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 medications or hormones.

• The meditative breathing exercise called paced respiration has been shown to significantly reduce hot flashes and emotional symptoms.^{26, 27} 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) has been shown to prevent or relieve a broad range of menopause symptoms for many women.²⁹ Other studies have shown no improvement. Safety of long-term use beyond 6 months 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 health professional 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.³ Regularly eating and drinking soy may also help even out menopause symptoms. But studies have shown mixed results. They have yet to clearly show that soy is effective for treating hot flashes.³³
• 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 http://www.usp.org/USPVerified/dietarySupplements/.

If you are using an alternative medicine or herbal remedy, make sure your health professional knows. Include the type and amount you are taking, as well as how long you have been taking it and why.