Choosing Natural: How Women Are Easing Menopause Without More Pharma

If you are in perimenopause or menopause and your body is feeling hormonally out of balance, it can feel like the world is giving you two choices:

1. Suffer.
2. Take standard hormone replacement therapy (HRT) from a pharmaceutical company, through a doctor who may or may not really hear you.

If you aim to age naturally, or you have conflicted feelings about the medical system, that can leave you feeling stuck.

Reality is more nuanced. Nothing in the supplement or herbal world has been shown to work as strongly, or studied as deeply, as HRT for hot flashes, night sweats, vaginal symptoms, and bone loss. The Menopause Society’s 2022 hormone therapy position statement and 2023 nonhormone therapy statement are very clear on that.

At the same time, there are food based strategies, herbs, and bioidentical hormones, including those from compounding pharmacies, that can give some relief and a sense of control, if you understand what they do.

Here is a simple overview of:

1. Food and plant based helpers
2. Herbs and supplements with evidence
3. Natural or bioidentical hormones
4. When to start and when to taper

This is not medical advice. It is a conversation starter to take with you into an appointment with your preferred natural medicine doctor or primary care physician. It is also an invitation to share with other Menotopia readers the specific natural supplements and remedies that are working for you, or worked well in past phases of perimenopause.

1. Food and plant based hormone helpers

These are subtle levers, and they also support long term health.

Soy and other phytoestrogens

Soy contains isoflavones, plant compounds that gently interact with estrogen receptors. A 2025 systematic review and meta analysis of randomized trials found soy isoflavones gave a small but real improvement in overall menopause symptoms compared with placebo. The effect was noticeable, not dramatic.

On a personal note, I drank soy milk daily from about the age of 39 until I switched to an estradiol patch post menopause to see if it would help my hypothyroid symptoms, and I noticed my skin became drier and more leathery when I stopped.

Practically, using soy as a helper looks like:

• Working tofu, tempeh, edamame, or soy milk into meals most days, especially in place of red or processed meat and refined carbs
• Pairing soy with vegetables, whole grains, and healthy fats, while dialing back ultra processed and high sugar foods, for extra support with hot flashes, mood, cholesterol, blood sugar, and bone health

Recent reviews on soy and breast cancer suggest that soy foods are still safe, and may even lower recurrence risk, for many breast cancer survivors who eat moderate amounts, usually one to three servings a day. See this 2022 review on soy intake and breast cancer risk and this 2025 paper on soy foods in women’s health if you want to go deeper.

If you take thyroid hormone, you usually just need to separate your levothyroxine from soy rich meals by a few hours so absorption stays consistent. I was drinking soy in my morning coffee and eventually stopped, because timing it a few hours after my thyroid pill was not realistic for me.

S-equol (for example, Equelle)

Some women also use S-equol, a soy derived compound that your gut bacteria normally make from isoflavones. Products like Equelle give you S-equol directly. A 2019 meta analysis found that S-equol supplements reduced hot flash scores in postmenopausal women compared with placebo, especially in women who do not naturally produce equol. The effect is still milder than full HRT, but this is one of the better studied “designer phytoestrogen” options.

Red clover and flaxseed

Red clover also contains isoflavones. A 2021 systematic review and meta analysis in Nutrients found that red clover isoflavones reduced daily hot flashes in peri and postmenopausal women, especially in those with frequent symptoms, although the size of the effect was modest. A 2024 update on botanical phytonutrients for menopause reached similar conclusions and called for more long term safety data.

Flaxseed brings fiber, omega 3 fats, and lignans, another class of phytoestrogens. It is great for digestion and cholesterol. Trials looking directly at hot flashes have been mostly neutral, so I file flax under “healthy baseline food,” not “symptom rescue.”

2. Herbs and supplements with some evidence

This is the stuff that fills whole store shelves. The research is usually quieter than the marketing.

Black cohosh

Black cohosh is marketed hard for hot flashes. The Menopause Society’s 2023 nonhormone therapy position statement reviewed the data and concluded that evidence for vasomotor symptom relief is inconsistent and not strong enough to recommend it as a proven treatment.

