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Navigating Menopause With Integrative Medicine

In our integrative medicine practice, we combine conventional medicine with alternative & holistic medicine, striving to treat mind-body-spirit as one interconnected system from the roots up. At Hearthside Medicine, we care for many patients at various stages of life under the umbrella of family medicine. We have an increasing number of patients seeking a holistic approach to transitions in their hormones--some wanting bioidentical hormones, some wanting only herbal options, and some wanting a blend of plant-based and conventional treatments.

This blog is part of a longer series on perimenopause and menopause and focuses on alternative options and non-hormone prescriptions for hormonal transitions.

We offer bioidentical hormones and testing as well as non-hormonal prescriptions for those who prefer that route as well. To read more about these topics check out the following blogs:

Integrative medicine for symptoms & hormonal health

Plant-based therapies

There are a variety of plant-based therapies used for hot flashes including isoflavones (dietary or supplements) and herbal therapies.

Plant-derived estrogens (phytoestrogens & Isoflavones )

Phytoestrogens have been marketed as a natural alternative to hormones for menopausal symptoms.

Isoflavones are part of a group of plant-based chemicals called phytoestrogens. These chemicals act like a weaker form of estrogen in the body.

The main isoflavones in soy are genistein and daidzein. When you eat soy, bacteria in your intestines break it down into its more active forms. Broccoli and broccoli sprouts are also rich in phytoestrogens.

When isoflavones bind to some receptors, they mimic the effects of estrogen. When isoflavones mimic estrogen, they might help reduce hot flashes and other symptoms of menopause.

However, the amount of hormone-like compounds they possess are scant compared to taking HT. However, some may prefer this option, and I always advocate for plant-based medicine if it accomplishes the goal of the user and is safe.

Phytoestrogens are found in soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Isoflavone supplements, a type of phytoestrogen, can be purchased. Other foods that are being studied and are believed by many to have positive effects on estrogen balance in menopause include peaches, sesame seeds, garlic and cruciferous veggies such as broccoli and broccoli sprouts.

It’s uncertain if phytoestrogens help to reduce hot flashes or night sweats; most studies have not reported benefit or report very conflicting data.

Since phytoestrogens might act like estrogen in some tissues of the body. Many experts suggest that those with history of breast cancer avoid phytoestrogens. Others say they may actually reduce risk of breast cancer. I always advise you consult with your oncologist if you have active or history of breast cancer.

Phytoestrogens have both estrogenic and anti-estrogenic properties and are categorized as isoflavones, coumestans, or lignans.

Isoflavones and phytoestrogens have not been consistently found to be more efficacious than placebo for hot flashes, though advocates of plant-based medicine would disagree.

Two types of isoflavones, genistein and daidzein, are found in soybeans, chickpeas, and lentils and are thought to be the most potent estrogens of the phytoestrogens (although they are much weaker than human estrogens).

Lignans (eg, enterolactone and enterodiol) are found in flaxseed, lentils, grains, fruits, and vegetables.

In a review of 11 randomized clinical trials of soy or isoflavone supplementation, only three of eight trials with at least six weeks of follow-up demonstrated a beneficial effect.

In contrast, a meta-analysis of 21 trials in menopausal women with hot flashes receiving phytoestrogens reported a decrease in the number of daily hot flashes but no change in night sweat frequency. Although this was statistically significant, it may not be clinically significant for those with severe, frequent hot flashes.

When different isoflavones were analyzed separately, red clover was ineffective for hot flashes, similar to results from previous studies. Again, there are some conflicting studies that show red clover having some benefit over placebo.

Genistein (Isoflavin)

Four genistein trials suggested that doses >30 mg/day might reduce hot flash frequency compared with placebo.

Red Clover (Isoflavone)

The data on this one is conflicting at best—with many studies showing no benefit over placebo and others showing possible benefit.

