What are the alternatives to HRT?

Falling levels of oestrogen leading up to and beyond the menopause can cause problems. Symptoms of hormonal changes include vaginal dryness, skin problems, hot flushes, night sweats and itching. In addition, bones lose calcium and become thin and fragile, a condition known as osteoporosis. Many women also complain of poor concentration and memory, mood swings, depression, fatigue, loss of self-esteem and libido.

Hormone replacement therapy can be very effective in alleviating menopausal problems, but it's not for everyone. So what are the alternatives?

Natural options
Most nutritional and herbal therapies try to rebalance hormonal levels as much as possible. Phytoestrogens are natural plant chemicals that bind to oestrogen receptor cells in the body and mimic the hormone's effects. There are several of these chemicals - notably lignans that are found in linseeds (and sprinkling these on your breakfast cereal is a good idea) - but isoflavones have gained the highest profile. Scientific interest was initially aroused when researchers noticed that women in Asian countries who eat a diet high in soy, an isoflavone powerhouse, experienced fewer menopausal hot flushes.

According to the Women's Nutritional Advisory Service's recent Menopause Report, which draws on scientific trials of isoflavones and anecdotal responses from women, little and often is the secret. Consuming 100 mgs of isoflavones in small quantities at regular intervals throughout the day is claimed to keep blood oestrogen levels high enough to control serious hot flushes. In less severe cases, 50 mgs may be sufficient. Maryon Stewart, director of WNAS, recommends a combination of soy-rich foods (soy milk and yoghurt, tofu and miso) and Novagen, a standardised supplement of red clover, a plant stacked with isoflavones.

A variety of creams containing 'natural' progesterone are available on prescription in the UK and over the counter in Europe and the US. The active ingredient is extracted from soy or yam and is chemically identical to the progesterone found in the human body, unlike synthetic progestogens.