Safety is the bigger headline. The updated LiverTox monograph on black cohosh and a 2024 review of herbal induced liver injury both note that black cohosh is one of the botanicals most often linked to acute liver damage in case reports, even though the overall risk appears low.

My take:

• If you try it, treat it as a short term experiment, not a forever supplement
• Avoid it if you have liver disease, drink heavily, or take other liver stressing meds
• Stop and get help fast if you notice dark urine, yellowing eyes, or unexplained extreme fatigue

Black cohosh plus St John’s wort

Some European products combine black cohosh with St John’s wort to target both hot flashes and low mood. The same 2023 nonhormone therapy statement notes that this combo can improve overall menopause ratings and depressive symptoms compared with placebo, but flags St John’s wort for major drug interactions.

St John’s wort can reduce levels of many prescriptions and interact with antidepressants. So this approach belongs in the “only with a knowledgeable clinician reviewing your full med list” category.

Maca

Maca (Lepidium meyenii or peruvianum) is a Peruvian root. Women use it for mood, energy, and libido. A 2024 comprehensive review that pooled randomized trials suggests maca can modestly improve sexual desire and satisfaction in some menopausal women, without acting like classic estrogen in blood tests.

Evidence for hot flash relief is limited. If libido and mood are big pain points, maca is one of the more promising “natural” experiments, if you accept that the data is still early.

Swedish flower pollen extract (Relizen, Femelis Meno, Sérélys)

Swedish flower pollen extract is sold under names like Relizen, Femelis Meno, or Sérélys and marketed as nonhormonal hot flash relief. A randomized controlled trial found that a purified pollen extract reduced hot flashes and improved quality of life compared with placebo, and it appears to work without acting like estrogen. You can read a good summary in the Memorial Sloan Kettering Monograph and the underlying 2015 trial.

This is one of the better studied “nonhormonal, nonprescription” options, though the data set is still much smaller than for HRT.

Vitex (chasteberry)

Vitex agnus castus, or chasteberry, shows up in a lot of hormone balancing formulas. It is probably more of a “peri” herb than a classic menopause tool. A 2019 randomized trial in midlife women found that vitex extract reduced overall menopausal symptom scores, including hot flashes and sleep problems, compared with placebo. You can read that study here: vitex and menopausal symptoms.

I think of vitex mainly for women who are still cycling but dealing with irregular periods, PMS like mood swings, and early perimenopause symptoms, not as a stand alone hot flash solution.

Herbs that probably do not do much for hot flashes

The Menopause Society’s 2023 nonhormone therapy review looked across trials of evening primrose oil, dong quai, ginseng, and assorted multibotanical blends. Overall, they did not consistently beat placebo for vasomotor symptoms.

They may have other niche benefits, but they are not real substitutes for HRT when it comes to hot flashes and night sweats.

Wild yam and “natural progesterone” creams

Over the counter wild yam creams and “natural progesterone” creams are heavily marketed. The Menopause Society explains in the same 2023 statement that there is no biochemical pathway in humans to turn wild yam (dioscorea) into progesterone, and trials of yam creams for hot flashes showed no benefit over placebo. Some creams have even been found adulterated with undisclosed hormones. For me, that puts them in the “skip it” category.

Supportive nutrients

Magnesium, omega 3 fats, and vitamin D and calcium (if you are low) are more about whole body terrain. Better sleep, a calmer nervous system, and stronger bones will never be a waste of time. These belong as a foundation under your symptom strategy, not the main event.

3. Natural and compounded hormones

Now we are closer to what HRT does, just outside the classic big pharma lane.

Bioidentical really means molecule match

Bioidentical hormones are molecules that match what your ovaries used to make. That includes:

• FDA approved estradiol patches, gels, and sprays
• FDA approved oral micronized progesterone
• Compounded estradiol, estriol, progesterone, and sometimes low dose testosterone from a compounding pharmacy

The Menopause Society’s 2022 hormone therapy position statement makes it clear that standard, regulated hormone therapy is still the most effective treatment for hot flashes, night sweats, and genitourinary syndrome, and it helps prevent bone loss and fractures when used in the right window.

So you can absolutely have bioidentical hormones without going the custom compounded route.