A meta-analysis of randomized controlled trials assessing the effect of a specific

standardized extract of red clover isoflavones on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily frequency of hot flushes


Once in your body, soy isoflavones bind to the same receptors as estrogen. Receptors are like docking stations on the surface of cells.

In a 2012 analysis of 19 studies, soy isoflavone supplements reduced the severity of hot flashes by just over 26 percent, compared to a placebo. A Cochrane review from 2013 found no firm evidence that dietary soy or isoflavone supplements eased hot flashes. But it did find a benefit from supplements that were high in genistein, one of the main isoflavones in soy.

A 2015 analysis of 10 studies found that plant isoflavones from soy and other sources reduced hot flashes by 11 percent.

In a 2012 analysis of 19 studies, soy isoflavone supplements reduced the severity of hot flashes by just over 26 percent, compared to a placebo. A Cochrane review from 2013 found no firm evidence that dietary soy or isoflavone supplements eased hot flashes. But it did find a benefit from supplements that were high in genistein, one of the main isoflavones in soy.

A 2015 analysis of 10 studies found that plant isoflavones from soy and other sources reduced hot flashes by 11 percent.

Many studies show that soy and soy isoflavones can modestly reduce the number and severity of hot flashes, but it doesn’t work as quickly as hormone therapy.

Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.

You can also take soy isoflavones in supplement form or by eating diet high in soy products such as soy milk, tofu, miso, tempeh, and edamame. The North American Menopause Society recommends starting at a dose of 50 milligrams a day.

Because soy can have estrogenic properties, its effects can vary depending on the existing level of hormones in the body. Premenopausal women have much higher circulating levels of estradiol—the major form of estrogen in the human body—than postmenopausal women. In this context soy may act like an anti-estrogen, but among postmenopausal women soy may act more like an estrogen.

Many experts suggest that dietary soy is reasonable in women with ER+ breast cancer but that dietary supplements should be avoided until safety has been established.


This ingredient is likely in one of your menopause supplements because it is one of the most potent adaptogens for those vasomotor symptoms of hot flashes and night sweats.

However, two North American species of licorice have been found to induced these liver enzymes, meaning they can cause you to process your prescription drugs way too fast—impacting the therapeutic quality and possibly safety of your prescription.

Licorice is a potent root that has the potential to negatively affect the body in other ways, too. It contains glycyrrhizic acid, which can elevate sodium levels and reduce potassium levels, an effect that could lead to "abnormal heart rhythms, as well as high blood pressure, edema (swelling), lethargy, and congestive heart failure," according to the U.S. Food & Drug Administration. For this reason, the FDA warns black licorice lovers over 40 with hypertension or heart problems to limit how much of it they eat.

Also of note-- It increases blood pressure in some people!

Borage Oil is rich in gamma linolenic acid (GLA), some research states it is beneficial in supporting hormonal balance for women but others contradict this. GLA is said to be relatively safe. However, there are concerns that borage oil may be toxic. Evening primrose oil seems to be a safer source of GLA than borage oil.

Both borage oil and evening primrose oil may lower the seizure threshold. People who take anticonvulsant medicines should not take these oils. Some omega-6 fatty acids, such as GLA, may increase or decrease the effects of certain medicines. Talk to your healthcare provider before taking borage oil.

Black Cohosh

Commercially available preparations of black cohosh usually contain 1 mg of the active ingredients in each 20 mg dose of extract.

Many postmenopausal people use black cohosh for hot flashes, but clinical trials have shown that it is not more effective than placebo. There have been concerns that it can stimulate breast tissue like estrogen, increasing risk of recurrence in those who have had breast cancer. So far, there is no evidence that it is harmful, even in those with breast cancer. Still, some experts suggest that with breast cancer avoid black cohosh until this has been studied more extensively.

There have also been concerns about possible hepatotoxicity (abnormal liver function tests) with black cohosh but a meta-analysis of five black cohosh trials involving a total of 1117 women found no evidence of an adverse effect on liver function.

