Additions and alternatives to HRT – phytohormone supplements

Navigating the world of menopause supplements is often confusing and overwhelming especially when it comes to natural alternatives. So many women struggle to find reliable information and give up searching, struggling on with their symptoms instead.

However, it’s worth seeking them out: some herbal treatments can be a very effective alternative or addition to Hormone Replacement Therapy (HRT) – especially phytohormonal supplements.

What are phytohormonal supplements?

These are herbal supplements that can boost female sexual hormones, usually due to the phytoestrogens they contain – weaker plant-based oestrogens which are similar to, but not quite the same, as those found in HRT.

What symptoms can phytohormonal supplements help with?

For some women, they can help ease hot flushes, night sweats, fatigue, anxiety, vaginal dryness and impaired sleep.

How long does it take for them to help with symptoms?

The benefits of these natural remedies increase over time as their activity builds up in your body, week after week. Therefore, if you take these you should give yourself at least one to two months to appreciate their full effects.

Furthermore, the effective daily dose for any herb may vary considerably depending on the supplement and your individual situation. As a result, the exact dose of a phytohormonal remedy cannot always be recommended upfront.

Some important things to flag

It is also important to flag that:

• your individual reaction to herbal supplements can sometimes be unpredictable, especially when dealing with multiple preparations
• herbs can interfere with some pharmaceutical treatments

Since every woman has different needs and a different medical history, speaking to a health care practitioner with expertise in supplementation (such as a registered nutritional specialist, a herbalist, a naturopath, or a doctor or a pharmacist with expertise in natural medicine), is always the best way to ensure that you are about to take the most appropriate and safest supplement(s) for you.

What phytohormonal supplements do I recommend?

Before we look at my top recommendations it’s important to call out that because all the remedies below have a phytohormonal activity, there is a lack of evidence of safety for use in women who have, or have had hormone-related cancer. They may not be the safest option for them. I share information on non-phytohormone supplements that could help in this blog.

BLACK COHOSH

This plant is well-known for its claimed effect on menopausal symptoms, especially hot flushes, sweating and sleep problems ^[1], although how it works is not yet fully understood.

It is not certain that black cohosh contains phytoestrogens. There have been suggestions that black cohosh may change how the neurotransmitter serotonin ^[2] behaves in the body and it may also have anti-inflammatory properties. As a result of these activities, it may decrease the severity of your menopause-related symptoms.

It must be avoided if you suffer from severe liver diseases, if you are taking tamoxifen, or have a hormone-related cancer history, because of its possible phytohormonal activity.

SOY

Soy contains isoflavones, powerful phytoestrogens which may help ease menopause symptoms, especially hot flushes^[3], as well as protect bones. It may be particularly useful in the postmenopause, helping you reduce the risk of long-term issues such as osteoporosis and cardiovascular disease ^[4][5].

It is extremely important that you look after your gut flora while taking soy isoflavones as they are converted into their active form by your friendly tummy bacteria. Therefore, adding a good supplement containing probiotics, the good bacteria for your bowels, on top of a healthy diet, is a positive way to enhance the benefits of this herbal remedy.

Soy is not recommended if you are taking thyroid medication as it could impair its absorption. If you still wish to take soy, there should be as long a time interval as possible between taking the soy supplementation and the thyroxine.

There is a lack of evidence for the safety of soy supplements if you have hormone-related cancer history.

You should not take soy if you have been found to be allergic to it.

SAGE

This Mediterranean herb has a mild oestrogenic activity so works in a similar but less intense way than oestrogen because of the flavonoids it contains. Clinical studies suggest that taking 300mg of sage extract per day can decrease the severity of hot flushes after around eight weeks of supplementation^[6]. Furthermore, sage has traditionally been used for excessive sweating – good news if you’re suffering from night sweats^[7]. Lastly, this plant may help to improve your memory^[8] and is packed with antioxidants, molecules that can help protect against cell damage.

