Alternatives to HRT

By Dr Ornella Cappellari

After the overview of HRT treatment, the question that immediately arises is: what can you do if you can’t take HRT?

Is there nothing out there that can make you feel any better or like a human being again?  There are different methods that can help you to tackle the symptoms and make the onset of the menopause more tolerable. Among the alternatives are: plant/herbal treatments and supplements, acupuncture, yoga, physical exercise and stress reduction techniques. Let’s take a look at each alternative.


Vitamin E

75% of menopausal women experience hot flushes and research has shown a significant reduction in their severity and frequency when vitamin E is taken daily1. The same dose has also shown to help reduce vaginal dryness. Food sources include avocados, seed oils, nuts, leafy green vegetables, whole grains and wheat germ. If you decide to go for a supplement, look for one containing d-alpha-tocopherol, as it has better absorption.

Omega 3 essential fatty acids

They support hormone balance and have a lubricating effect on the body and as such may help with vaginal dryness. These fatty acids have also been linked to a reduction in risk of breast cancer. Food sources include oily fish (salmon, mackerel, herring, sardines, seafood and fresh tuna), nuts, seeds and green leafy vegetables.

Vitamin D

Many women are prescribed HRT as a prevention for osteoporosis, particularly if they have gone through an early menopause or have had a full hysterectomy. However, supporting bone density doesn’t rely on just having the right hormones present. There are key vitamins as well, and vitamin D is one of them, as it is so complex that it acts more like a hormone. Calcium absorption (which is responsible for bone density/calcification) depends on vitamin D, and it’s synthetised through sunlight on the skin. Our ability to absorb it decreases with age and given that food sources containing vitamin D are limited, it is pivotal to take supplements. Aside from trying to spend some time in the sun (which also could boost your mood), taking supplements in the form of D3 (which is better absorbed) is recommended.

B vitamins

If you’re experiencing stress, panic attacks, anxiety or depression, then B vitamins can help. Also known as the ‘stress nutrients’, B vitamin groups assist your nervous system, the production of your serotonin and helps your adrenal glands to manage stress. Foods containing B vitamins include green leafy vegetables, meat, fish, eggs, dairy and fortified foods.

Herbal Treatments

Black cohosh

This medicinal herb has been used for centuries to support menopausal women, and may help with hot flushes, depression, night sweats and vaginal dryness. Research has shown an improvement in symptoms in up to 80% of women using it within six to eight weeks. There has been a lot of controversy over this herb, however, with some calling into question the safety for breast tissue. It must be noted through that recent research suggests that black cohosh is a selective estrogen receptor modulator (SERM), which means that it stimulates only certain estrogen receptors in the body: namely, the bones and the brain, excluding the womb and breast tissue. The best way to take black cohosh is as a supplement.

Phytoestrogenic foods

Foods rich in phytoestrogens may help to moderate symptoms due to their effect on estrogen receptors in the cell membrane. In cases where estrogen levels are low, they lock into receptors and stimulate a mild estrogenic effect. Where there is an estrogen excess, the phytoestrogens block cell receptors. Foods rich in phytoestrogens include soya foods, lentils, linseeds, mung beans, garlic, fennel, parsley and celery.

Milk thistle

The active ingredient in milk thistle is a bioflavonoid named silymarin, which can help to support hormonal balance through its protective action on the liver. Any excess hormones we have in our body are detoxified and excreted via the liver and gut, which makes milk thistle a good herb to help support hormonal balance.

A Note On Plant and Herbal Treatments

Many herbal treatments, like isoflavones (a class of phytoestrogens2 — plant-derived compounds with estrogenic activity) and bioidentical molecules do not come under the regulations of EMA (European Medicinal Authority)3. Very few in fact, are subject to quality control and there is lack of standardization of strength and dose and little or no requirement of evidence of effectiveness or regulations of side effects. This puts the end user in a position of not being protected as there is a lack of clear regulation.

