It seems each week there's a new study on hormone replacement therapy (HRT) for menopausal women, and depending on the week, it's either safe or dangerous.

For instance, a recent study said a drop in the number of new breast cancer cases in women over the age of 40 was attributed to a drop in the number of women taking HRT.

Several weeks earlier, another study showed women in their fifties could take HRT without affecting their heart's health. In 2003, a major study indicated HRT increased the risk of heart attack and breast cancer for older women.

With all of this conflicting information, more women are simply choosing to ditch HRT in favour of various prescription drugs and alternative medications, as well as lifestyle changes.

Registered dietician Leslie Beck, author of the book Managing Menopause, says, "Most women in my practice don't want to go the HRT route. They change their diets first, then look at other remedies if symptoms like hot flashes and night sweats are really interrupting their lives."

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"Most women in my practice don't want to go the HRT route." -Leslie Beck, dietician

Spicy foods, along with hot beverages such as tea and alcohol, can be triggers for hot flashes, so the key is figuring out which ones apply to a specific individual.

"Keep a journal of what you're eating," advises Mary Addison, clinical program specialist at Women's College Hospital in Toronto. "When you get a hot flash, go back and see what might have triggered it."

Women also need to ensure they're getting proper exercise and plenty of fluids.

Alternative treatments

However, even after making a number of lifestyle changes, many women still experience symptoms severe enough to disrupt sleep and daily life. That's when they start looking at alternatives to HRT.

Some drugs with an unlabelled use (for symptoms other than those for which a drug has been developed) effectively combat menopausal symptoms. Clonidine, a blood pressure medication, is used by some health-care professionals for hot flashes. A study conducted on the epilepsy drug Gabapentin found it can also reduce hot flashes in women. Anti-depressants are also prescribed.

Many women prefer to follow a more natural route, but it's not easy, according to Addison.

"One of the big problems is we're so far behind in research around women's health particularly around natural products," she said. "People have to be careful with natural remedies because they can react with other medications."

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"One of the big problems is we're so far behind in research around women's health particularly around natural products." -Mary Addison, Women's College Hospital

Black cohosh is one of the better-documented treatments for hot flashes. Beck said.

"In the past I recommended this because of the research. However, the Herbal Alternatives for Menopause Trial released in December by the National Institute of Health found black cohosh does nothing to relieve hot flashes."

Evening primrose oil, often touted as helpful against hot flashes, has also been shown in studies to be ineffective.

"I started evening primrose before menopause. I had minimal menopausal symptoms other than the odd hot flash, although I had friends who were just dripping. I also kept bowls of soy nuts all over the house," said sales rep Valerie Gerechter, 52.

Soy is another product many women turn to, but it too should be used with care.

"Soy in food a couple of times a week, no problem," Beck said. "However, I would caution any woman with a family history of breast cancer against taking soy supplements."

Beck added: "In post-menopausal women we're not sure if soy might act as an estrogen promoter. It acts differently in pre-menopausal women than in post-menopausal.

"Any time you are going for soy protein powders or capsules you're getting more like a pharmacological dose, so I advise any woman with a family history of breast cancer to speak to their physician before they load up."

Herbal combos

A number of multi-herb combinations have popped up on the market for women shunning HRT.

"Usually their main ingredient is black cohosh, possibly soy and other herbs," Beck said.

"I recommend a certain product developed by a doctor in the United States, and a lot of women in my practice have really reported improvements in hot flashes."

Sabina Latendorf, 43, uses a combination product to deal with perimenopausal symptoms.

"I was suffering from pre-menstrual syndrome for the first time in my life, so I put myself on a herbal product after consulting a naturopath," she said. "Taking it consistently has mellowed all the symptoms."

Beck said women who take Vitamin E report fewer hot flashes and some also find the Chinese herb dong quai effective.

For insomnia, vitamin B12 and valerian help some women get to and stay asleep. Melatonin is also helpful in providing a good night's sleep. And what might be one woman's sleepless night can provide a business opportunity for someone else, with several companies selling fabrics for pillowslips and nightgowns that help with night sweats.

Check the labels

When using natural products, women are advised to check for either an eight-digit number, either a natural product number (NPN) of a homeopathic medicine number (DIN-HM), which shows Health Canada has assessed the product for safety, effectiveness and quality.

To keep up to date on what's new, Addison recommends checking out the North American Menopause Society, which has a newsletter with all of the latest information on menopause.

When all else fails, it would be nice to simply advise women, "Don't sweat it." But with menopause, that's what it's all about.

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