Sage should be avoided if you are taking strong sedatives, or medication for diabetes or epilepsy, as it could alter their effectiveness, or if you have a history of hormone-related cancer.

RED CLOVER

Like soy, this is an excellent source of isoflavones, important phytoestrogens^[9]. However, red clover’s isoflavones seem to be more concentrated and more effective in the short term than those from soy ^[10]. Therefore, a great option can be to try a combination of these two plants throughout your menopausal journey.

Red clover can be very good for helping with hot flushes, vaginal dryness and bone loss due to its phytohormonal activity^[11]. Usually, you should be able to appreciate these effects by taking at least 80 mg of red clover isoflavones per day.

However, it must be avoided if you are on prescription anticoagulants due to their mild blood thinning effect, or if you have had hormone-related cancer.

LIGNANS (FLAX SEEDS OR NORWAY SPRUCE)

Lignans are an extremely interesting class of phytoestrogens. They are usually extracted from flax seeds or the Norway Spruce tree.

Lignans can help with hot flushes, bone loss, vaginal dryness, and mood and memory disorders^[12], thanks to their phytohormonal activity.

Recent research suggests that lignans may also play some positive protective role on breast and female hormone-sensitive tissues in post-menopausal women ^[13][14] – though further studies are needed to clarify this and the clinical relevance that this may have.

Lignans are not recommended if you have a hormone-related cancer history, due to their phytohormonal activity.

SHATAVARI

This plant is traditionally used in Ayurvedic medicine as a booster for female health. It contains phytoestrogens and can have a positive effect on all menopausal symptoms^[15], especially on hot flushes and vaginal dryness. This plant can also help regulate your body’s systems, so can improve your resistance to stress and reduce anxiety^[16].

You will be able to best leverage the benefits of Shatavari by taking 500-1000 mg of its root extract per day.

Shatavari is not recommended if you have a hormone-related cancer history, as it contains phytoestrogens, or if you are taking strong diuretics, as it may increase their effect and, therefore, the possible risk of dehydration.

AGNUS CASTUS (VITEX) or CHASTE BERRY

Commonly used for premenstrual syndrome (PMS), this herb contains mild phyto-progestogens, molecules similar to progesterone, the other important female hormone alongside oestrogen.

If you are still having periods, taking a good quality extract of agnus castus (from 20mg to 40 mg daily), either throughout your cycle or preferably in the last 14 days, can help you ease your premenstrual symptoms^[17], especially during the perimenopause, when PMS can worsen^[18].

Agnus castus can also be very useful for postmenopausal women^[19] since it can aid sleep and relaxation. For this purpose and in this scenario, it should be taken every day, preferably at night.

Always speak to a qualified healthcare practitioner

In conclusion, since every woman is unique, and there isn’t a ‘one size fits all’ rule when dealing with health, it is always highly recommended to speak with a healthcare professional expert in natural remedies before starting your journey with phytohormonal supplements. In this way, you will be able to receive not only personalised advice on the best menopausal supplementation for you, but also all the nutritional and lifestyle tips to best support your general wellbeing in this new important phase of your life.

Davide Ferrilli (MSc Pharm, PG Master in Herbal Medicine, MGPhC, MANP, MGNC) is a Registered Pharmacist, Nutritional Consultant, Herbalist and member of the Association of Naturopathic Practitioners. Davide strongly promotes a holistic vision of health, especially for chronic disorders. Whilst practicing as a pharmacist, he studied Herbal Medicine, gained a Diploma as Nutritional Consultant and attended a 2 year course in Bioenergetic Nutrition according to Chinese Medicine. He runs HealisticYou, where he offers personalized holistic consultations and promotes his original nutritional method (PEF). Davide also collaborates with like-minded psychotherapists and healthcare professionals both in Italy and in the UK. His science-based approach is focused on personalized nutrition, supplementation and lifestyle, combining Western and Eastern medicine.