What Relieves Menopausal Symptoms? Alternatives to Hormone Replacement Therapy

New understanding of the risks of hormone therapy has resulted in a great deal of interest in alternatives that could help with hot flashes and other symptoms of menopause. Many women are trying herbs and natural supplements to relieve their menopausal symptoms. Some of these herbs and supplements have strong, hormonal-like effects, but unfortunately, there are few well-designed clinical studies on their safety and effectiveness. This summary is adapted from the National Women’s Health Network’s book The Truth About Hormone Replacement Therapy, with one section based on the Tufts University Health Newsletter. It provides information about several potential alternatives to hormone therapy.

What Might Work:

Phytoestrogens: Soy and Other Beans/Legumes:
There is evidence that estrogens naturally occurring in soybeans and other food plants (phytoestrogens) help counteract hot flashes. Most (though not all) studies have shown that supplementing your diet with phytoestrogens can help some of the symptoms of menopause, such as hot flashes and vaginal dryness. Eating beans is safe, but there are no long-term safety data regarding large doses of dietary supplements that contain phytoestrogens. And, beware of overstated health claims. Both the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) required several companies to stop making claims that products containing phytoestrogens can help to prevent or treat serious or life-threatening diseases or conditions like cancer, heart disease, and osteoporosis. http://www.fda.gov/bbs/topics/news/2005/NEW01260.html

Black Cohosh: Several studies show that black cohosh may decrease hot flashes, lessen excessive sweating, and improves vaginal lubrication as well as other menopausal symptoms. Unfortunately, there are no published studies in which black cohosh has been taken for more than six months, and the safety of long-term use is unknown. There is concern about the risk of endometrial cancer with long-term use, and it is unclear whether it is safe for breast cancer survivors. Side-effects include headache, stomach discomfort, nausea, vomiting, disturbances in vision, and possibly a slower heartbeat.

Kava: Several trials have shown kava significantly reduces anxiety. There is only one small study of kava herb for menopausal symptoms, which found significant improvements in menopausal symptoms as well as relief from anxiety. Kava can cause mild gastrointestinal upsets or allergic skin reactions, and large chronic doses can cause a fish scale-like skin rash, which often goes along with eye irritation. Kava has also recently been linked to liver problems.

St John’s Wort: This herb is popularly used in the U.S. as an antidepressant. Studies have found it to be mild to moderately effective for this use. The most common side effect is susceptibility to sunburn, although gastrointestinal effects and fatigue may also occur. This herb should not be combined with other antidepressants, and check with a physician before taking it if you are taking other medication.

Ginkgo: A recent summary of all published articles using ginkgo to treat dementia shows it may be helpful in early Alzheimer’s disease. The latest information suggests ginkgo may work best to prevent rather than treat dementia.

“Natural” Hormones:

  • Estriol: This hormone can be used to treat hot flashes and other menopausal symptoms, if taken in high doses. It also seems to be beneficial in maintaining bone density. There is no evidence to support claims of anti-cancer effects, and two recent studies show that estriol causes endometrial stimulation. Women who have a uterus should take an oral form of progestin to protect it from estrogen-induced endometrial cancer.
  • Natural Progesterone: There is some evidence that natural progesterone is useful in the treatment of hot flashes. There is no evidence, however, that it benefits bone density. Forms of natural progesterone include:
    • Topical Progesterone Cream: There is only one clinical trial which supports the use of topical progesterone cream to help hot flashes. Two studies indicate that levels of progesterone do not rise high enough from use of the skin creams to prevent the possibility of endometrial cancer for a woman with a uterus who is taking estrogen, and the FDA and FTC have required several companies to stop making claims that progesterone cream products are safe or effective for preventing or treating serious or life-threatening diseases or conditions like cancer, heart disease, and osteoporosis. http://www.fda.gov/bbs/topics/news/2005/NEW01260.html
    • Oral Progestins: The oral form is sometimes used to treat hot flashes. This form protects the uterus from endometrial cancer, but it is unclear whether it increases, decreases, or does not affect breast cancer risk. Side effects include depression, bloating, and other symptoms.

Clonidine: According to the Tufts Health Letter, this blood pressure medication may be mildly to moderately effective for hot flashes. However, this is powerful medication that is also used to treat aggressive/hyperactive behavior and Tourettes Syndrome. Side effects include drowsiness, headache, stomach ache, dizziness, nausea, dry mouth and depression.

 Hypnosis: A study published in 2012 conducted an experiment with 187 postmenopausal women who experienced hot flashes. Participants who were treated with clinical hypnosis reported a 74% reduction in hot flash frequency, compared with those who received a control therapy. No negative side effects were reported in this study.

No Evidence That These Work:

Chaste-Tree Berry: While many herbalists believe it ‘balances’ hormone levels, especially in women with unpredictable or heavy bleeding before menopause, there are no clinical studies on the use of Chaste-Tree Berry for menopausal symptoms. It does, however, appear to be safe.

Dong Quai: One study found that this herb by itself did not affect hot flashes, or other symptoms. Chinese herbs, however, are given in mixtures. It contains an anticoagulant that can cause bleeding when used at the same time as another anticoagulant (such as warfarin). It can increase the risk of sunburn.

Siberian Ginseng or Eleuthero: There are no studies on its use to treat menopausal women.

Evening Primrose: A study of this herb found it did not help with hot flashes.

Ginseng: A study found no significant improvement in psychological well-being, hot flashes, or other symptoms. It should not be combined with other stimulants and can interact with anticoagulants and the antidepressant phenelzine.

Licorice: There are no studies on the use of this herb for menopausal symptoms. There are serious although rare side effects associated with eating licorice, including swelling, high blood pressure, low potassium levels; there are even some documented cases of heart arrhythmia. Licorice effects can also mimic the effects of systemic steroids.

Red Clover: This herb contains some phytoestrogens. Studies have shown no benefit for red clover extract or for the standardized product containing it: Promensil. It does not seem to be effective, and its safety is unclear.

Sage: This herb is believed to help hot flashes and night sweats, but safety is a concern. It is potentially dangerous because it contains a toxic component called thujone, which can cause seizures or other neurological symptoms with long-term use.

Vitamin E: There appears to be no evidence that it is useful for the treatment of menopausal symptoms.

“Natural” Hormones:

  • DHEA: This is a powerful hormonal drug. In high doses it may increase bone density, and help with depression and other conditions. As an anti-aging supplement or a new version of hormone replacement therapy, however, it has many risks. Problems may include increased body hair and acne, as well as concerns about the possible increased risk of cardiovascular disease or cancer.
  • Wild Yams: Although wild yam contains the chemical compound from which progesterone is derived, it is not converted into progesterone in the body. Eating or applying wild yam extract does not result in increased progesterone levels in humans, and therefore offers none of the benefits of natural progesterone.

Ipriflavone: There is little evidence that ipriflavone helps reduce fractures. The best, most recent study showed ipriflavone made no difference in fracture rates or bone density. Ipriflavone alone is not an effective treatment for bone loss in women without ovaries. There is some evidence that ipriflavone may be helpful used together with estrogen to maintain bone density, but the studies are inconsistent. Side effects may include a decrease in one type of white blood cells, leading to increased risk of infections.

As with any “natural” remedy, before taking herbs or “natural” hormones to treat menopausal symptoms, women should discuss it with their physicians. Side-effects for particular medical conditions as well as interactions with other herbs or drugs can cause serious health risks.