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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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November 06 2018

7 Herbal Alternatives to HRT

By Mark Sisson
15 Comments

For many women, menopause can introduce new health challenges. In addition to the symptoms that perturb basic quality of life like hot flashes, headaches, night sweats, and irritability, menopause is also associated with higher risk for serious health concerns like osteoporosis, cognitive decline, and metabolic syndrome. This has made the standard treatment for menopause—hormone replacement therapy, or HRT—a multi-billion dollar business.

A few weeks ago, I explored the benefits and risks of HRT. It has its merits certainly, but it’s not for everyone. Today’s post is for those people. Say you’ve waded through the morass of HRT research and would prefer a different route. Or maybe you’ve actually tried conventional or bioidentical HRT and found it just didn’t work for you. Whatever the reason, you’re probably interested in using “natural” products if you can swing it and if it’ll actually help.

Are there herbal alternatives to HRT that actually work?

As a matter of fact, there are.

Black Cohosh

A medicinal herb native to North America, black cohosh was traditionally used to treat a wide variety of conditions, including rheumatism and other arthritic conditions, colds, fevers, constipation, hives, fatigue, and backache. They used it to help babies get to sleep and soothe kidney troubles. In the mid 20th century, it gained popularity in Europe as a treatment for women’s hormonal issues. Modern clinical research bears out its relevance for menopause:

It’s effective against hot flashes, reducing both severity and frequency.

It improves objective markers of sleep quality (the reduction in hot flashes certainly can’t hurt).

It improves insulin sensitivity, which often degrades during menopause.

It improves early post-menopausal symptoms across the board, leading to a 12.9 point reduction in the Green climacteric score (a basic measure of menopause symptom severity).

In one study, black cohosh was comparable to conventional HRT for reducing most menopausal symptoms and better at reducing anxiety, vaginal bleeding, and breast tenderness.

Here’s a great black cohosh product.

Maca

In its native Peru, maca root was traditionally used as a root vegetable (like a turnip or radish), as well as for its pharmacological properties as an aphrodisiac and subtle stimulant. Incan warriors reportedly used it as a preworkout booster before battles. Today, we know it as an adaptogen—a substance that helps your endocrine system adapt to stress, rather than force it in one direction or another.

A 2011 review of the admittedly limited evidence found that maca shows efficacy against menopause. More recently, maca displayed the ability to lower depression and blood pressure in menopausal women. And earlier, maca helped perimenopausal women resist weight gain and menopausal women regain their sexual function and reduce depression and anxiety.

What’s going on here? According to a 2005 study, maca actually lowers follicle-stimulating hormone and increases luteinizing hormone in postmenopausal women, thereby increasing estrogen and progesterone production.

Make sure you buy gelatinized (cooked) maca, as that’s what the studies use.

Red Clover

The red clover blossom is a rich source of isoflavones, estrogen-like compounds that interact with receptors in our bodies and relieve many symptoms of menopause.

Twelve weeks of red clover cuts the Menopause rating score in half (a good thing!).

Twelve weeks greatly reduces the intensity and frequency of hot flashes and night sweats. Including some probiotics has a similar effect.

Red clover also improves vaginal cellular structure and function while (again) improving menopause symptoms and reducing triglycerides.

More exciting, there’s reason to believe that red clover may reduce the risk of breast cancer and improve bone mineral density in menopausal women.

Here’s a potent red clover supplement.

And then there are those herbs and plants with more limited scopes.

Ginseng

Ginseng has limited application in menopause. It improves sexual function, and Korean red ginseng appears to help libido and reduce the total hot flash score, but neither type of ginseng reduces oxidative stress, improves endometrial thickness, or reduces hot flash frequency.

Here’s some Korean red ginseng. Here’s some concentrated ginseng.

Evening Primrose

It’s good for hot flashes, and that tends to improve other things like socializing and sex, but that’s about it.

