Sarah Askwith, a physiotherapist from Wimbledon, found her hormone replacement therapy stopped controlling hot flushes after two years, despite trying multiple types, and doses.
Desperate for relief from worsening symptoms that disrupted her sleep and heightened her anxiety, she joined a six-week gut health programme run by nutrition firm Zoe, which included a personalised diet plan based on microbiome testing.
By the end of the trial, her hot flushes, fatigue and anxiety had all but disappeared, an outcome echoed by Professor Joyce Harper of University College London, who stressed that dietary changes can significantly influence menopause symptoms without requiring expensive interventions.
Her experience highlights a growing recognition that while HRT remains the first-line treatment for menopausal symptoms, it does not perform for everyone, and alternatives are urgently needed for the estimated quarter of women who suffer severe issues including sleep loss, mood swings and reduced libido.
In parallel, regulatory bodies are expanding non-hormonal options: NICE has issued final draft guidance recommending Veoza (fezolinetant), a once-daily tablet from Astellas Pharma, for moderate to severe hot flushes and night sweats when HRT is unsuitable or declined.
Veoza works by blocking specific nerve pathways in the brain that trigger temperature dysregulation, offering a targeted approach distinct from hormone-based therapies, and has been deemed cost-effective by NICE evaluators.
Helen Knight, director of medicines evaluation at NICE, said the evidence shows fezolinetant meaningfully reduces symptoms and provides value for taxpayers, addressing a long-standing gap in treatment access for women who cannot or will not use HRT due to conditions like deep vein thrombosis, pulmonary embolism, diabetes or heart disease.
Sue Mann, National Clinical Director for Women’s Health at NHS England, welcomed the decision as a vital new option that could help hundreds of thousands of women regain control over their health and daily functioning.
The need for diverse solutions is underscored by stark international comparisons: only 16 per cent of menopausal Japanese women report hot flushes, compared to 40 per cent in the UK, a difference largely attributed to dietary patterns.
Alcohol consumption and excess weight are also known to worsen symptoms, reinforcing the role of lifestyle factors alongside medical treatments.
For Helen Barnard, 56, a global events manager, night sweats became so severe they left her feeling like ‘a shell of myself’, damaging her confidence and mental health as she avoided social interactions and altered her work schedule to manage excessive sweating.
She described waking with drenched hair, feeling conscious of spreading dampness during meetings and believing colleagues focused on her appearance rather than her words, a psychological burden that compounded the physical discomfort.
Her story illustrates how vasomotor symptoms can extend beyond physical discomfort to affect professional performance, self-esteem and emotional wellbeing, particularly when women feel unable to discuss their experiences openly.
Medical experts explain that declining oestrogen levels sensitise the hypothalamus, the body’s internal thermostat, making it overreact to minor temperature shifts and triggering sudden heat surges or excessive sweating in some women.
In severe cases, these symptoms resemble clinical hyperhidrosis and can persist for years as hormone levels fluctuate during the menopausal transition.
While HRT can be highly effective, it is not appropriate for all, leaving a significant portion of women to seek alternatives ranging from prescription non-hormonal drugs to accessible dietary and lifestyle adjustments.
The convergence of personal testimony, clinical guidance and scientific insight suggests that managing menopause effectively requires a pluralistic approach — one that respects individual medical histories, preferences and cultural contexts.
How long did it accept for Sarah Askwith’s symptoms to improve on the Zoe gut health programme?
Her hot flushes, fatigue and anxiety improved significantly within six weeks of starting the tailored diet plan.
Can Veoza be used by women who have a history of blood clots?
Yes, Veoza may be prescribed when HRT is medically not recommended, such as in cases of deep vein thrombosis or pulmonary embolism, following a clinical assessment.
Is it necessary to enrol in a commercial programme like Zoe’s to benefit from dietary changes for menopause symptoms?
No, experts state that women can achieve similar improvements through general dietary adjustments without signing up for specific programmes.
What percentage of women in the UK experience hot flushes during menopause compared to Japan?
Around 40 per cent of menopausal women in the UK report hot flushes, compared to only 16 per cent in Japan, a difference largely linked to diet.
