Alternative Approaches to HRT


It’s new years but hot flashes get old in a hurry. Estrogen can work for most women with low estrogen, but many women can’t take it and others just prefer an alternative route.

Fortunately, there are things you can do that help reduce the hot flashes for many women. Here are some suggestions I make to my patients:

One simple thing is to ask your doctor to check your vitamin D level (get a 25-OH vitamin D). Low levels are very common and if yours is low, it can increase your risk for heart disease, breast cancer, brittle bones and increase hot flashes. I have found many women have fewer hot flashes and feel much better correcting their vitamin D level. It’s simple; just take a vitamin D3 supplement. There are videos about this and related topics at

Other non HRT approaches include:

  • Drink plenty of water daily (8 glasses or more)
  • Daily exercise (walking 30 minutes is great)
  • Get into a yoga class (I like Kundalini Yoga best and I discuss the many benefits in A Woman’s Book of Yoga)
  • Meditate daily – even 1 to 5 minutes at first and work your way up to longer
  • Mindfulness-Based Stress Reduction is another great non HRT way to reduce hot flashes
  • Acupuncture – one study obtained a 60% improvement.
  • Avoid caffeine, spicy foods and alcohol
  • Carry a cool wipe

Herbal approaches include:

  • Black cohosh (20 mg twice daily)
  • Soy (50 to 100 mg of the soy isoflavones in a capsule or 25 to 40 grams of the protein in a smoothie or added to your food)
  • iCool is a non soy isoflavone if you’re allergic to soy
  • Flaxseed, another plant estrogen, 1-3 tablespoons on cereal in the morning

There are also non HRT prescription meds such as:

  • SSRI antidepressants [there is evidence showing that paroxetine (Paxil, Paxil CR), escitalopram (Lexapro) and fluoxetine (Prozac) can be effective in controlling hot flashes] and SNRI antidepressants such as venlafaxine (Effexor) have been used widely for hot flashes. A recent study suggests that adding zolpidem (Ambien, Edluar, Zolpimist) to these medications may be helpful for improving sleep but not hot flashes.
  • Neurontin (gabapentin) the anti-seizure medication. Start low and increase dose slowly up to 900 mg daily. It causes drowsiness in some women.
  • Clonidine (Catapres) acts on the brain to lower blood pressure and it helps some women (but not all) reduce hot flashes. It can cause dry mouth and constipation.

There are many alternative options in my book The Soy Solution for Menopause from Simon & Schuster.

Women who are thinner have less hot flashes than women who weigh more.

I’ve used all of these approaches to help different patients who either cannot or will not take HRT and have low estrogen. Talk with your health care providers and ask them to work with you find what will work best for you. With persistence, most women find a combination that works for them.


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