Here’s some cold-pressed primrose oil.

St. John’s Wort

You might remember St. John’s Wort as an herbal treatment for such conditions as depression and anxiety, but it’s also quite effective against certain symptoms of menopause.

In one study, 3 months of daily St. John’s Wort supplementation helped perimenopausal women go from three hot flashes to one hot flash a day, get better sleep, and have a better quality of life. In another, it took 8 weeks of St. John’s Wort for both perimenopausal and postmenopausal women to reduce the frequency and severity of their hot flashes. Researchers also combined it with black cohosh to successfully treat hot flash-related moodiness.

This is a pretty good product.

Wild Yam

The yam has been used for hundreds of years for menopause treatment. These days, we know it contains estrogen mimetics known as phytosterols with clinical efficacy in menopausal women.

Try this one.

Before you go fill your Amazon cart with supplements and start chowing down on powders and pills, however, make sure you’re making the right move.

Talk to your doctor about the herbal alternatives mentioned today. Discuss and research potential interactions with medications and even supplements you’re already taking. Be sure to cite the relevant references.

Minimize the variables. Don’t start taking everything from this article. Start with one and evaluate.

Don’t underestimate the power of plants. Just because something is “herbal” or “botanical” doesn’t mean it’s completely benign at all doses.

That’s it for today, folks. Take care, and be sure to write in down below.

Have you ever used any herbs or botanicals to treat menopause symptoms? If so, what worked? What didn’t?

References:

Mehrpooya M, Rabiee S, Larki-harchegani A, et al. A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. J Educ Health Promot. 2018;7:36.

Jiang K, Jin Y, Huang L, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015;18(4):559-67.

Mohammad-alizadeh-charandabi S, Shahnazi M, Nahaee J, Bayatipayan S. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chin Med. 2013;8(1):20.

Zheng TP, Sun AJ, Xue W, et al. Efficacy and safety of Cimicifuga foetida extract on menopausal syndrome in Chinese women. Chin Med J. 2013;126(11):2034-8.

Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal woman’s health: A systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95(38):e4914.

Lee MS, Shin BC, Yang EJ, Lim HJ, Ernst E. Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas. 2011;70(3):227-33.

Stojanovska L, Law C, Lai B, et al. Maca reduces blood pressure and depression, in a pilot study in postmenopausal women. Climacteric. 2015;18(1):69-78.

Brooks NA, Wilcox G, Walker KZ, Ashton JF, Cox MB, Stojanovska L. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Menopause. 2008;15(6):1157-62.

Shakeri F, Taavoni S, Goushegir A, Haghani H. Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomized, controlled trial. Climacteric. 2015;18(4):568-73.

Lipovac M, Chedraui P, Gruenhut C, et al. The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women. Gynecol Endocrinol. 2012;28(3):203-7.

Hidalgo LA, Chedraui PA, Morocho N, Ross S, San miguel G. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005;21(5):257-64.

Lambert MNT, Thorup AC, Hansen ESS, Jeppesen PB. Combined Red Clover isoflavones and probiotics potently reduce menopausal vasomotor symptoms. PLoS ONE. 2017;12(6):e0176590.

Beck V, Rohr U, Jungbauer A. Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy?. J Steroid Biochem Mol Biol. 2005;94(5):499-518.

Abdali K, Khajehei M, Tabatabaee HR. Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010;17(2):326-31.

Briese V, Stammwitz U, Friede M, Henneicke-von zepelin HH. Black cohosh with or without St. John’s wort for symptom-specific climacteric treatment–results of a large-scale, controlled, observational study. Maturitas. 2007;57(4):405-14.

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15 thoughts on “7 Herbal Alternatives to HRT”

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  1. Thanks for the specific product recommendations. Someone recommended St. John’s Wort a few weeks ago to me but I haven’t started using it because I am always concerned starting a new supplement – I get overwhelmed by all of the options out there and want to be sure I’m getting good quality. I’ll try the NusaPure.

