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Health Information Menopause: Alternatives to Hormone Replacement Therapy

Alternatives to Hormone Replacement Therapy

The first alternative to hormone replacement therapy is a healthy lifestyle. Positive moves you can make to feel better are: don’t smoke, eat a variety of foods low in saturated fat, trans fat, and cholesterol and moderate in total fat. Include grains, especially whole grains and a variety of dark green leafy vegetables, deeply colored fruit, and dry beans and peas in your eating plan. Also, maintain a healthy weight, and be physically active for at least 30 minutes most days of the week, preferably daily.

The list of alternatives to hormone therapy below includes some locally applied hormone products, which might not carry the same risks as those that deliver medication throughout the body. Talk to your doctor about the risks and benefits of each alternative you’re considering.

Be aware that some of these remedies are regulated by the Federal Government as dietary supplements, and as such do not undergo premarket approval and may not have data showing them to be safe and effective. Talk with your doctor or other health care provider about the best treatment for you for each symptom.

Alternatives for Postmenopausal Conditions:


  • Lifestyle behaviors to protect bone density.
    • Follow an eating plan rich in calcium and vitamin D.
    • Thirty minutes of weight-bearing exercises such as walking, jogging, stair climbing, weight training, tennis, and dancing, done three to four times a week can help prevent osteoporosis.
    • If you smoke, quit.
    • Limit how many alcoholic beverages you drink.
  • Designer estrogen raloxifene (Evista), which preserves bone density and prevents fractures (although not hip fractures).
  • Bisphosphonates Actonel or Fosamax, which preserve bone density, prevent fractures, and can reverse bone loss
  • Teraparatide (parathyroid hormone), which may reverse bone loss
  • Calcitonin (a nasal spray or injectable), used to treat women who have osteoporosis, which may prevent some fractures (This drug is not approved for preventing osteoporosis.).

    Note: Phytoestrogens (see “hot flashes” below) have not been shown to prevent osteoporosis or reduce the risk of fractures.

Heart disease

  • Lifestyle behaviors, including:
  • Following a healthy eating plan that includes a variety of foods low in saturated fat, trans fat, cholesterol and moderate in total fat, and rich in fruits and vegetables
  • Choosing and preparing foods with less salt
  • Not smoking
  • Maintaining a healthy weight
  • Being physically active
  • Preventing and controlling high blood pressure
  • Preventing and controlling high blood cholesterol
  • Managing diabetes
  • Taking prescribed medication to control heart disease

To Alleviate Menopausal Symptoms:

Hot flashes

  • Lifestyle changes. These include dressing and eating to avoid being too warm, sleeping in a cool room, and reducing stress. Avoid spicy foods and caffeine. Try deep breathing and stress reduction techniques, including meditation and other relaxation methods.
  • Phytoestrogens. Soybeans and some soy-based foods contain phytoestrogens, which are estrogen-like compounds. Soy phytoestrogens can be consumed through foods or supplements. Soy food products include tofu, tempeh, soy milk, and soy nuts. Other plant sources of phytoestrogens include such botanicals such as black cohosh, wild yam, dong quai, red clover, and valerian root. However, there is no solid evidence that the phytoestrogens in soybeans, soy-based foods, other plant sources, or dietary supplements really do relieve hot flashes. Further, the risks of taking the more concentrated forms of soy phytoestrogens, such as pills and powders, are not known. Dietary supplements with phytoestrogens do not have to meet the same quality standards as do drugs. Little is known about the safety or efficacy of these products.
  • Antidepressants, such as Effexor, Paxil, and Prozac. These medications have been proved moderately effective in clinical trials.

Vaginal dryness

  • Vaginal lubricants and moisturizers (available over the counter).
  • Products that release estrogen locally (such as vaginal creams, a vaginal suppository, called Vagifem, and a plastic ring, called an Estring)—these are used for more severe dryness. The ring, which must be changed every 3 months, contains a low dose of estrogen and may not protect against osteoporosis.

Mood swings

  • Lifestyle behaviors, including getting enough sleep and being physically active
  • Relaxation exercises
  • Antidepressant or anti-anxiety drugs
  • Insomnia
  • Over-the-counter sleep aids
  • Milk products, such as a glass of milk or cup of yogurt— choose low-fat or fat-free varieties—consumed at bedtime
  • Do physical activity in the morning or early afternoon— exercising later in the day may increase wakefulness
  • Hot shower or bath immediately before going to bed Memory problems
  • Mental exercises
  • Lifestyle behaviors, especially getting enough sleep and being physically active

This article was adapted from “Facts About Menopausal Hormone Therapy” from the National Heart, Lung, and Blood Institute, on of the institutes of the National Institutes of Health.


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Menopause: Alternatives to Hormone Replacement Therapy

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