Among the alternative therapies for hot flashes, black cohosh is one of the most widely used; however, systematic reviews and meta-analyses suggest that black cohosh is no more effective than placebo for treatment of hot flashes. My thoughts? If placebo works and is safe…great!

Maca root is included for overall tonic support for the endocrine system. It is considered an adaptogen as are holy basil and ashwagandha below and has been touted to help with energy and mood and hormones.

Holy Basil

Holy Basil has powerful anti-stress properties and is an adaptogen herb. It is great source for treating anyone who experiences stressful times and/or anxiety. It supports the adrenal system, which during menopause, fluctuates hormonally.


It helps protect the immune system, supports healthy blood sugar metabolism and lowers cholesterol. It improves brain

function, such as memory changes. It reduces anxiety and depression, and enhances sexual potency for both men and women.

Using Ashwagandha on a regular basis provides positive effects. It will help balance your brain, heart, moods and even your sex drive!


Maca sometimes known as “Peruvian ginseng,” yet has no relation to ginseng. Found in Peru, and enjoyed for thousands of years for its beneficial properties. This root will increase strength, energy, stamina, libido and sexual function. It improves perimenopause and menopausal symptoms like hot flashes, night sweats, anxiety and depression.

Rhodiola offers adaptogenic and antioxidant support and some believe it helps with mood and energy that can wane or vacillate in menopause.

I appreciate the following information from Dr. Aviva Romm’s blog on herbal remedies for menopause:

Dr. Aviva’s Cool Down Extract for Hot Flashes

She recommends getting the individual extracts from Herb Pharm, Gaia Herbs, or Mountain Rose online and mixing them yourself--purchase an empty 4 oz. dropper bottle from Mountain Rose, or mix these in a glass bottle and take the recommended dose daily.

1 oz. chaste tree tincture (regulates hormones, reduces menopausal symptoms)

1 oz. lemon balm tincture (cools hot flashes, improves mood)

1/2 oz. motherwort tincture (relaxing, calming, cools hot flashes and menopausal symptoms)

1/2 oz. black cohosh tincture (80 mg twice daily, cools hot flashes, improves menopausal mood and symptoms)

1/2 oz. hops tincture (100-200 mcg for at least 12 weeks, cools hot flashes, relieves vaginal dryness)

1/2 oz. sage leaf tincture (cools hot flashes)

To prepare: Combine the different extracts in a 4 oz. dropper bottle or glass bottle.

Dose: Take 1 teaspoon in 1/4 cup hot water, 2-3 times daily. You can take this formula until hot flashes are no longer a problem.

Note: Omit sage leaf and hops extract if you have a history of estrogen receptor positive cancer as they are estrogenic.


3 gm. per day (3-6 capsules) of Chinese ginseng (Panax ginseng) taken daily not only reduces hot flashes, but can boost your libido and lower high cholesterol! Take in the early part of the day as ginseng can be stimulating and interfere with sleep.


Rheum rhaponticum, or Rhubarb, in the form of an extract called ER731 has been shown in a clinical trial to be very effective in the treatment of hot flashes. The proprietary extract can be found in the product Estrovera by Metagenics or try Herb Pharm’s Rhubarb Extract as directed on bottle. Estrovera contains ERr 731 a special extract of rhubarb root that has been shown in clinical studies to significantly reduce menopausal hot flashes and other menopausal symptoms compared to placebo. Rhapontic Rhubarb (Rheum rhaponticum L.) Root+ Extract (ERr 731(tm))


Valerian for More than Sleep

Get your Valerian (Valeriana officinalis) in capsule form, as it has a bad taste. The dosage is 150–300 mg of a product standardized to 0.8% valerenic acid. Use one hour before bedtime or

225 mg of Valerian in capsules taken 3 times daily can dramatically reduce hot flashes after just 4 weeks of use—it may help with sleep as well

Pine Bark

Pycnogenol, an extract of pine bark, is not only an excellent antioxidant, but effective in reducing hot flashes in a dose of 60-100 mg twice daily.

