While hormone replacement therapy can be very effective in alleviating symptoms of menopause, some women would rather try natural remedies. Anne Woodham investigates the options

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.

Research is on-going but two British studies found only a small increase in blood hormone levels. Results indicate it may relieve hot flushes for some women, but does not appear to benefit osteoporosis.

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).

Traditional Chinese medicine associates menopausal symptoms with 'weakness of the kidney' (hot flushes), 'deficient blood' and 'imbalance between the kidney and liver'. Herbal remedies containing dong guai (Chinese angelica), ginseng, rehmannia and peony are prescribed to rebalance the system. Acupuncturists use needles to achieve similar effects in restoring the even flow of chi ('vital life energy') throughout the body.

A homeopath will want to diagnose your 'constitutional' type in order to prescribe the most effective preparations, but certain standard remedies are frequently used. These include Natrum mur for weepiness, depression, weariness and vaginal dryness; Sepia for forgetfulness, anxiety, irritability and night sweats; Sulphur for hot flushes and depression.

Reducing stress and encouraging relaxation are important elements in coping with anxiety and other menopausal problems. Aromatherapists recommend a massage with sandalwood, German camomile or rose essential oils, which are all believed to have additional benefits in relieving hot flushes and mood swings. Adding a few drops of lavender, rose or ylang ylang to the bath is also very relaxing.

Reflexology, while claiming to treat the reproductive organs by stimulating points on the feet, also eases stress. Meditation, t'ai chi and yoga are tried and tested techniques to calm both body and mind.

Most complementary therapies emphasise the importance of dietary and lifestyle factors:

• Limit alcohol and caffeine intake
  
• Stop smoking
  
• Follow regular sleep patterns
  
• Avoid anxiety-inducing situations
  
• Take regular exercise
  
• Practise a relaxation technique
  
• Eat at least five portions of fresh fruit and vegetables daily at regular mealtimes

Further information

Women's Nutritional Advisory Service tel:l 01273 609699 www.naturalhealthas.com