Why people still seek compounded hormones

Compounded hormones can make sense if:

• You cannot tolerate fillers or adhesives in commercial products
• You need a strength or blend that does not exist off the shelf, for example a specific estriol rich vaginal cream or a lower starting estradiol dose
• You value a practitioner who uses detailed symptom tracking and, sometimes, labs to adjust a small custom regimen

The cautions are real. Because compounded products are not regulated like drugs, potency can vary by batch, and we do not have large long term safety data for many combinations, especially mixed estrogen formulas and off label testosterone doses in women. Both the 2022 hormone therapy statement and the 2023 nonhormone statement recommend FDA approved options first when possible.

If you go the compounded route, it helps to work with someone who also understands mainstream HRT guidelines and is willing to revisit your plan every year.

4. When to begin and when to taper

Timing is a big source of confusion, so here is a simple way to think about it.

Food based helpers

You can add soy foods, flax, and basic nutrients as soon as you notice perimenopause rumblings:

• Cycles shortening or stretching
• Sleep becoming chaotic
• New anxiety or irritability, and early hot spells

You can usually keep these in your life through peri and post menopause, as long as your body and labs stay happy.

Herbal supplements

Treat herbs like time boxed trials.

• Start when symptoms are clearly bothering your sleep, work, or relationships, but you are not ready for hormones
• Try one product at a time for 8 to 12 weeks while tracking hot flashes, sleep, mood, and side effects
• If you see no shift, stop
• If you see benefit, keep going, but build in a check in every 6 to 12 months, and consider tapering or taking short breaks as your cycles settle and you move into a more stable post menopause state

If you have liver issues, a history of hormone sensitive cancer, or several prescriptions, make your “start” decision together with a clinician who can see the whole picture.

Systemic hormones

For full body estrogen plus progesterone, timing matters more.

Both the 2022 hormone therapy statement and summaries from expert groups such as Let’s Talk Menopause emphasize the “window” idea. Hormone therapy tends to have its best benefit to risk balance when started within about 10 years of the final menstrual period and usually before age 60, in women without major contraindications.

That is true whether you use commercial bioidentical products or compounded ones.

Stopping is personal. Many women:

• Stay on a stable dose for a few years
• Taper slowly once symptoms calm, or switch to local only treatments such as vaginal estrogen or DHEA
• Adjust based on how they feel and how their health risks evolve

Vaginal moisturizers and lubricants

For vaginal dryness and pain with sex, nonhormonal vaginal moisturizers and lubricants are an important first step, especially if you are not ready for or cannot use vaginal estrogen. Products based on hyaluronic acid, polycarbophil, or simple water based formulas can make a real difference. The 2023 nonhormone therapy statement and other guidelines list these as first line treatment for genitourinary symptoms in women who want to avoid hormones.

Local vaginal treatments that do contain hormones, such as low dose vaginal estrogen or DHEA, are absorbed very little into the bloodstream. They are often started later, when dryness, painful sex, or urinary issues show up. The 2022 hormone therapy statement notes that vaginal estrogen can be used at any age and for extended durations when needed, with periodic review.

5. Pulling it together

It is completely fair to be wary of big pharmaceutical companies and a healthcare system that has a long history of dismissing women. It is also fair to be wary of supplement companies that sell expensive “natural” menopause kits on very thin evidence.

Real power lives in the middle:

• Knowing HRT is still the strongest, best studied tool for many menopause symptoms
• Using food, lifestyle, and a small, carefully chosen set of herbal or nutrient experiments in a way that fits your body and your life
• Staying open to adjusting your plan as your symptoms and risk factors change

You can love herbs and still decide a tiny estradiol patch is worth it. You can try soy and maca first, then come back to hormones later if sleep and sanity are still in pieces.

If you want to use this as a worksheet, write down your top three symptoms, what supplements you are currently taking, and whether they are minimizing or removing your symptoms. That snapshot makes it much easier to discuss treatment options with your naturopath or doctor as you move through the phases of peri and post menopause and stay as vital and healthy as you can.

Thank you to my wonderful friend Isobel for inspiring this post, and helping me think fully about those of us choosing not to use HRT.