If you are wanting some relief from the symptoms of perimenopause but are unable to use hormone replacement therapy (HRT) for medical reasons or personal preference, then this article outlines non-hormonal alternatives, as well as advice on diet and exercise.
It's important to note that HRT is a natural treatment for menopause as it replaces hormones within the body, so when we talk about alternatives we're talking about non-hormonal alternatives.
What Are The Non-Hormonal Alternatives To HRT?
There are several non-hormonal alternatives to HRT, these are:
- Natural Remedies - Herbal medicine is a practice based on the use of plants or plant extracts to relieve symptoms.
- Alternative Medicine - Alternative medicine is a range of therapies used instead of conventional medicine, such as acupressure, acupuncture, and homoeopathy.
- Complementary Therapy - Interventions that tend to be used alongside conventional medicine such as aromatherapy with HRT.
- Non-hormonal Medical Treatments -Non-hormonal medical treatments are prescribed medications such as antidepressants to help with the psychological symptoms of perimenopause such as depression and anxiety.
In this article, we take a closer look at the natural remedies for perimenopause symptoms.
Natural Remedies For Perimenopause
The main herbal medicines that are often talked about to ease perimenopause symptoms are:
- Black Cohosh
- St John’s Wort
- Rhodiola Rosea
Each has been reported to ease various symptoms of perimenopause from hot flushes to mood changes. So, what are the benefits of these herbal remedies vs. HRT?
Black cohosh is a native North American plant and a member of the buttercup family. It has been used for years to treat a variety of ailments from coughs to menstrual problems. Nowadays, Black Cohosh is more commonly used for the relief of menopausal symptoms including hot flushes, night sweats, vaginal dryness, sleep disturbances and irritability1.
There have been many studies carried out since the 1950s into the effectiveness of Black Cohosh in relieving menopause symptoms. However, a review carried out in 2016 found ‘no significant associations between supplementation of black cohosh use and relief of menopausal symptoms…’1.
Black Cohosh’s active ingredients are unknown, and studies have found varying results as to whether it helps raise oestrogen levels or its effect on LH and FSH levels.
In terms of side effects, clinical trials have been carried out on Black Cohosh and found low incidences of any adverse side effects other than stomach upsets and rashes1.
However, it can interact with other medications, such as those that are changed and broken down by the liver. Black Cohosh can interact with these medications by decreasing how quickly the liver breaks them down. It can also increase the side effects of the medication2.
St John's Wort
St John’s Wort is a natural remedy for low mood, mild depression, and anxiety, which are often symptoms of perimenopause. It has also been known to reduce hot flushes and night sweats in some women3.
St John’s Wort contains active compounds such as hypericin, hyperforin and melatonin. It is not recommended for anyone taking medications such as the contraceptive pill, blood thinning medication, medicines for cholesterol, heart disease, high blood pressure, antibiotics or antidepressants (SSRIs) to name a few.
St John’s Wort also has reported side effects that include headaches, dizziness, restlessness, fatigue, dry mouth, nausea, vomiting and allergic reactions.
Rhodiola Rosea is a herbal medicine used for symptoms associated with stress including fatigue, exhaustion and mild anxiety. A review4 carried out in 2015 concluded that there were “numerous lines of evidence that indicate R. [Rhodiola] Rosea should be investigated as a potential selective oestrogen receptor modulator (SERM) to prevent, delay or mitigate menopause-related cognitive, psychological, cardiovascular and osteoporotic conditions.”
Rhodiola Rosea has been deemed possibly safe if taken for a short period of time but might cause dizziness, excess saliva production or dry mouth5. However, there is not enough reliable information to know if this herbal medicine is safe to take over a long period of time.
What Are The Risks Of Natural Remedies For Menopause?
Before considering herbal medicine to manage perimenopause symptoms it’s important to understand some of the issues associated with natural remedies or supplements:
Efficacy and Safety of Herbal Medicine
The main issue associated with herbal medicines is the fact that they are classified as food or dietary supplements. Therefore, herbal medicine does not require a product licence which means the products do not need to have evidence of the quality, efficacy, or safety before they are marketed to the public6.
However, all herbal medicines bought in the UK and EU need to have the THR (traditional herbal registration) mark to demonstrate the product meets specific safety and quality standards. Be wary of buying herbal medicines online and outside of the UK/EU or having herbal medicines prepared for you by an individual.
Quality of Source Materials
The efficacy and safety of herbal medicine is largely determined by the quality of the source materials. This not only covers how the herb is grown, but collected, stored and manufactured1. One of the biggest challenges for manufacturers of herbal medicine when it comes to quality control of the finished product is the difficulty in ascertaining the inclusion of the whole plant or starter materials. This makes it much harder to ensure quality and accuracy in dosage than for other pharmaceutical products.
Interactions with Other Medicines
The other issue with herbal medicine is the possible interaction with other medication. Some herbal medicines can reduce or increase the effects of existing medication.
Inconsistencies in Ingredient and Dosage
Studies have been carried out which highlighted a variation in both ingredients and dosage between the same herbal medicine from different brands7. It’s important to ensure you are getting a consistent dosage with any herbal medicine you are taking. Buying the same herbal medicine from different brands may not mean the concentration of the active ingredient and dosage is the same, unlike other medication either prescription or non-prescription.
Some people choose to take herbal medicine as it’s perceived to have fewer side effects and are less harmful than pharmaceutical medications. However, this is not the case due to the points noted above.
What Are The Other Alternatives To HRT?
You may have heard of another alternative to HRT called ‘bioidentical’ HRT or compounded bioidentical HRT (cBHRT).
The British Menopause Society describes compounded bioidentical HRT as:
“…precise duplicates of hormones such as estradiol E2, estriol E3, estrone E1, progesterone, dehydroepiandrosterone, testosterone and levothyroxine…”8.
Compounded bioidentical hormone replacement therapies come in a variety of preparations and manufactured by ‘specialist pharmacies’ both in the UK and abroad. The issues with cBHRT, as outlined by the British Menopause Society, are8:
- [they] do not follow the same regulatory pathway of evaluation by the MHRA as conventional pharmaceutical products.
- Have not been through the rigorous process of drug development which conventional medicines and products such as rBHRT [conventionally prescribed regulated bioidentical HRT] undergo.
- Have not been scientifically evaluated in controlled randomised clinical trials for effectiveness and safety against placebo or conventional HRT.
As such the British Menopause Society does not recommend compounded bioidentical HRT as an alternative to regulated HRT as there is no evidence on which to based effectiveness or safety.
Regulated HRT is molecularly identical to the hormones produced in the body and is available on NHS e.g. oestradiol gel and micro ionised progesterone. Read our blog on HRT to learn more.
A healthy diet should not be underplayed when it comes to maintaining a healthy hormone balance.
Ensuring your diet is rich in fresh fruits and vegetables, particularly broccoli, sprouts and carrots will help you gain the key nutrients you need to support long term health as well as maintain a good hormone balance.
Include foods such as soya, lentils, chickpeas, flaxseeds, oats and wholegrain rice which all contain phytoestrogens. These are plant-based foods that help to balance hormones and provide oestrogenic ‘activity’ where required.
Eating foods that also contain B vitamins such as B1, B9 and B12, omega-3, vitamin D, calcium and magnesium to help support heart and bone health.
Read more in our menopause diet guide.
Exercise is important at all stages of our lives, but particularly so during menopause. It’s important to have a regular exercise routine that includes aerobic as well as strength-building activity to support cardiovascular health and promote strong bones to protect against osteoporosis.
Although exercise hasn’t been proven to relieve menopause symptoms such as hot flushes or night sweats, it can help improve low mood, stress and anxiety. Exercise leads to the production of endorphins, or ‘feel good’ hormones, that lift your mood.
In addition, being outside when you exercise enhances this effect. Not only is being out in nature good for your mental health but being outside, particularly between April and September helps boost vitamin D levels from the action of sunlight on the skin.
It’s important to note that NICE guidelines advise that herbal remedies which are not regulated by a medicine authority should not be considered safer than pharmaceutical medicines. This is due to the wide variety in their effectiveness and potency and the potential to cause significant side effects and interactions with other medication. The same warning is given for compounded bioidentical HRT.
HRT has over the last few years gained bad press in relation to breast cancer, but there is far more risk of developing breast cancer due to a poor lifestyle than taking HRT. You can read more about the benefits and risks of taking HRT in our blog.