Alternatives to hormone replacement therapy for management of menopause symptoms

Many women use alternatives to hormone therapy believing them to be safer and 'more natural', especially following the current controversies regarding hormone replacement therapy. The choice of treatments is confusing, and unlike conventional medicines, not much is known about their active ingredients, safety or side-effects, or how they may interact with other therapies. They can interfere with warfarin, antidepressants and antiepileptics with potentially fatal consequences. Some herbal preparations may contain oestrogenic compounds, and this is of concern for women with hormone-dependent disease such as breast cancer. There is also concern about contaminants such as mercury, arsenic lead and pesticides. This paper examines the evidence underlying the commonly used options both in terms of efficacy and safety.