By Jan Roberts

Women are increasingly concerned about the potential dangers of fluctuating hormone levels during and following menopause - but synthetic hormone replacement therapy has come under fire for its potential risks. What's a woman to do? Consider natural alternatives.

In the past 40 years, menopause, once unmentioned and borne in silence in Western society, has come to be regarded as one of the key life events that can compromise women's physical, mental and emotional well-being. With the increase in women's life expectancy and their expectation of retaining vitality and vigor far longer than their mothers, women initially were offered a solution in the form of hormone replacement therapy. However, HRT is a fairly crude attempt to offset the decrease in natural hormone levels occurring at menopause by introducing a variety of synthetic or animal estrogenic compounds and/or progesterone, at various levels, with dosage largely adjusted by a process of trial and error.

Hormone Replacement Therapy: Risky Business

While initially embraced enthusiastically by women wishing to avoid what they were led to believe was an inevitable decline in "their youth" - changes in skin and hair texture, sex drive and memory - along with mood changes and an increase in hot flashes and night sweats, HRT has now been shown to come with significant risk factors. While there is still no conclusive opinion on HRT's potential to increase breast cancer and other side effects, many doctors have resorted to using bio-identical hormones and lower dosage forms.

However, whether the use of bio-identical hormones will reduce the adverse effects seen with HRT is still open to debate and will only truly be known in the longer term. Furthermore, even with lower dosages, unless a doctor is monitoring hormone levels over the woman's full monthly cycle and on a regular basis, both HRT and bio-identical hormone therapy rely on a relatively hit-and-miss approach that may take considerable time to fine tune. Other issues are: What form of estrogen should a woman be given? When does she reach an estrogen "saturation point"? What happens when she has a history of breast cancer in the family? How does her estrogen dosage affect the levels of hormones naturally occurring in her body? The list of questions goes on.

Soy and Herbal Alternatives: What Works?

Not surprisingly, female patients and many health care practitioners have increasingly turned to natural alternatives, including plant-based solutions such as black cohosh, red clover, wild yam and soy-containing compounds. However, while certainly lacking the potential side effects of HRT, these phyto-compounds still impact only one aspect of the overall physiological changes that occur during the pre- and postmenopausal periods; unless, of course, women are taking three different products! Effectiveness is also an important consideration when dealing with natural alternatives. There are only a few products that have any research to back them.

Most importantly, while many natural alternatives may reduce some symptoms, as a group, they have been clinically shown by the National Institutes of Health to have little real effect on actual hormone levels. It is this decline in hormone levels at menopause that directly relates to a woman's susceptibility to heart disease, osteoporosis and cognitive function; and is why many doctors, in an attempt to avert these life-threatening conditions, continue to prescribe HRT, despite the potential risks. Other options that have been offered to pre- and postmenopausal women, such as calcium supplementation, are further attempts to fix a symptom, when what is actually required is a much more holistic approach.