What are the alternatives to HRT?

Vitamins
In other dietary approaches, nutritional therapists often recommend supplements of vitamin C and E, but supporting evidence is not spectacular. In a 1998 American study, daily 800 iu doses of vitamin E reduced the number of hot flushes, but only by one a day. The subjects barely noticed the difference. Supplements or foods rich in calcium (oily fish and dairy products), boron (which protects against calcium loss) magnesium and vitamin K (involved in bone production) are usually advised to prevent osteoporosis.

Herbalists rely on hormone-balancing herbs such as black cohosh, agnus castus, hops and wild yam in treating menopause problems. In scientific trials of a standardised extract of black cohosh, marketed as Remifemin, German researchers found it relieved hot flushes and believe the herb may inhibit sudden hormonal surges.

Individually tailored remedies prepared by herbalists can contain as many as ten herbs. As well as wild yam and black cohosh, medical herbalist Anne McIntyre says she often includes motherwort as a relaxant, lemon balm and ginseng to lift the spirits and rose petals to cool the system. St John's wort is traditionally used if depression is a problem, and sage is a favourite to relieve hot flushes. A recent small Scottish trial of Menosan, a standardised tincture of fresh sage, found that it reduced the frequency and severity of hot flushes by over half (56 per cent). Sage, a mild phytoestrogen, is thought to have a rebalancing effect on the hypothalamus, a part of the brain that regulates sweating.

Diet considerations
Ayurvedic remedies make use of Indian herbs Ashwagandha, shatavari, Neem and sandalwood. Drinking a cup of strained cold water in which three dessertspoons of coriander seeds have soaked overnight is said to relieve hot flushes. Practitioners also advise limiting your intake of hot spices, sour fruits (tomatoes, rhubarb and citrus) and salty foods (bacon and ham).