Researchers found that an extract of pine-tree bark -- under the brand-name Pycnogenol -- seemed to ease symptoms of women starting menopause. Fatigue, headache, vaginal dryness and menstrual problems were among the most common symptoms at the study’s start.

However, all symptoms tended to improve over six months of Pycnogenol treatment,

Dong quai

Some people say dong quai relieves symptoms such as hot flashes. Researchers are not sure whether dong quai acts like estrogen or blocks estrogen in the body. Studies are conflicting, and one study found that dong quai did not help to relieve menopausal symptoms.


Use the tincture (alcohol extract), 1-2 mL (about 40-80 drops) before bed for night sweats. It can make you sleepy, so avoid using before driving. Hops has mildly estrogenic effects so this herb is not recommended if you have risk factors for estrogen receptor positive breast cancer.

Pollen extract

A few studies suggest that pollen extract may be helpful in relieving both premenstrual and menopausal symptoms such as hot flashes. Although the mechanism by which this may occur is not well understood, pollen extract appears not to have hormonal effects. Therefore, it may be useful for breast cancer patients experiencing hot flashes. However, studies in cancer populations are needed to ensure safety, effectiveness, and to confirm that it does not negatively interact with chemotherapy drugs.

Passion Flower

One of the best herbs to promote sleep and ease anxiety--use 1-3 mL repeated every hour for 2-3 hours before bed, and every 3-6 hours during the day for mild to moderate anxiety. Caution when combining with antidepressant or psychiatric medications!


One of my favorite herbs for emotional irritability related to hormonal changes, motherwort relieves anxiety and is useful when there are benign heart palpitations. Dose is 2 mL of extract several times daily as needed, or capsules taken as recommended on the package.

St John’s Wort

Often used for depression, St John's wort can be used as an effective treatment for the vasomotor symptoms of perimenopausal or postmenopausal women. Do not combine with other medications that can increase serotonin such as antidepressants or 5-HTP without discussing with your provider.

Wild Yam

Wild yam is a plant. It contains a chemical called diosgenin. This chemical can be converted in the laboratory into various steroids, such as estrogen and dehydroepiandrosterone (DHEA). The root and the bulb of the plant are used as a source of diosgenin, which is prepared as an "extract," a liquid that contains concentrated diosgenin. However, while wild yam does seem to have some estrogen-like activity, it is not actually converted into estrogen in the body. It takes a laboratory to do that. Sometimes wild yam and diosgenin are promoted as a "natural DHEA." This is because in the laboratory DHEA is made from diosgenin. But this chemical reaction is not believed to occur in the human body. So, taking wild yam extract will not increase DHEA levels in people. Although wild yam cream is marketed as a source of natural progesterone, it does not contain progesterone, and the body cannot convert it into progesterone.

Wild yam is most commonly used as a "natural alternative" to estrogen therapy for symptoms of menopause, infertility, menstrual problems, and other conditions, but there is no good scientific evidence to support these or other uses.


Vitex (chaste berry) can be used in the perimenopause if periods are irregular, and also relieves emotional symptoms.


While increased urinary tract infections in menopause generally need to be treated by improving associated vaginal dryness or decreased tone and fullness of the genitourinary tissues, d-mannose makes an excellent addition for its ability to help prevent infections.

Pueraria mirifica

This herb has been used in Thailand for over 700 years to help women quell perimenopausal symptoms. It is believed that it has ability to interact with the body’s own estrogen to help diminish hot flashes

It is being used in various traditional systems for treating menopausal syndrome-related ailments. The predominant phytochemical constituents are isoflavones, also known as phytoestrogens.

This herb has been traditionally used as a vitality enhancer and rejuvenating agent particularly for older women. It contains a class of phytoestrogens known as Chromenes that rival estrogen itself in potency. The herb is highly estrogenic as a result, and is considered the standard herbal 'estrogen replacement therapy' in some cultures due to its potencies.