  2. I would not recommend Ginseng, too hot for women, especially when experiencing hot flashes. Also, not St. Johnswort also, this herb is especially specific applications.

  3. Do you have thoughts about seed cycling in addition to or instead of herbal supplements?

  4. My biggest problem with menopause was severe hot flashes and night sweats. I did try black cohosh, but it didn’t seem to help. I then tried a Chinese herbal remedy called Eight Flavor Rehmannia Teapills by Plum Flower. These are tiny little balls made of: Romania glutinosa root-prep, Cornus officinalis fruit, Dioscorea opposita rhizome, Alisma plantago aquatica rhizome, Paeonia suffruticosa root-bark, Poria cocos fungus, Phellodendron amurense bark, Anemarrhena asphodeloides rhizome. This stuff worked remarkably well, and took about two weeks to kick in. I picked it up on Amazon. It runs about $37 for 1000 pills. I think if that hadn’t worked so well, my next step probably would have been to keep trying different products and/or consult an herbalist.

  5. My biggest problem with menopause was severe hot flashes and night sweats. I did try black cohosh, but it didn’t seem to help. I then tried a Chinese herbal remedy called Eight Flavor Rehmannia Teapills by Plum Flower. These are tiny little balls made of: Romania glutinosa root-prep, Cornus officinalis fruit, Dioscorea opposita rhizome, Alisma plantago aquatica rhizome, Paeonia suffruticosa root-bark, Poria cocos fungus, Phellodendron amurense bark, Anemarrhena asphodeloides rhizome. This stuff worked remarkably well, and took about two weeks to kick in. I picked it up on Amazon. It runs about $37 for 1000 pills. I think if that hadn’t worked so well, my next step probably would have been to keep trying different products or consult an herbalist.

  6. Any recommendations for post menopause. Never took HRT and I am about 8 years in.

  7. Great article Mark, we need more like it! My only comment is to find and work with a naturopathic/functional doctor. Mine is a miracle worker and asks questions and runs test that other doctors do not. She is able to track my hormones and other data to be sure I am navigating this as easily as possible. We make adjustments as necessary. Been a lifesaver!

  8. Thank you for taking the time to research this. Being sweaty in bed is not conducive to sleeping, nor to cuddling. A spouse does not like to get “sorry, I’m hot,” anymore than, “I have a headache.” So you are helping men here too! I’m very grateful.

    Fish oil in large quantities helps my nighttime pre-menopausal hot flashes, but only if I take it at the right time of day! 5000 mg taken about 2-4 hours before bedtime is the sweet spot for me. It has worked wonders.

    1. I will try the fish oil – great idea! I’m pre-menopausal too and wake up in the middle of the night with my shirt soaked in sweat.

  9. I take maca in the morning, and a product called Femopause at night. I’ve considerably lessened hot flashes, except when I’m really stressed, or drink caffeine you know. I’m also trying shatavari root powder (1/2 tsp/day) for vag goodness.

  10. Hey Mark. I was 7 years in peri-menopause. Hour on the hour hot flashes. I tried black cohosh and it made me terribly nervous-to the point of shaking. I don’t like pot for the same reason. I couldn’t wait for it to subside. I just duked it out during that time. I feel it made me stronger to outlast difficulty.

  11. Have just been using the ‘normal’ (non gelatinized) Maca for many years. It brought back my period within weeks (after years of amenorrhea)!! Now 1-2 years into menopause, I’m the only female in my family who has not experienced ANY hot flashes or night sweats! Me thinks it’s the Maca! 🙂

  12. I’ve found and taken some of these in a menopause supplement bottle and other mixes or isolates from behind a health food store – hopefully wasn’t too estrogenic.
    Watch out for sun exposure if you’re taking a lot of St. John’s Wort. I got a sunburn on it.

  13. What do you think about amberen? Is that as effective? What about soy?