7 Herbal Alternatives to Hormone Replacement Therapy, or HRT

For many women, menopause can introduce new health challenges. In addition to the symptoms that perturb basic quality of life like hot flashes, headaches, night sweats, and irritability, menopause is also associated with higher risks for serious health concerns like osteoporosis, cognitive decline, and metabolic syndrome. This has made the standard treatment for menopause—hormone replacement therapy, or HRT—a multi-billion dollar business.
A few weeks ago, I explored the benefits and risks of HRT. It has its merits certainly, but it’s not for everyone. Today’s post is for those people who want to try something else. Say you’ve waded through the morass of HRT research and would prefer a different route. Or maybe you’ve actually tried conventional or bioidentical HRT and found it just didn’t work for you. Whatever the reason, you’re probably interested in using “natural” products if you can swing it and if it’ll actually help.

Are there herbal alternatives to HRT that actually work?
As a matter of fact, there are.
Which Herbal Hormone Replacement Therapy (HRT) Treatments Work?
These are the eight most promising herbal alternatives to hormone replacement therapy:

Black Cohosh
Maca
Black Seed Oil
Red Clover
Ginseng
Evening Primrose
St. John’s Wort
Wild Yam

Black Cohosh for Sleep and Hot Flashes
A medicinal herb native to North America, black cohosh was traditionally used to treat a wide variety of conditions, including rheumatism and other arthritic conditions, colds, fevers, constipation, hives, fatigue, and backache. They used it to help babies get to sleep and soothe kidney troubles. In the mid 20th century, it gained popularity in Europe as a treatment for women’s hormonal issues. Modern clinical research bears out its relevance for menopause:

It’s effective against hot flashes, reducing both severity and frequency.
It improves objective markers of sleep quality (the reduction in hot flashes certainly can’t hurt).
It improves insulin sensitivity, which often degrades during menopause.
It improves early post-menopausal symptoms across the board, leading to a 12.9 point reduction in the Green climacteric score (a basic measure of menopause symptom severity).
In one study, black cohosh was comparable to conventional HRT for reducing most menopausal symptoms and better at reducing anxiety, vaginal bleeding, and breast tenderness.

Maca for Weight Management and Sexual Function
In its native Peru, maca root was traditionally used as a root vegetable (like a turnip or radish), as well as for its pharmacological properties as an aphrodisiac and subtle stimulant. Incan warriors reportedly used it as a preworkout booster before battles. Today, we know it as an adaptogen—a substance that helps your endocrine system adapt to stress, rather than force it in one direction or another.

A 2011 review of the admittedly limited evidence found that maca shows efficacy against menopause.
Maca displayed the ability to lower depression and blood pressure in menopausal women.
And earlier, maca helped perimenopausal women resist weight gain and menopausal women regain their sexual function and reduce depression and anxiety.
According to a 2005 study, maca actually lowers follicle-stimulating hormone and increases luteinizing hormone in postmenopausal women, thereby increasing estrogen and progesterone production.

Black Seed Oil for Metabolism and Bone Density
The oil of the black cumin seed is a “good seed oil.” Used for thousands of years as a medicinal herb, it has remarkable effects on oxidative stress, inflammation, and even allergy symptoms, but it also shows promise as a treatment for menopause.

Menopausal women who took black seed powder (the actual seed, powdered) saw a reduction in metabolic syndrome, improving both blood lipids and blood glucose. Notably, there was no change in body weight, indicating a powerful effect of the black seed alone.
Black seed oil supplementation improved biomarkers related to bone density in postmenopausal women.

Red Clover for Night Sweats, Hot Flashes, Bones, and More
The red clover blossom is a rich source of isoflavones, estrogen-like compounds that interact with receptors in our bodies and relieve many symptoms of menopause.

Twelve weeks of red clover cuts the Menopause rating score in half (a good thing!).
Twelve weeks greatly reduces the intensity and frequency of hot flashes and night sweats. Including some probiotics has a similar effect.
Red clover also improves vaginal cellular structure and function while (again) improving menopause symptoms and reducing triglycerides.
More exciting, there’s reason to believe that red clover may reduce the risk of breast cancer and improve bone mineral density in menopausal women.

Ginseng for Sexual Function and Hot Flashes
Ginseng doesn’t have as broad an application for menopause as some of the other herbs, but what it does it does well.

It improves sexual function.
It increases libido.
It reduces the total hot flash score.

However, ginseng does not appear to reduce oxidative stress, improve endometrial thickness, or reduce hot flash frequency. Still helpful if you’re suffering from any of the conditions it does improve.
Evening Primrose Oil for Mental and Social Benefits
Evening primrose is another “good seed oil,” extracted from the seeds of the evening primrose flower and high in gamma linolenic acid.

St. John’s Wort for Hot Flashes and Depression
You might remember St. John’s Wort as an herbal treatment for such conditions as depression and anxiety, but it’s also quite effective against certain symptoms of menopause.

In one study, 3 months of daily St. John’s Wort supplementation helped perimenopausal women go from three hot flashes to one hot flash a day, get better sleep, and have a better quality of life.
In another, it took 8 weeks of St. John’s Wort for both perimenopausal and postmenopausal women to reduce the frequency and severity of their hot flashes.
Researchers also combined it with black cohosh to successfully treat hot flash-related moodiness.

Wild Yam for Overall Menopause Symptoms
The yam has been used for hundreds of years for menopause treatment. These days, we know it improves symptoms in menopausal women, though we’re not exactly sure why. The study is actually pretty interesting:

Women swapped out their staple starch (rice) for yams. They ate about a pound of yams a day.
There was another control group who switched from rice to sweet potatoes (not the same thing as yams).
At the end of the trial, the yam eaters had better antioxidant status, better lipids, LDL particles more resistant to oxidation, and higher estrogen levels. The sweet potato eaters were unchanged.

Before you go fill your Amazon cart with supplements and start chowing down on powders and pills, however, make sure you’re making the right move.
Talk to your doctor about the herbal alternatives mentioned. Discuss and research potential interactions with medications and even supplements you’re already taking. Be sure to cite the relevant references.
Minimize the variables. Don’t start taking everything from this article. Start with one and evaluate.
Don’t underestimate the power of plants. Just because something is “herbal” or “botanical” doesn’t mean it’s completely benign at all doses.
Oh, and make sure you’re also addressing the potential dietary and behavioral interventions you can try.
That’s it for today, folks. Take care, and be sure to write in down below.
Have you ever used any herbs or botanicals to treat menopause symptoms? If so, what worked? What didn’t?

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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