Naturally supporting menopause: Alternatives to hormones

Are you suffering from typical menopausal symptoms but don't want to resort to traditional hormone replacement therapy (HRT)? Although HRT is often effective, it's not suitable or desired for every woman. That's why herbal alternatives are increasingly coming into focus: preparations made from soy, red clover, black cohosh, or shatavari are gaining popularity.

In this article you will learn how these substances work in the body, whether they are a good alternative to HRT and what you should pay attention to when using them.

The most important points in brief

• Menopausal symptoms, such as hot flashes, can often be alleviated with hormone replacement therapy, but not every woman wants to or can take hormones.
• Preparations made from soy, red clover, black cohosh or shatavari are becoming increasingly popular and represent a possible gentle alternative.
• Some of the herbal remedies have hormone-like effects and can also positively influence symptoms through other mechanisms.
• Be sure to discuss taking this medication with your doctor, especially if you have pre-existing conditions or are taking other medications at the same time.

What is hormone replacement therapy (HRT)?

Hormone replacement therapy is a medical treatment in which estrogens (often together with progestogens) are used to specifically compensate for the hormone deficiency during menopause.

Because estrogen levels drop sharply during this phase, about 80% of women experience moderate to severe symptoms such as hot flashes, sleep problems, or mood swings. HRT can help to effectively relieve these symptoms and restore hormonal balance (1).

The most common complaints include:

• Hot flashes and night sweats
• Vaginal dryness
• Sleep disorders
• Depressive moods (2).

Hormone replacement therapy is considered particularly effective in relieving severe symptoms. However, due to potential health risks, including an increased risk of thrombosis, breast cancer, and cardiovascular events, it is now only recommended for the short-term treatment of vasomotor symptoms (hot flashes, night sweats) (3).

Why do many women seek natural alternatives?

There are several reasons why women seek natural alternatives to HRT:

• Fear of side effects : Since the Women's Health Initiative (WHI) highlighted the potential risks of long-term hormone replacement therapy in the early 2000s, many women have become more cautious.
  
• Medical contraindications : Not every woman can take hormones. HRT is not suitable for women with certain pre-existing conditions, such as breast cancer or thrombosis.
  
• Desire for gentler methods : Many women prefer a more natural approach and want to support their bodies with herbal remedies.
  
• Short-term solution only : Since HRT is only recommended for short periods, women are looking for long-term alternatives (4).

Natural alternatives to HRT: An overview

Natural alternatives to hormone replacement therapy mainly refer to herbal preparations that can provide support in various ways for menopausal symptoms.

The most commonly used herbal remedies are:

• Isoflavones (from soy and red clover)
  
• Black cohosh (Cimicifuga racemosa)
  
• Shatavari (Asparagus racemosus)
  
• Hops, flaxseed, St. John's wort

Most of these substances are available as dietary supplements and can easily be purchased in pharmacies, drugstores, or online. The costs usually have to be borne by the individual, as statutory health insurance does not cover them (3). In the following section, you will learn which substances are particularly popular and what is currently known about their effects.

Isoflavones from soy and red clover: Plant phytoestrogens in focus

Isoflavones are secondary plant compounds belonging to the group of phytoestrogens . They are particularly abundant in soybeans and red clover. The most important isoflavones are genistein, daidzein, and glycitein.

Isoflavones have a similar chemical structure to the body's own estrogen and therefore bind to the same "docking sites" in the body. This allows them to mimic some of the effects of estrogen, albeit less potently. Of particular interest is their preferential binding to the estrogen receptor beta (ERβ), which is primarily found in the cardiovascular system, the urogenital tract, and bones (4).

Good to know: Studies show that consuming soy and soy products as part of a balanced diet does not lead to an excessive increase in estrogen in the body, i.e., it does not promote estrogen dominance (10).

What do studies on isoflavones show?

• Studies show that high doses of isolated genistein can reduce hot flashes, while low doses of genistein show no significant effect (3)
  
• A meta-analysis found a reduction in the frequency of hot flashes by 20.6% and in their intensity by 26.6% (5)
  
• An herbal preparation containing 72 mg of isoflavones from soybeans and red clover showed a significant reduction in hot flashes over six months (4)
  
• Studies show that red clover extracts can also relieve vaginal dryness (6)

Restrictions:

• Low-dose products show no significant effect
  
• The effect depends heavily on the dosage and the specific composition of the isoflavones.

One possible reason for the differing study results could be the individual utilization of isoflavones. Researchers suspect that the composition of the gut microbiota plays a key role. For example, more than half of Asian women can effectively metabolize isoflavones, while this is the case for less than 20% of European women (3, 4).

Black cohosh (Cimicifuga racemosa)

Three main groups of constituents have been identified in black cohosh that are presumably responsible for its effects. These include phenolic compounds such as ferulic and isoferulic acid, as well as triterpene glycosides (e.g., actein and 26-deoxyactein) and the group of phenylpropanoids.

Current research suggests that the plant may act via the following mechanisms:

• Binding to serotonin receptors, which influence mood and temperature regulation
• Activity at opioid receptors, which play a role in hot flashes
  
• Influencing certain areas in the hypothalamus that are responsible for regulating body temperature (5, 7)

What do studies on black cohosh show?