It has been tested numerous times for reducing menopausal symptoms (as estrogen replacement therapy itself is quite effective), and despite the universal promise it shows many studies are not blinded and not run against a placebo; on the topic of menopausal symptoms, this is a significant problem as placebo can be very potent (Black Cohosh is an example, as the placebo effect in menopause has been reported to reach up to a 50% reduction in symptoms).

Based on the preliminary evidence, it does appear promising and effective for menopausal symptoms, but much more research is needed before it can be considered a main opinion. There is currently no evidence to support the notion that this herb is somehow safer than estrogen replacement therapy, so their benefits and risks should be seen as interchangeable for the time being.

Amantilla and Babuna

These natural medicines originate from the valerian plant (Valeriana officinalis) and the flower of the manzanilla plant (Matricaria recutita, commonly known as chamomile), respectively. In a double-blind, randomized, placebo-controlled multicentered study, Amantilla was 82.5 percent effective in helping patients sleep, while Babuna was 68.8 percent effective. On nights when you’re keyed up, try 15 drops of Babuna thirty minutes before going to bed, followed by 15 drops of Amantilla at bedtime.


DIM (diindolylmethane) is the active ingredient in cruciferous vegetables; it promotes proper hormone metabolism. Although research on DIM is still quite limited, it’s thought to help balance estrogen levels in your body

Observational studies associate high cruciferous vegetable intake with a reduced risk of certain cancers, including breast and prostate cancer.

While cruciferous vegetables are the primary food source of DIM, you would need to eat several servings every day to reap this compound’s benefits. People looking to treat a specific condition like acne or prostate issues may seek a concentrated dose in the form of a DIM supplement.

DIM works in two ways. First, it blocks the enzyme that converts testosterone into estrogen. So if you have a tendency to aromatize your testosterone to estrogen (like me), DIM can be very helpful (a DUTCH test will show this).

DIM can be very helpful but it’s NOT helpful if---

Your estrogen levels are low.. If you begin taking DIM, it is likely to lower those levels, even more, aggravating symptoms like night sweats and hot flashes.

You’re taking megadoses (50-200 mg is plenty). More is not better in this situation.

You’re not having regular bowel movements… estrogen is eliminated in bowel movements and constipation or other gut health issues keep it in the body.

DIM is generally well-tolerated with a few mild symptoms for a few days. Side effects of DIM include:



Brain fog

Dark urine (pink to orange to brownish)

The consensus is that darkened urine is harmless and will return to normal once you stop taking your DIM supplement. Some say it’s a good sign that DIM is working on your liver to neutralize estrogen metabolites.

Due to a lack of research in humans, little is known about the long-term safety and side effects of DIM supplements.

Current human research doesn’t show DIM supplements to be toxic or have serious side effects. The most common side effects include darkening of the urine, an increase in bowel movements, headaches, and gas.

Less common side effects include nausea, vomiting, diarrhea, and skin rash.

As DIM supplements interact with estrogen levels, they may affect people with hormone-sensitive cancers or who are on hormone therapies. Such individuals should steer clear of DIM supplements unless under the supervision of a medical professional.

A dose of about 15 mg per day of actual DIM in an absorbable formulation is advised. These amounts can be increased up 3-4 times this amount on an individual basis.

Since pure DIM must be provided in an absorption-enhancing formulation, the dose for DIM sometimes specifies the weight of the absorbable formulation, which is only one-fourth, or 25 percent DIM. The suggested dose of 100 to 200 mg per day refers to milligrams of such an absorbable formulation. This dose range corresponds to 25 to 50 mg per day of actual DIM.


This substance is derived from high concentration broccoli and broccoli sprouts. Proponents claim it helps protect estrogen-sensitive tissues by promoting healthy estrogen metabolism and supporting detoxification of harmful estrogen metabolites and xenoestrogens (estrogen-like compounds found in things like microplastics). Some companies will combine DIM and Glucoraphanin into an estrogen-balance blend. This is found in broccoli and broccoli sprouts.