However, the MHRA (Medicines and Healthcare Products Regulatory Agency) has developed a certification trademark called Traditional Herbal Registration (THR), which means that products listed here are considered safe (if used as intended) and have a standardised dose (although effectiveness has not been assessed yet). Most important to keep in mind is that these alternative treatments do not prevent risk of osteoporosis and heart disease.

Other Techniques

A Belgian studyof 2016 demonstrated that, for a large number of women, relaxation techniques, regular physical activity, acupuncture and avoiding stress had satisfaction rates comparable to those seen in women who had had HRT treatment.


Acupuncture may help reduce night sweats and hot flushes though more research is needed to ensure that it is not a placebo effect. However, a publication of 20175 demonstrates that acupuncture has a more rapid reduction in vasomotor symptoms and increase in health-related quality of life in postmenopausal women but probably has no long-term effects. In this publication, many other studies are cited which claim the same results giving encouraging reasons to consider acupuncture.


Magnets are used in the form of bracelets, necklaces and even a ‘magnet in your knickers’.  Scientific literature currently offers no evidence at all that they work. Any benefits are likely to be linked to the placebo effect – believing that they do work, which may help mood and therefore severity of symptoms – or because menopausal symptoms vary so much from week to week and month to month. Although there is no evidence to say that the magnets do work, they are  safe and so if you do wish to try them you can do so without concern. If you find that it improves the quality of your life, why not?

Yoga and Physical Exercise

Yoga and physical exercise are useful in general. Yoga encourages meditation and mindfulness and this can help you to cope with the symptoms. Physical exercise can help with the impact of changes in bone density and weight control associated with the menopause. It also appears to help with mood swings as it stimulates endorphin which can make you feel more relaxed. Reflexology also requires more studies.

Progesterone Skin Creams

Last, but not least, we have progesterone skin creams. There is a large industry which promotes the use of these creams promising they can help menopausal symptoms and bone density. A US and UK study showed no increase in bone density over two years (as noted on the website of the National Osteoporosis Society) and there are few studies which show without doubt that the cream helps menopausal symptoms. Only one study, which used a bioidentical progesterone cream specifically compounded for the trial, found the evidence that the bioidentical progesterone was more effective than the placebo in relieving menopause-related vasomotor symptoms. Vaginal bleeding and headaches were the most commonly reported side effects by the studies.

In conclusion, there are many different strategies you can employ that are not HRT based to at least partially overcome the symptoms of the menopause. The important thing is to always choose the solution that works better for you.


1. Minerva Ginecol. 2015 Feb;67(1):1-5. Resveratrol, tryptophanum, glycine and vitamin E: a nutraceutical approach to sleep disturbance and irritability in peri- and post-menopause. Parazzini F.

2. J Steroid Biochem Mol Biol. 2014 Jan;139:225-36. doi: 10.1016/j.jsbmb.2012.12.004. Epub 2012 Dec 25. The pros and cons of plant estrogens for menopause. Bedell S, Nachtigall M, Naftolin F.

3. Post Reprod Health. 2016 Jun;22(2):67-9. doi: 10.1177/2053369116648273. Alternatives to hormone replacement therapy (HRT) (Sections 1 and 8). Woyka J.

4 Maturitas. 2016 Aug;90:24-30. doi: 10.1016/j.maturitas.2016.04.018. Epub 2016 May 7. Coping with menopausal symptoms: An internet survey of Belgian postmenopausal women. Depypere H, Pintiaux A, Desreux J, Hendrickx M, Neven P, Marchowicz E, Albert V, Leclercq V, Van den Branden S, Rozenberg S.

5 Chin J Integr Med. 2011 Dec;17(12):893-7. doi: 10.1007/s11655-011-0930-9. Epub 2011 Dec 3. Perspectives in clinical research of acupuncture on menopausal symptoms. Baumelou A1, Liu B, Wang XY, Nie GN.