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Seven natural HRT alternatives

If you've talked to your doctor about menopause, it's likely you've been offered HRT: hormone replacement therapy. This medication provides synthetic versions of the hormones that decline naturally during menopause, usually given in a combined form with oestrogen and progesterone.

It's natural to want to find a solution to the symptoms you're experiencing, and many in the medical profession see HRT as a solution for all symptoms of menopause. However, HRT does have its pros and cons, and there are natural alternatives to consider.

The pros and cons of HRT

Some women swear by HRT and have found great comfort in relief from their symptoms of night sweats, insomnia, continual hot flushes and vaginal dryness. Unfortunately, when you stop taking HRT, you'll go through menopause again as your hormones decline.

HRT may also be prescribed if your doctor believes you are at risk of osteoporosis, due to the effects of oestrogen on supporting bone turnover. Some studies suggest that HRT may increase your risk of ovarian and breast cancer. However, the absolute increase in risk is small, and this is something to discuss with your GP based on your family and lifestyle history.

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Natural Alternatives to HRT

Vitamin E

Around 75% of menopausal women experience hot flushes, and research has shown a significant reduction in their severity and frequency from taking 400IU of vitamin E per day. The same dose of vitamin E has also been shown to help reduce vaginal dryness. Good food sources include avocados, seed oils, nuts, leafy green vegetables, whole grains and wheat germ. If you opt for a vitamin E supplement, look for one that contains d-alpha-tocopherol, as this is better absorbed.

Omega-3 essential fatty acids

The signs of omega-3 deficiency are similar to many symptoms experienced during menopause: dry skin, fatigue, depression, and aching joints. Omega-3 essential fats also support hormone balance, and have a lubricating effect in the body, so may help with vaginal dryness, and have been linked to a reduction in risk of breast cancer. Good food sources include oily fish (salmon, mackerel, herring, sardines, seafood and fresh tuna), nuts, seeds and green leafy vegetables.

If you don't like fish, it's worth supplementing fish oil daily. Look for one with at least 200mg of EPA per daily dose. For vegetarians, include flax and chia seeds in your daily diet, and look for a vegetarian omega 3 supplement.

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Phytoestrogenic foods (plant oestrogens)

Foods rich in phytoestrogens, or plant oestrogens, may help to moderate symptoms of menopause due to their effect on oestrogen receptors on the cell membrane. In cases where oestrogen levels are low, they lock on to receptors and stimulate a mild oestrogenic effect. Where there is an oestrogen excess, the phytoestrogens block cell receptors.

Foods rich in phytoestrogens include soybeans and other plant-based foods such as beansprouts, chickpeas, flaxseed, sesame seeds and wholegrains.

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Vitamins, minerals and plant oestrogens to support women through the menopause

  • Vitamin B6 to regulate hormonal activity, high dose of vitamin E
  • Calcium, magnesium and vitamin D for healthy bones
  • Phytoestrogens from soy and omega 3 from flax
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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 black cohosh within six to eight weeks.

There's been a lot of controversy over this herb, with some calling into question the safety of black cohosh on breast tissue. However, most recent research suggests that black cohosh is a selective oestrogen receptor modulator (SERM), which means that it stimulates only certain oestrogen receptors in the body: namely, the bones and the brain, and not womb or breast tissue.

The best way to take black cohosh is as a supplement, and some menopause supporting supplements contain this herb. Or you could visit your local medical herbalist who can make you a bespoke tincture containing black cohosh.

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Traditional Herbal Medicine for menopause symptoms

  • Traditionally used to help relieve menopause symptoms such as hot flushes, night sweats and mood swings
  • Registered Traditional Herbal Medicine, regulated by the MHRA
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Milk thistle

The active ingredient in milk thistle is a bioflavonoid called 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 an excellent herb to help support hormonal balance.

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 nutrients too, of which one is vitamin D.

Vitamin D is essential for calcium absorption, and is made through the action of sunlight on the skin. The cloudy days common in Northern European countries mean it's difficult to get enough sun to make sufficient vitamin D, and our ability to absorb the vitamin decreases with age, so it's important to take a supplement. Alongside sensible sun exposure when the sun is out, supplement at least 10mcg of the D3 form, which is better-absorbed than D2.

B vitamins

If you're experiencing stress, panic attacks, anxiety or depression, then B vitamins can be very supportive. Known as the 'stress nutrients', B vitamins help to support your nervous system, the production of your feel-good neurotransmitter serotonin, and help your adrenal glands to manage stress.

As the B vitamins work in harmony, it's best to choose a B complex that provides a range of B vitamins from B1 to B6, plus B12 and folic acid. Food sources of B vitamins include green leafy vegetables, meat, fish, eggs, dairy and fortified foods.

For more advice and information about the menopause, visit our menopause product and advice hub.

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Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.