Melatonin is secreted by the brain’s pineal gland in response to cycles of light and darkness. It helps your body regulate its sleep-wake cycles, so it can be good for travel-related insomnia. Natural melatonin secretion is also affected by depression, shift work, and seasonal affective disorder (SAD). The usual dose is 0.5–3.0 mg, taken one hour before bedtime.


5-HTP (5–hydroxytryptophan) increases serotonin, which is converted to melatonin, which is why it may be helpful for sleep pattern disruption, as well as PMS and seasonal affective disorder (SAD). The starting dose is 100 mg, three times per day. Gradually increase over several months to 200 mg, three times per day. Some studies do show increased anxiety and other side effects after 250 mg.


Magnesium deficiency is associated with insomnia. Most people have less-than-optimal magnesium levels. If you experience restless sleep or wake up frequently during the night, adding magnesium may help you sleep more soundly. I love CALM magnesium citrate powder. Others prefer magnesium glycinate, stating that it doesn’t has as many GI side effects (diarrhea). Too much magnesium, regardless of the type, can cause diarrhea and stomach cramps (which is why is also works great for the occasional constipation!).

Magnolia bark

Magnolia bark is used to promote relaxation and sleep, as well as to ease anxiety and stress by lowering adrenaline. Research shows that magnolia bark can reduce the time it takes you to fall asleep and can increase the amount of time you spend in both REM sleep and NREM sleep. For people with anxiety, magnolia bark can be as effective as the drug diazepam without the risks of dependency or side effects. The standard dosage is around 250 – 500 mg daily with a higher dosage recommended for improving sleep.

L-Theanine. This amino acid found in tea leaves increases the levels of GABA, serotonin, and dopamine – calming neurotransmitters in the brain that regulate emotions, mood, concentration, alertness, sleep, and energy. Increased levels of these chemicals help with sleep, as well as menopause-related mood swings, difficulty concentrating and changes to appetite during menopause.

Herb Pharm’s Relaxing Sleep blend:

This contains Valerian, Passion flower, Hops, Chamomile flower, and Catnip leaf (nope, not just for the kitties!) and is an excellent blend that contains herbs for both sleep and hot flashes.

Caution: Do not take sleep herbs with prescription sedatives without your provider’s guidance.

Phytoestrogen blend:

  • Vitex. This is an herb that helps to promote production of progesterone.

  • Black Cohosh. This is an herb that helps to regulate estrogen production.

  • Red Clover. This is a phytoestrogenic herb, meaning that it resembles estrogen and has estrogen-like effects on the body.

  • Ashwagandha. Supports DHEA production and can help support the adrenal system.

  • Motherwort. This herb helps to enhance the synergy and efficacy of the blend of herbs. (Note: motherwort is generally contraindicated in those with thyroid conditions… another reason to have proper testing and assessment prior to use).

You can use these herbs in tincture form from companies like Herb Pharm or Gaia Herbs or get them in loose from your local herbalist or herbal apothecary and make your own tea or tincture.

Additional Natural Support

One of my favorite integrative physicians is Dr. Romm (also an herbalist). She recommends the following dietary and lifestyle strategies to prevent and ease hot flashes:


Nutrition can prevent or decrease symptoms and problems of menopause.

Eat plenty of fiber from vegetables and flax seeds daily

Eat good quality fats (olive oil, walnut oil, coconut oil, butter) at each meal and take essential fatty acids daily, especially evening primrose and fish oil

Keep your blood sugar balanced with ample protein at each meal, eat every few hours, and minimize sugar and empty calories

Eat legumes regularly for their “phytoestrogens”

Emphasize a plant-based diet rich in phytoestrogens including cupfuls of cooked green leafies like kale, collard greens, broccoli, and Napa cabbage daily, as well as legumes such as garbanzo beans and lentils.

