Alternatives to Hormone Replacement Therapy

With the demise of Hormone Replacement Therapy (HRT), what alternatives are available for the millions of women suffering from debilitating post-menopausal symptoms? Unfortunately, the answer is "not much". One option is to use HRT with smaller doses. If the risks decrease proportionally with the dose (i.e., by taking half the previously prescribed dose of hormones, the risk increase also goes down by a factor of two), the risk increment becomes small enough to be almost meaningless*. However, the dependence of the risk on the dose is not currently known.

Some natural remedies, such as black cohosh have been suggested as providing some relief from these symptoms. Remifemin, manufactured by GlaxoSmithKline, a well-known drug manufacturer, contains black cohosh. At the Remifemin web site you can find a the results of some studies that claim that Remifemin reduces menopause symptoms by 70% after 12 weeks of use. The site claims that Remifemin is safe; however, one should remember that the safety of medication (including herbal medication) can only be established after studies with hundreds of thousands of patients. It took decades of research to find problems with HRT, and there is no reason to believe apriori that other, less well-tested remedies are safer.

A detailed article in Annals of Internal Medicine v 137, p 805 (2002), lists numerous remedies that were tried and failed. The list is long, and if you would like to review it, please click here. The article does reference some studies that support the use of Remifemin. The authors state that "black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data precludes recommending long-term use". The authors also note that soy seems to have a modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than the soy foods themselves.

* Please see our Risk Tutorial for a better understanding of risks, and our HRT Study summary for information on the absolute risks of HRT.

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Last Modification - Oct 18, 2004