endurance in a home or gym workout.

One question I get fairly often is: “Are you on HRT?”

And when I say no, the next question is usually, “Why not?”

My answer is actually pretty simple: "I don't feel like I need it."

That doesn't mean I'm against hormone replacement therapy (HRT), and it certainly doesn't mean I think every woman should navigate perimenopause or menopause without it. HRT can be an appropriate and valuable option for many women, and that is a conversation each woman should have with a qualified healthcare provider based on her symptoms, health history, risks, and personal preferences.

For me, however, my experience has been different.

As a Board Certified Health and Wellness Coach, and as a woman going through this stage of life myself, I have spent years making nutrition, exercise, sleep, stress management, and other healthy lifestyle habits a priority. So far, those choices have helped me manage the changes of menopause well enough that I haven't personally felt the need to pursue HRT.

I Don't Believe Menopause Automatically Requires Medication

Menopause is a natural biological transition, but "natural" doesn't mean it is always easy.

Hot flashes, sleep disruption, mood changes, brain fog, body composition changes, fatigue, and other symptoms can have a significant impact on a woman's quality of life. Some women experience relatively mild changes, while others have symptoms that are much more disruptive.

My approach has been to first ask: "What can I do to support my body through this transition?"

For me, that has meant consistently working on the foundations of health rather than waiting until symptoms become overwhelming.

What Has Helped Me

There isn't one magic food, supplement, workout, or wellness habit that I can point to. I believe it has been the combination of many choices practiced consistently over time.

1. I prioritize strength training

Strength training is one of the biggest priorities in my own routine. As we move through midlife, maintaining muscle becomes increasingly important for strength, mobility, metabolic health, bone health, and healthy aging. I don't exercise simply to burn calories or make the scale go down. I train because I want to remain strong, capable, independent, and metabolically healthy as I age.

2. I pay attention to what I eat

   
   

I focus on a nutrient-dense diet that provides my body with what it needs rather than constantly restricting food.

Protein is especially important to me because it helps support lean muscle mass, recovery, satiety, and healthy body composition. I also prioritize fiber, whole foods, fruits and vegetables, healthy fats, and balanced meals. That doesn't mean I eat perfectly. However, I don't believe perfection is necessary or realistic. What matters much more is what we do consistently.

3. I take sleep seriously

   
   

Sleep can become much more challenging during perimenopause and menopause, and poor sleep can spill into nearly every other area of health. I make getting adequate, quality sleep a priority rather than treating it as something I'll get to when everything else is finished.

4. I manage stress instead of ignoring it

   
   

We can't eliminate stress from our lives, but we can become much more intentional about how we respond to it. Stress management, boundaries, exercise, recovery, mindset, and simply recognizing when I need to slow down have all become important parts of how I take care of myself during this stage of life.

5. I don't drink alcohol.

Another lifestyle choice I've made is not drinking alcohol. This is a personal choice and certainly isn't meant to suggest that every woman going through menopause needs to completely eliminate alcohol. For me, however, not drinking is simply part of the way I choose to support my health.

Alcohol can affect areas that are already important to pay attention to during midlife, including sleep quality, energy, mood, weight management, and for some women, menopause symptoms such as hot flashes.

Because I put so much emphasis on protecting my sleep, maintaining a healthy body composition, supporting my workouts and recovery, and feeling my best, alcohol isn't something I personally include in my lifestyle. Like everything else I've discussed, I don't look at this one habit in isolation. It's another piece of the bigger picture and one of the many choices I make consistently to support my body through menopause and healthy aging.

6. I pay attention to my body

   
   

Perhaps most importantly, I don't assume that every change is something I simply have to tolerate because I'm getting older. I pay attention. If my sleep changes, my energy drops, my body composition shifts, or I simply don't feel like myself, I look at what may have changed and what I can realistically adjust. That awareness allows me to be proactive instead of reactive.

Lifestyle Isn't a Guarantee That You Won't Need HRT at Some Point

This is an important distinction. I don't want another woman to read my experience and think, “If I just eat better and exercise more, I shouldn't need HRT either.” That's not the message.

Two women can follow very similar lifestyles and have completely different menopause experiences. Genetics, medical history, symptom severity, individual physiology, and many other factors can influence how a woman experiences this transition.

Healthy lifestyle habits can be incredibly valuable, but they aren't a promise that you won't experience symptoms or that you will never want or need medical treatment. My experience is mine, not a prescription for yours.

I'm Not Anti-HRT

I think this is worth saying very clearly. Choosing not to use HRT myself does not make me anti-HRT. I believe women deserve good information, appropriate medical guidance, and the ability to make informed decisions about their own bodies. For some women, that decision may include HRT. For others, it may not. For some, the answer may change over time.

My current choice is based on how I feel, how I'm functioning, my personal health circumstances, and the fact that the lifestyle strategies I use are working well for me right now. If that changes, I would evaluate my options with an appropriate healthcare professional just as I would encourage someone else to do.

HRT or No HRT, the Foundations Still Matter

This may actually be the most important message of this entire conversation. HRT and a healthy lifestyle don't have to be competing approaches.

Whether a woman chooses HRT or decides not to use it; it is important to remember that nutrition, resistance training, sleep, stress management, healthy body composition, social connection, and other lifestyle behaviors still matter. HRT isn't a replacement for taking care of your health, just as a healthy lifestyle isn't necessarily a replacement for medical treatment when it's needed. The two can coexist.

This Is Why I'm So Passionate About Helping Women Over 40

I'm not only a Board Certified Health and Wellness Coach. I'm also living through this stage of life. I understand how frustrating it can be when your body suddenly seems to respond differently than it used to. The strategies that worked at 30 may not work the same way at 45, 50, or beyond.

I also don't believe women should be told that weight gain, loss of strength, exhaustion, poor sleep, and feeling disconnected from their bodies are simply things they have to accept as part of getting older. There is a lot we can influence, and that's where I focus my work.

I help women over 40 look at the bigger picture. Specifically their nutrition, movement, strength, sleep, stress, habits, mindset, and daily routines. I then help them determine where realistic changes could make a difference.

My goal isn't to tell a woman whether she should or shouldn't take HRT. My goal is to help her build a lifestyle that supports her health either way.

You Have Options

If you're navigating perimenopause or menopause and wondering what you can do to feel better, you don't have to overhaul your entire life overnight. Sometimes the best place to begin is simply identifying what's working, what's not, and where a few targeted changes could have the biggest impact.

That's exactly the kind of work I do with my clients. If you're ready to lose fat, gain strength, and age with confidence, I invite you to schedule a Health Jumpstart Call with me. We can talk about what you're experiencing, what you've already tried, and what kind of support may make sense for you.

Menopause isn't about fighting your body. It's about learning how to support the body you have now, and building the strength and habits that will carry you into the years ahead.

If you are interested in a more in depth look at this subject, I have also written a Substack Post that goes deeper into this subject and gives the 6 foundations I use, as well as a lifestyle audit that you may find valuable.

In health,

Alais Reta, B.S., NBC-HWC

Alais B. Health and Wellness

This article reflects my personal experience and is intended for educational purposes only. It is not medical advice or a recommendation for or against hormone therapy. Decisions regarding HRT should be discussed with a qualified healthcare provider who can consider your individual medical history, symptoms, risks, and needs.