Can’t Take HRT? Supplements May Not Be the Best Alternative

In 1942, Wyeth Pharmaceuticals introduced the first hormone replacement therapy (HRT) for women going through menopause. Over the intervening decades, doctors have gone back and forth on the safety and efficacy of using HRT to treat symptoms like hot flashes and vaginal discomfort.

To get relief, women who worried about the safety of HRT — the therapy has evolved and is now considered a safe option for women younger than 60 — turned to dietary supplements instead of HRT to try controlling their symptoms.

Unfortunately, experts have little faith in the efficacy and possibly safety of these supplements, according to a 2023 position statement released by The Menopause Society.

“Menopausal symptoms like hot flashes, night sweats and insomnia can last for years, affecting the quality of a woman’s life. Menopause also raises her risk for heart disease and dementia. HRT is treatment of choice to help many women control moderate to severe symptoms,” says endocrinologist Dr. Andrea Klemes, chief medical officer, MDVIP. “Of course, HRT is not right for every woman, particularly if breast, ovarian or endometrial cancer, stroke or blood clots are a risk. However, leaning on supplements may not be the answer either.”

Nutritional Supplements

Common over-the-counter supplements used to ease menopause symptoms include:

Black cohosh – an herb native to North America used to treat estrogen-related conditions, such as easing hot flashes and night sweats. These claims lack scientific evidence. Further, black cohosh may increase the effects of estrogen in some parts of the body, while decreasing it in others, which may be problematic. It also increases liver enzymes, potentially causing liver damage in some users.

Dehydroepiandrosterone (DHEA) – a hormone produced by the adrenal glands. It’s prescribed to treat a thinning vaginal lining. But it’s also available as a synthetic over-the-counter supplement, derived from chemicals in wild yams or soy. It’s taken to reverse some of the physiological changes associated with menopause such as the loss bone density, muscle strength, sexual function and skin tone. Studies conflict: Some found that DHEA may improve bone density, sexual function and skin tone; however, not muscular strength. DHEA also is controversial because it’s suspected to raise the risk of hormone-sensitive cancers such as breast, ovarian and endometrial.        

Red ginseng – an herbal remedy used for centuries in Asian cultures to help manage menopause symptoms. Studies have found that it helped with sexual function and eased intensity of hot flashes, but it didn’t relieve frequency of hot flashes or adjust hormonal levels. Red ginseng also has been found to affect menstruation, heart rate, blood pressure and appetite, as well as cause headaches and breast pain. It also can interact with calcium channel blockers, statins and antidepressants.      

Red clover – a wild plant that belongs to the legume family. It’s credited with having a wide range of uses, including easing menopause-related issues such as hot flashes, heart disease and osteoporosis. However, studies regarding its value are mixed. Moreover, red clover contains isoflavones, plant-based compounds with a similar structure to estrogen. Some studies suggest isoflavones raise the risk for breast cancer in women who have a personal or family history of breast cancer, as well as thyroid problems. Red clover also is known for interacting with anticoagulants and Methotrexate, an anti-rheumatic drug.

Soybean – a legume grown in Eastern Asia that’s processed into soy products like protein, milk and fiber. Soy is recognized for easing some effects of menopause. For instance, it can help control the frequency and intensity of hot flashes, strengthen bones, lower bad cholesterol and possibly improve blood pressure. Soy supplements and foods are effective because they’re a good source of plant-based estrogen isoflavones, but they can interact with:

• Tamoxifen, a breast cancer medication
• Estrogen-based medications
• Osteoporosis medications including raloxifene, a post-menopausal osteoporosis drug
• MAOI antidepressants

Soy supplements and foods also can decrease the absorption of zinc and iron supplements and increase the risk of bleeding, particularly if you’re taking a blood thinner, (e.g., aspirin, warfarin/Coumadin, clopidogrel/Plavix).

St. John’s wort – a plant native to Europe that’s often used as a supplement to treat menopause symptoms, including depression and anxiety. Studies support its use to manage depression and seasonal affective disorder, and its effectiveness in controlling menopause-related anxiety when combined with black cohosh. However, studies are mixed regarding its ability to relieve other menopausal symptoms. More importantly, St. John’s wort interacts with a long list of medications, making it a debatable choice for menopause symptoms. In fact, the concern over St. John’s wort’s drug interactions led France to ban it and other countries to require a prescription.

Wild yam – a vine (not to be confused with the starchy vegetable yam) that has diosgenin, a plant-based estrogen that can be chemically converted into estrogen, DHEA, progesterone and cortisone. In fact, diosgenin also was used in the 1960s to make the first birth control. Wild yam has been used since the 1700s to ease numerous female ailments like morning sickness, menstrual cramps, nausea, menopause symptoms and menopause-related osteoporosis; however, there isn’t any scientific evidence to support its use for these issues. Furthermore, wild yam can induce side effects and interactions with medications and other herbs. It is a natural hormone replacer, you may need to avoid it if you have a personal or family history of hormone-related cancers such as breast, ovarian or uterine, as should women who are breastfeeding or pregnant and those with a protein S deficiency.    

“There’s a couple of red flags with most of these supplements. First, many studies conducted with these products have mixed results. Second, the active ingredient in many of them is plant-based estrogen, which are not safe for women who are not taking HRT for health reasons,” says Klemes. “If you can’t or don’t want to use HRT, I strongly suggest you consult your physician before taking a dietary supplement.”

Options Beyond Supplements

If you and your doctor feel HRT and dietary supplements are not the best choice for you, try these approaches to alleviate menopause symptoms.

• Anxiety
• Depression
• Weight gain
• Sleeplessness
• Hot flashes and night sweats
• Brain fog
• Weaker bones/osteoporosis
• Cholesterol
• Low libido

“Every woman’s situation is unique, that’s why it’s so important to work with your doctor, particularly someone who knows you very well,” Klemes says.

If you don’t have a doctor, consider joining an MDVIP-affiliated practice. They more have time to help you in your pursuit of a healthier lifestyle, which may ease menopause symptoms. Find a physician near you and begin your partnership in health »