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Alternatives to Hormone Replacement Therapy in Menopause

1 August 2007


Introduction: Since the Women's Health Initiative study results in 2002, many women are turning to alternative therapies instead of hormone replacement therapy for symptomatic menopause.

Background: Complementary and alternative medical therapies have been used for centuries in other cultures, and now many products are available over-the-counter in the United States. In addition to non-hormone prescription medications, women are using different herbs, supplements, and therapies such as acupuncture to help alleviate their menopausal symptoms, often times without their medical provider knowing they are taking them.

Purpose: To review current evidence available on the efficacy, benefits, risks, and side effects for a number of alternatives to hormone therapy that exist in the United States for symptomatic menopause.

Methods: An extensive review of the literature including MEDLINE (1990 - 2007), Cochrane Database of Systematic Review, Natural Medicines Comprehensive Database.

Results: While nothing is as beneficial in relieving hot flashes as hormone replacement therapy, there is evidence of symptom improvement with SSRIs/SNRls, clonidine, gabapentin, and black cohosh. Possible benefit from soy with genistein-isoflavone products and acupuncture. No evidence of benefit with dong quai, flaxseed, red clover, many other herbs, vitamin E, evening primrose oil, wild yam, or progesterone creams.

Comments: While improvement may be statistically significant with some of these therapies, the clinical benefit may not be worth the cost of these alternative options.

Conclusion: Unless contraindicated, short-term use of hormone replacement therapy is still the best option for symptomatic menopause. In patients who want to try an alternative, evidence supports recommending SSRI/SNRI, clonidine, gabapentin, and possibly black cohosh.


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