Navigating Menopause With Integrative Medicine

In our integrative medicine practice, we combine conventional medicine with alternative & holistic medicine, striving to treat mind-body-spirit as one interconnected system from the roots up. At Hearthside Medicine, we care for many patients at various stages of life under the umbrella of family medicine. We have an increasing number of patients seeking a holistic approach to transitions in their hormones--some wanting bioidentical hormones, some wanting only herbal options, and some wanting a blend of plant-based and conventional treatments.

This blog is part of a longer series on perimenopause and menopause and focuses on alternative options and non-hormone prescriptions for hormonal transitions.

We offer bioidentical hormones and testing as well as non-hormonal prescriptions for those who prefer that route as well. To read more about these topics check out the following blogs:

Integrative medicine for symptoms & hormonal health

Plant-based therapies

There are a variety of plant-based therapies used for hot flashes including isoflavones (dietary or supplements) and herbal therapies.

Plant-derived estrogens (phytoestrogens & Isoflavones )

Phytoestrogens have been marketed as a natural alternative to hormones for menopausal symptoms.

Isoflavones are part of a group of plant-based chemicals called phytoestrogens. These chemicals act like a weaker form of estrogen in the body.

The main isoflavones in soy are genistein and daidzein. When you eat soy, bacteria in your intestines break it down into its more active forms. Broccoli and broccoli sprouts are also rich in phytoestrogens.

When isoflavones bind to some receptors, they mimic the effects of estrogen. When isoflavones mimic estrogen, they might help reduce hot flashes and other symptoms of menopause.

However, the amount of hormone-like compounds they possess are scant compared to taking HT. However, some may prefer this option, and I always advocate for plant-based medicine if it accomplishes the goal of the user and is safe.

Phytoestrogens are found in soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Isoflavone supplements, a type of phytoestrogen, can be purchased. Other foods that are being studied and are believed by many to have positive effects on estrogen balance in menopause include peaches, sesame seeds, garlic and cruciferous veggies such as broccoli and broccoli sprouts.

It’s uncertain if phytoestrogens help to reduce hot flashes or night sweats; most studies have not reported benefit or report very conflicting data.

Since phytoestrogens might act like estrogen in some tissues of the body. Many experts suggest that those with history of breast cancer avoid phytoestrogens. Others say they may actually reduce risk of breast cancer. I always advise you consult with your oncologist if you have active or history of breast cancer.

Phytoestrogens have both estrogenic and anti-estrogenic properties and are categorized as isoflavones, coumestans, or lignans.

Isoflavones and phytoestrogens have not been consistently found to be more efficacious than placebo for hot flashes, though advocates of plant-based medicine would disagree.

Two types of isoflavones, genistein and daidzein, are found in soybeans, chickpeas, and lentils and are thought to be the most potent estrogens of the phytoestrogens (although they are much weaker than human estrogens).

Lignans (eg, enterolactone and enterodiol) are found in flaxseed, lentils, grains, fruits, and vegetables.

In a review of 11 randomized clinical trials of soy or isoflavone supplementation, only three of eight trials with at least six weeks of follow-up demonstrated a beneficial effect.

In contrast, a meta-analysis of 21 trials in menopausal women with hot flashes receiving phytoestrogens reported a decrease in the number of daily hot flashes but no change in night sweat frequency. Although this was statistically significant, it may not be clinically significant for those with severe, frequent hot flashes.

When different isoflavones were analyzed separately, red clover was ineffective for hot flashes, similar to results from previous studies. Again, there are some conflicting studies that show red clover having some benefit over placebo.

Genistein (Isoflavin)

Four genistein trials suggested that doses >30 mg/day might reduce hot flash frequency compared with placebo.

Red Clover (Isoflavone)

The data on this one is conflicting at best—with many studies showing no benefit over placebo and others showing possible benefit.

A meta-analysis of randomized controlled trials assessing the effect of a specific

standardized extract of red clover isoflavones on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily