Doctors often prescribe supplemental estrogen or a combination of estrogen and synthetic progesterone (commonly called HRT, hormone replacement therapy) to replace women's natural hormones in order to manage the symptoms of menopause, such as hot flashes.
They also prescribe it because studies show that estrogen helps to decrease the risk of developing osteoporosis, or fragile, brittle bones, and may help prevent heart disease. But many women can't or don't want to take the medication.
"The women who come to me are interested in getting off their HRT and finding alternatives," or not starting it in the first place, says Tori Hudson, N.D., a naturopathic physician whose practice in Portland, Ore., specializes in menopause. Her patients worry about the side effects and possible health risks of hormones.
So what's a woman to do who doesn't want to just sweat out menopause or become another broken-hip statistic? Hudson and other health practitioners recommend that women start by exercising regularly, managing stress, eating a healthful diet and giving up smoking.
Only weight-bearing exercises, such as walking, jogging and playing tennis, strengthen bones. Getting outside regularly provides the body with some of the vitamin D it needs to absorb calcium, critical for maintaining bone mass. Women should eat foods that are rich in "phytoestrogens," compounds in certain plants, herbs and seeds that act like estrogen in the body, Hudson said.
Good choices are flaxseed and soybeans, including tofu. In countries where the regular diet includes a lot of phytoestrogen-rich foods, women have fewer menopause symptoms, a number of studies suggest. Women may also want to investigate supplements with compounds that act like estrogen, including ginseng, fenugreek, licorice, gotu kola, dong quai, black cohosh and evening primrose, according to the North American Menopause Society's "Menopause Guidebook."
Opting Out of Estrogen
But "more research is needed to prove their effectiveness," the guidebook warns. "What's more, most of these products are not 'quality-controlled.'" They may contain very little of their advertised ingredients, and they can have dangerous side effects.
Hudson devises her own medications for patients, using natural hormones and botanicals. They include estrogen, testosterone or progesterone that are derived from plants and biochemically identical to human forms of the hormone, she said.
To learn more about useful alternatives to HRT, she recommends reading her book, "Women's Encyclopedia of Natural Medicine," or one of the many other books on menopause, such as "Dr. Susan Love's Hormone Book: Making Informed Choices About Menopause."
Treating menopausal symptoms without estrogen isn't for everyone, and it isn't easy. "It takes a lot of work — you have to be like a scientist," said Lois Heddens, 52, of Ashfield, Mass. She takes estrogen, but she has friends who have decided to eat a special diet and take supplements instead. "They say they have to do it that way because they got sick or they had problems on estrogen," she explained.
But for some women forgoing estrogen is the stress-free way to go. "If I was taking a pill every day I probably wouldn't be thinking it was helping my bones — I'd be worrying about cancer," says Melissa Herman, 59, of Bethesda, Md. Instead of taking estrogen, she runs, eats a good diet and takes vitamins.