Alternatives to HRT: Complementary Care

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence.

Alternatives to hormone replacement therapy (HRT) include complementary care options like acupuncture, dietary changes, excercise and vitamin or herbal supplements

Complementary care options include acupuncture; eating a serving of soy foods and ground flaxseeds daily; or walking, swimming, dancing, or bike riding every day for 30 minutes or more. You can also try vitamin E (800mg) or the herb black cohosh. If nothing helps alleviate your symptoms, you may want to join or create a support group to help you deal with them. The following herbs, supplements, and complementary care practices may help alleviate hot flashes in some women.


Acupuncture is designed to influence the body’s life force, which is known as “qi” or “chi” (pronounced chee). According to acupuncture principles, chi flows through the body along paths called meridians. By twirling hair-thin needles inserted at specific points along meridians, each of which is associated with a particular physical problem, acupuncture seeks to correct imbalances. Acupuncture has been gaining an increased role in Western medicine, first in Europe, then in the United States. In 1997, the National Institutes of Health acknowledged that acupuncture is effective in treating certain conditions. Although hot flashes weren’t among those listed, there is some evidence from studies conducted in Europe that it is effective. In one Swedish study, women who underwent acupuncture therapy had relief from hot flashes that lasted several months. If you decide to try acupuncture, you should be sure to see a licensed acupuncturist. You may also want to check to see if your health insurance covers acupuncture as part of its alternative and complementary medicine coverage.

Black Cohosh

Black cohosh is an herb that has long been used by Native Americans to treat menstrual and menopausal symptoms, but its mechanism is not understood. More recently it has become popular in the United States as a suggested treatment for hot flashes. A study of Remifemin Menopause, made from an extract of black cohosh, found that 70% of the 150 peri-and postmenopausal women in the study who took 40mg of Remifemin for 12 weeks reported a decrease in menopausal symptoms, including hot flashes. The group taking the higher dose did not do better than the lower standard-dose group. There was no placebo group in this study to compare the response with. Black cohosh may be a good option for some women. The advantage of it over other alternatives is that it doesn’t have side effects, like clonidine and antidepressants. But it’s also clear that more is not better, and that women who do decide to try it should stick to the standard dose. The question for breast cancer survivors is whether it is estrogenic. On this front we actually have some data. First of all there is no known phytoestrogen in black cohosh. Second, there is no evidence that black cohosh binds to the estrogen receptor. Finally, in a petri dish, breast cancer cells were exposed to black cohosh in the absence of estrogen, in the presence of estrogen, and in the presence of tamoxifen. They found that the black cohosh given alone inhibited cell growth. When estrogen was added it blunted the growth usually seen and it enhanced the effects of tamoxifen. This effect has been replicated in four other studies on cell lines. Studies in women have confirmed this lack of estrogenic effect.

Red Clover

Another commonly used herb, red clover, contains the daidzein and genistein found in soy as well as formononetin and biochanin. It is marketed for hot flashes and menopausal symptoms. There have been two randomized controlled studies comparing it to placebo. Neither study found that red clover was better than the placebo. There is concern about its ability to stimulate breast cancer, but this has not been studied. In addition, red clover produces dicumarol, which can block blood clotting.


Soy is a food source of isoflavones. Sometimes it is called a phytoestrogen. This is a poor word choice. Although soy acts like estrogen in some organs, it blocks estrogen in others—so it’s more like a phytoSERM (selective estrogen receptor modulator) than a pure estrogen. There have been several randomized controlled studies on hot flashes and soy, showing a reduction in hot flashes not only in countries where soy is a large part of the diet, like China and Japan, but also in the West. But there are other studies that didn’t show that soy was effective at all. In addition, soy not only decreases LDL cholesterol (the bad kind), but also increases the good cholesterol, HDL, significantly. And unlike Premarin, which increases triglycerides, soy decreases them. It also increases bone density. Some women who have had breast cancer report that they are worried about eating soy because it might fuel their ER-positive tumors. There is no evidence that eating small amounts of soy is a problem. But if this concerns you, just don’t eat it.

Additional Resources: You can learn more about what is known about these and other herbs and supplements on these websites:

Information specific to cancer survivors is available on these sites:

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