• Several studies show that black cohosh can reduce hot flashes, especially their severity and how distressing they are perceived (3)
• A larger review study showed significant improvements in hot flashes, night sweats and sleep disturbances (7)

There is now also an official classification for black cohosh: The European Medicines Agency (EMA) has approved preparations containing a standardized black cohosh extract for the symptomatic treatment of menopausal symptoms (5).

Shatavari (Asparagus racemosus)

Shatavari is an herb from Ayurvedic medicine that is traditionally used to promote female health.

The root contains:

• Steroidal saponins (shatavarins) as the main active ingredients
  
• Phytoestrogens,
  
• Flavonoids and alkaloids
  
• Quercetin glycosides (8)

The exact mechanism of action is not yet fully understood, but studies suggest several possible effects:

• Hormone-modulating : Phytoestrogens can bind to estrogen receptors and balance hormonal activities.
  
• Influence on the HPO axis: The connection between the hypothalamus, pituitary gland and ovaries may be positively influenced, which could help to balance hormonal imbalances (8)
  
• Adaptogenic effect : Shatavari can help the body cope better with stress (9)

What do studies show about Shatavari?

• A double-blind, randomized, placebo-controlled study with 70 women showed a significant reduction in hot flashes, night sweats, insomnia, anxiety, nervousness, vaginal dryness and loss of libido (8)
• Another study found significant improvements in hot flashes, fatigue, mood swings and perceived stress (9)
• No significant side effects were reported in the studies, which suggests a good safety profile (8)

Note: Clinical evidence for shatavari is still limited. Further studies with longer durations and larger, more diverse samples are needed to fully assess its efficacy and safety.

What should you pay attention to when using it?

If you would like to try natural alternatives to hormone replacement therapy, consider the following points:

1. Product quality:
   • Look for standardized preparations with a defined active ingredient content
   • Choose products from reputable manufacturers with quality seals
   • Organic quality can avoid pesticide residues
   
2. Have patience:
   • Herbal remedies often don't work immediately
   • Initial effects may become apparent after 2–4 weeks
   • The full effect often only occurs after 8–12 weeks of continuous use.
   
3. Medical advice is necessary:
   • Discuss taking herbal supplements with your doctor, especially if you have pre-existing medical conditions.
   • Some preparations can interact with other medications
4. Realistic expectations:
   • Natural alternatives can alleviate symptoms, but they are not equally effective for all women.
   • They do not usually completely replace HET
   • The effect is often milder than with hormonal preparations

Despite intensive research, many questions remain unanswered:

• Long-term effects: How safe are herbal preparations when taken for years?
  
• Optimal dosage: Which dose is best suited for which symptoms?
  
• Interactions: How do different plant-based active ingredients interact with each other?

Conclusion

Menopausal symptoms don't have to leave you feeling helpless. Natural remedies made from soy, red clover, black cohosh, or shatavari can help make everyday life more comfortable. It's important to choose high-quality, standardized products , adhere to the correct dosage, and be patient, as the effects usually only become noticeable after a few weeks. You should also always discuss taking these remedies with your doctor to ensure you select the right ones for you.

This way you can shape the menopause in a self-determined and active way, strengthen your well-being and experience this phase of life more consciously, instead of letting yourself be restricted by discomfort.

Frequently Asked Questions

1. What are natural alternatives to hormone replacement therapy (HRT)?
   Natural alternatives are primarily herbal preparations such as isoflavones, black cohosh or shatavari, which can have hormone-like effects and are intended to alleviate menopausal symptoms.
2. Which menopausal symptoms can be alleviated with natural remedies?
   Herbal preparations are primarily used for hot flashes, night sweats, sleep disturbances, mood swings and vaginal dryness.
3. How do isoflavones from soy and red clover work?
   Isoflavones belong to the phytoestrogens, which have weak estrogen-like effects. They bind to estrogen receptors, especially ERβ, and can thus influence, for example, the heart, bones, and urogenital tract.
4. Does black cohosh really help with hot flashes?
   Studies show that black cohosh can alleviate hot flashes and night sweats in some women. However, the effect depends on the dosage, the specific preparation, and individual factors.
5. What is Shatavari and how is it used?
   Shatavari is an Ayurvedic herb traditionally used to support women's health. It contains phytoestrogens and other plant compounds that can influence hormonal balance and stress resistance.
6. Are herbal remedies suitable for every woman?
   Not all women respond equally well to herbal remedies. It is essential to consult a doctor before taking them if you have conditions such as breast cancer or thrombosis.
7. How long does it take for herbal remedies to take effect?
   Initial effects may occur after 2–4 weeks, but the full effect is often only seen after 8–12 weeks of continuous use.
8. Can natural alternatives replace hormone replacement therapy?
   Herbal remedies can alleviate symptoms, but usually do not completely replace HRT. Their effects are often milder, but the risks and side effects are often lower.
9. What should you look out for when buying herbal remedies?
   It is important to use standardized preparations with a defined active ingredient content, products from reputable manufacturers and organic quality to avoid pesticide residues.
10. What open questions remain regarding the effectiveness of herbal remedies?
    Among the aspects that remain unclear are individual differences in effect, optimal dosages, long-term safety, and possible interactions between different herbal active ingredients.

literature
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