Add Flax seed, 1-2 TBS fresh ground daily, to your daily diet

“Fatten up”: Ample good quality dietary fat, including olive oil, coconut oil, butter or ghee, and walnut oil, as well as fresh avocado is necessary for maintaining hormone synthesis. In fact, if you are underweight you have a higher risk of having hot flashes – and there is no connection between good quality dietary fat and a higher risk of high cholesterol – with olive oil it's just the opposite!

Other non-medication interventions:

Hot flashes.

Using a small fan at your desk, or a large one in your bedroom at night can help decrease the discomfort of hot flashes. You may notice hot flashes appear with certain triggers, such as heat, or emotional anxiety. Daily exercise and avoiding alcohol may help reduce the number of flash attacks as well.

Breathing exercises for stress-reduction may be of help when you feel a hot flash coming on. Paced respiration – A relaxation-based method known as paced respiration appears to be relatively easy to learn, but its impact on hot flash symptoms is not yet established

Weight loss – As noted above, obesity is a risk factor for hot flashes

Weight loss may help reduce hot flashes

Sleep disturbance. If you have chronic sleep disturbance, proper sleep hygiene is important. Try to maintain the same sleep schedule every day of the week and weekend, do not consume caffeine after noon, and do not let yourself get emotionally worked-up in the late evenings by watching or reading the news, or discussing stressful topics just before bedtime. Turn off all screens 1-2 hours before bed. Avoid heavy exercise after 4 pm but DO get daily exercise to sleep better. Avoid alcohol if you want to get a deep REM sleep and limit hot flashes and urinating in the middle of the night. Try sleeping with ear plugs and fans.

Start winding down in the evenings to help your body relax and make the transition to sleep.

2% progesterone cream.

Try bioidentical progesterone cream.Low dose progesterone cream (available over the-counter or by prescription) may be effective short term. Use one-quarter to one-half teaspoon at bedtime on skin. Progesterone binds to the GABA receptors in the brain and has a calming effect.

Mood changes.

For depression, insomnia, and anxiety that can occur with hormonal transitions, check out my blog “Treating Anxiety, depression, and insomnia naturally”

Decreased libido and Vaginal symptoms

The genital tissues have a high concentration of hormone receptors for good reason.

Vaginal dryness and pain during intercourse can sometimes be relieved with a personal lubricant, such as K-Y products, Astroglide, or Replens. However, a lubricant cannot restore tissue thickness, elasticity, and pliability. Sometimes lubrication just isn’t enough to keep the vagina comfortable during intercourse and a small amount of vaginal-only estrogen cream is needed.

So where is the science?

According to Up to Date, a well-regarded providers' resource, large meta-analysis shows that many of the supplements on the market for perimenopause and menopause rarely perform better than placebo. A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analysis can be performed when there are multiple scientific studies addressing the same question (Ie "Does primrose oil help with hot flashes?" ")

Acupuncture – Acupuncture is among the most frequently used complementary therapies for hot flashes, but results thus far are conflicting. In a systematic review and meta-analysis, acupuncture was less effective than hormone therapy, no different from sham acupuncture (eight studies), but statistically more effective than no therapy (four trials). Regardless, I love acupuncture and vote you try it to see what it may offer you.

Evening primrose oil – Evening primrose oil is a rich source of gamma-linolenic acid and is widely used by postmenopausal women to treat hot flashes and inflammation. However, available data suggest that it is no more effective than placebo. Using this product in conjunction with other medical treatment can cause adverse effects such as bleeding. Proponents claim that evening primrose oil can offer relief from a number of menopausal symptoms. However, there is little scientific support for the theory that evening primrose oil can help treat menopausal symptoms. In fact, the National Institutes of Health (NIH) states that "there’s not enough evidence to support the use of evening primrose oil for any health condition." That being said, many folks love primrose and believes it helps them. It is pretty safe and may have some benefit.

