Because of concern about hormone replacement therapy (HRT) health risks, many women have turned to alternative medicine for menopause symptom relief. As part of a stepwise treatment approach, you can consider using one or more of the following options for preventing or treating symptoms before trying prescription medicines or hormones.

• The meditative breathing exercise called paced respiration may reduce hot flashes and emotional symptoms. This approach has no known side effects, risks, or costs and can be safely combined with additional treatment, if needed.
• Black cohosh (Remifemin, 20 mg) may prevent or relieve menopause symptoms. But the research on black cohosh has had mixed results. Some studies have shown that black cohosh can relieve hot flashes.²⁴ But other studies have shown that black cohosh does not relieve hot flashes.²⁸ Also, the long-term safety is not yet known. (Risks similar to estrogen risks are a possibility.) Have regular checkups if you are using black cohosh, and make sure your doctor knows what you are taking.
• Soy phytoestrogens (isoflavones) are in more complete form when you eat them as food, rather than in a pill or powder. A high-soy diet has been linked to stronger bones, especially in the first 10 years after menopause, when estrogen levels drop and rapid bone loss happens.¹ Regularly eating and drinking soy may also help even out menopause symptoms. But studies have shown mixed results. They have not always shown that soy is effective for treating hot flashes.²⁹
• Yoga (which often includes meditative breathing) and/or biofeedback give you tools you can use to reduce stress. High stress is likely to make your symptoms worse.

Alternative treatments to avoid

Based on the latest research, some therapies are not recommended for menopause symptoms, either because they are not effective or because they can cause dangerous effects. These include:

• Kava, evening primrose, dong quai, valerian, dehydroepiandrosterone (DHEA), and angelica.
• Wild yam or natural progesterone creams.

Using alternative treatments

These types of medicinals are not required to have the same testing or purity standards as prescription and other nonprescription medicines. The amount of a drug in herbal preparations varies widely. It is also possible for nonregulated products to be contaminated with metals or other dangerous substances. Before trying any treatment, look for scientific studies that support its beneficial claims as well as information on risks. When buying herbs or supplements:

• Find a reputable brand or supplier.
• Look for the U.S. Pharmacopeia (USP)-verified mark on product labels. This is one way of finding a product that has been tested for safety and quality. For more information, see www.usp.org/USPVerified/dietarySupplements.

If you are using an alternative medicine or herbal remedy, make sure your doctor knows. Tell him or her the type and amount you are taking, how long you have been taking it, and why.