Alternatives to HRT: are they any good?

If you can’t use HRT or choose not to, you may well be thinking about alternative treatment options.

This could be prescription medications, herbal supplements such as black cohosh, St John's wort or red clover, alternative therapies such as acupuncture, or products such as the Ladycare device.

There is a very limited evidence base for the effectiveness of complementary and herbal therapies, but some women will undoubtedly find them helpful.

For advice on HRT and alternatives such as prescription medication and cognitive behavioural therapy (CBT), see our guide to Menopause symptoms and treatments.

Herbal medicines and supplements

Some women report that plants or plant extracts, such as St John’s wort, black cohosh and isoflavones (soya products including red clover supplements), can help reduce hot flushes and night sweats. 

Black cohosh and isoflavones

There are a lot of studies looking at the effectiveness of isoflavones, but the results are variable and generally show little value. Black cohosh and isoflavones can also react with other medicines that you may be taking for conditions such as breast cancer, epilepsy, heart disease or asthma, and their dose effectiveness and safety are unknown.

St John's wort

St John’s wort has positive effects for some women, but the ingredients may vary and their effects are uncertain. They can also interfere with other drugs, including those to treat breast cancer.

Other herbal treatments, including ginseng and Chinese herbal medicines, are not shown to improve hot flushes, anxiety or low mood.

You should check with your healthcare professional before taking any herbal medicine.

Herbal medicines: things to be aware of

Unlike conventional medicine, there is no legal obligation for herbal medicines to be licensed. Unlicensed products may vary greatly in their actual contents, effectiveness and potency, and there may be significant side effects.

A THR logo means a product has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA) as a traditional herbal remedy. For these products you can be sure that the product has the correct dosage, is of high quality and has suitable product information so you can use it safely.

Alternative medicine and complementary therapies

Acupuncture, acupressure, homeopathy, aromatherapy

Alternative therapies such as acupressure, acupuncture or homeopathy may help some women. More research is required on the benefits from these therapies though and, if they are used, this should be done with advice from qualified professionals.

Research showed women who received a placebo (sham acupuncture) had similarly positive outcomes to those who received acupuncture, but there is a very high placebo effect with both.

Bioidentical or compounded hormones

Some women prefer these ‘natural’, plant-derived hormonal combinations and find them very effective at relieving symptoms.

How it works: A doctor tests your blood or saliva for hormone levels and tops them up to so-called natural levels by having a compounding pharmacist make a preparation for you.

The evidence: A Cochrane review found low to moderate quality evidence that bioidentical hormone treatment in various forms and doses is more effective than placebo for treating moderate to severe menopausal hot flushes.

Things to be aware of: Bioidentical hormone treatments are unregulated, not subject to quality control and  it is not known whether they are safe with regard to long-term outcomes such as heart attack, stroke and breast cancer.

Ladycare device

Much like the magnet bracelets some people use for arthritis, the Ladycare magnetic device is claimed to relieve symptoms of menopause. It costs between £35 and £50, and is designed to be clipped on to your underwear, about four inches below the navel.

Ladycare claims that menopause symptoms, caused by diminishing hormones, create an imbalance of the autonomic nervous system (ANS) and that the magnetic Ladycare device rebalances the ANS ‘in many cases.’

However there is currently no evidence for this. The Advertising Standards Authority (ASA) has issued a notice of non-compliance against Ladycare, stating that its marketing claims that it naturally relieves the symptoms of menopause are unsubstantiated.

Self-help for menopause symptoms

There are some practical things you can do to help alleviate menopause symptoms such as hot flushes and night sweats without having medical treatment. These include:

• weight loss – studies have shown that overweight or obese women who lose weight experience reduced severity and/or frequency of hot flushes
• mindfulness-based stress reduction – one study showed some promise in this area, though more research is needed.

Other things that are commonly recommended are:

• cooling techniques – choose clothes designed to keep you cool or dress in removable layers, keep your bedroom cool and drink iced drinks when a hot flush starts
• avoid possible triggers – avoid spicy foods, tight clothes, and hot foods and liquids. Alcohol intake has shown no effect on hot flushes in studies
• exercise – there's insufficient evidence to support this helping hot flushes, but it has many general health benefits and is worth trying.

These methods haven't been studied so there isn't evidence to support them, but they may help some women cope with menopause symptoms.

Trouble sleeping

If you're struggling to sleep because of hot flushes or night sweats, here are some things that can help:

• eating regular meals at regular times, and avoiding late-night eating
• limiting caffeinated drinks, such as coffee and cola drinks
• avoiding alcohol – it can make you feel sleepy but can also affect your sleep cycle, waking you in the night.

For advice on getting help with unmanageable menopause symptoms, see our guide to Menopause symptoms and treatments.