Flaxseed – Flaxseed has not been shown to be more effective than placebo for hot flashes--however, it is a superfood, nutrient dense and full of fiber--all around, it is inexpensive, healthy, and if it helps, wonderful!

Other –No reduction in frequency of flushes was seen with ginseng or dong quai. Wild yam and progesterone creams also appear to be ineffective. Traditional medicinal Chinese herbs, reflexology, and magnetic devices have all been studied and appear to have no beneficial effect based on meta-analysis with a placebo-control group. Again, I am a fan of incorporating multiple healing modalities into care if the potential for help is there and potential of side effects or harm is minimal.

Herb Pharm and Gaia Herbs are two of my favorite herbal companies. Mountain Rose is a company that sells single herbal tinctures on-line.


Please note! While I am a fan of plant-based medicine, I want to stress that just because it is plant-derived does not mean it cannot have drug or health interactions--many of the above mentioned supplements can impact estrogen levels, which for those with a history of breast cancer, may be contraindicated (always get clearance from your oncologist!) Some plants/supplements listed above can decrease clotting levels (increase risk for bleeding, such as evening primrose), decrease iron levels or change thyroid levels (ashwagandha) or be too much for the liver--the safety profile of each listed above needs to be discussed between a provider and patient based on that patient's unique medical history and health.

For those who can't take the above mentioned supplements or need something additionally, the following non-hormonal prescriptions are often used for perimenopause/menopause:

Non-hormonal prescription options for symptoms

Non-estrogen treatments for hot flashes are effective in many women. None work as well as estrogen, but they are better than placebo (sugar pills). Not all women need treatment for hot flashes, since they are mild in some women. Options include:

Paroxetine — Paroxetine (sample brand name: Brisdelle) is the only nonhormonal therapy that is specifically approved for hot flashes (in the United States). This agent has been used for many years for depression but can be taken at a lower dose for hot flashes.

Gabapentin — Gabapentin (sample brand name: Neurontin) is a drug that is primarily used to treat seizures. It also relieves hot flashes in some women, preferably given as a single bedtime dose or during the daytime as well.

Antidepressants — Antidepressant medications are recommended as a first-line treatment for hot flashes in women who cannot take estrogen. Paroxetine is the only drug approved in the United States for hot flashes in this class, but each of these agents has been used for hot flashes. They also help often with sleep and mood, sometimes weight and libido.

●Venlafaxine (brand name: Effexor), desvenlafaxine (brand name: Pristiq), citalopram (brand name: Celexa), and escitalopram (brand name: Lexapro) were developed to treat depression, but studies show that they are an effective treatment for hot flashes. Paroxetine (sample brand name: Brisdelle, Paxil) is also effective for hot flashes, but you should not take paroxetine if you have breast cancer and are taking tamoxifen. The concern is that paroxetine can interfere with tamoxifen and make it less effective.

●Fluoxetine (brand name: Prozac) and sertraline (brand name: Zoloft) do not work as well as the other antidepressants listed.

Other antidepressant side effects and interactions are discussed in detail in a separate article.

Oxybutynin — Oxybutynin is a drug that is usually used to treat overactive bladder and urinary incontinence. It might also be effective for treating hot flashes, but more studies are needed. The most bothersome side effect is dry mouth.

About the author

Havilah Brodhead is a board-certified family nurse practitioner and chief medical officer and owner of Hearthside Medicine Family Care in Bend, Oregon, an integrative medical practice. Havilah loves incorporating natural, plant-based medicine and alternative medicine into her conventional medicine training. She and her fellow NP provider Marie Mency love to care for the whole family and share a special interest in Women's Health. Havilah loves to mountain bike, practice yoga, and spend time with her husband and two young daughters exploring Oregon.

Havilah Brodhead, FNP and Marie Mency, FNP/Women's Health are accepting new patients of all ages and take most insurances. Telehealth is available for Oregon and California residents as well.


We offer in-person and telehealth consults for Oregon residents, and Marie is also able to offer telehealth consults to residents of California in addition to Oregon.


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