Alternatives to HRT fact sheet

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Taking a healthy approach to menopause

Menopausal symptoms are essentially caused by the normal reduction in the levels of oestrogen produced by the body. They can include hot flushes, night sweats, pelvic floor issues, vaginal dryness, painful sex, urinary frequency, mood changes and libido changes. Most women who have symptoms will generally experience them for 4-6 years.

Many women explore options for safe and effective complementary or alternative medicine to relieve menopausal symptoms (1). Current guidelines suggest use of hormone replacement therapy (HRT) is safe and effective for treating menopause symptoms of most women for up to five years (2). However, some women are reluctant to use HRT while others have mild symptoms and are looking for alternative options.

This fact sheet provides an overview of lifestyle options and popular alternative treatments for women at this time.

Lifestyle changes

Menopause is a perfect time to evaluate your overall lifestyle and make changes to ensure you stay healthy, both now and in the future. Improving your lifestyle and enjoying better health can make it easier to tolerate menopausal symptoms when they occur.

Nutrition

There are a number of dietary changes that can be beneficial at menopause. Generally, women should aim to reduce intake of processed and refined foods while increasing intake of unprocessed or whole foods. Takeaway and convenience foods should be limited as these are often of poor nutritional value and high in salt, sugar and saturated fats.

A diet based on vegetables, legumes, fruit, wholegrains, lean meat, poultry, fish and dairy foods is recommended for all Australian adults. Healthy fats such as olive oil, canola oil, nuts and seeds should also be included. It is best to eat a variety of foods from each of the different food groups. Eating this diet can improve your overall quality of life (3) and help reduce the risk of developing health issues such as cardiovascular disease and type two diabetes.

It is also helpful to limit high GI carbohydrate foods which cause a rapid rise in blood sugar levels e.g. white bread, cake, soft drink and sweets. Low GI foods are broken down more slowly in the body thereby keeping blood sugar levels more stable. Fluctuating blood sugar levels can result in symptoms often attributed to menopause; tiredness, irritability, difficulty concentrating and anxiety (4). Limiting stimulants such as tea, coffee and chocolate as well as spicy foods such as chilli are reportedly helpful for reducing symptoms such as hot flushes.

Another important consideration at this time is calcium intake as it plays a role in preventing osteoporosis. If you are an Australian woman over 50 it is recommended that you consume 4 serves of calcium food each day. A serve is equivalent to:

  • 1 cup of milk or calcium enriched soy milk
  • a small tub of yogurt
  • 2 slices of hard cheese
  • 120g of soft cheese such as ricotta.

Low fat products are just as beneficial as full cream varieties. You should also make sure you are eating other high calcium foods such as canned fish with bones (sardines/salmon), almonds, dried figs and dark green leafy vegetables (Chinese greens, spinach). Vitamin D deficiency can reduce calcium absorption in the body. The main source of vitamin D for Australian women is daily exposure to sunlight.

Lifestyle changes generally mean that you will require less energy as you get older. If you continue to eat the same amount while expending less energy than before you will experience a gradual weight gain. Being aware of your overall energy intake and portion sizes as well as avoiding 'empty' foods that are high in kilojoules but low in nutrients can help to combat weight gain at menopause.

Exercise

Exercise affects the levels of hormones and chemicals in the body. For example, it increases the level of endorphins, the brain chemicals responsible for feelings of happiness. Exercise has been proven to be an effective treatment for mild to moderate depression and anxiety. It also helps stabilise blood sugar levels, boosts metabolism and improves sleep.

An exercise program should include a combination of aerobic, weight-bearing, strengthening and flexibility exercises;

  • Aerobic exercise increases the heart rate which provides protection from cardiovascular disease and assists in maintaining a healthy weight. Examples include jogging, walking, swimming or cycling.
  • Weight-bearing exercise is exercise that is done on your feet so the force of gravity acts through the skeleton (5). It helps to maintain bone mass, thereby preventing osteoporosis, and includes jogging, walking, tennis and netball.
  • Strengthening exercise works muscles against resistance, such as weight training. This exercise can also have a positive impact on bone mass.
  • Flexibility exercise mobilises and stretches joints, ligaments, muscles and tendons and includes yoga and Pilates. This exercise can help prevent falls and benefit conditions such as arthritis.

Activities which involve more than one type of exercise (e.g. brisk walking is both weight-bearing and aerobic) are ideal.

Some tips for starting an exercise regime include:

  • Choose a range of activities that includes the four different types of exercises.
  • Start slowly and gradually build up the activity level – if you have not participated in regular exercise for a period of time it is a good idea to have a physical examination by a doctor first.
  • Always perform warm up and cool down exercises and stretches to reduce the risk of injury and post-exercise soreness or stiffness.
  • To keep motivated choose activities that are enjoyable, exercise with others or keep an exercise diary.
  • Incorporate exercise into everyday routines such as getting to and from work, taking the stairs instead of the elevator, walking or cycling to the shops instead of driving.

Evidence – While there is no conclusive evidence that exercise directly reduces menopause symptoms such as hot flushes (6) there are too many other benefits not to do it. Regular exercise is known to improve overall physical and psychological health, thereby helping you to better tolerate symptoms and reducing your risk of developing other health issues.

Stress management

Stress is necessary for providing motivation and stimulation in our lives. When we experience stress our adrenal glands produce the hormone adrenaline, causing an increase in respiration, heart rate and blood pressure. This automatic 'fight or flight' response prepares the body to respond to an immediate threat or danger. Stress becomes a problem when people experience it, and the physical reactions it produces, too frequently. The repeated stimulation of the adrenal glands, for example, can interfere with their proper functioning. This can be problematic as these glands are an important source of oestrogen production after menopause. Women who experience high levels of stress may have stomach upsets, headaches, sleeping difficulties, muscle tension and an impaired immune system.

There are a number of strategies that you can learn to help cope with stressful situations. For example, it is possible to learn to change negative or distorted thinking patterns by reading one of the many self-help books available or by consulting a therapist. It can also be helpful to identify what you find stressful in your life so that you can make practical attempts to reduce the occurrence of such situations.

There are also many activities that you can participate in to help relieve stress including massage, yoga, relaxation/meditation, Tai chi and regular exercise. Learning specific relaxation techniques such as hypnosis, relaxation training, paced breathing and biofeedback techniques can also help. Many women also find acupuncture helpful (7) (see Acupuncture below).

Evidence – Stress reduction strategies including mindfulness training and cognitive behaviour therapy (CBT) have been shown to reduce the impact and severity of hot flushes and night sweats (8).

Other lifestyle considerations

Studies have shown that weight loss in women who are overweight can reduce or eliminate hot flushes (9). Alcohol, tiredness and stress are all known to make hot flushes feel worse.

Other lifestyle factors that may help you to deal with mild symptoms include:

  • not smoking
  • reducing alcohol consumption
  • wearing layered cotton clothes
  • avoiding overheating
  • ensuring adequate ventilation and airflow in your home, office etc.

Popular complementary and alterative medicine (CAM) treatments for menopause

Many women find complementary and alternative medicine treatments for menopause helpful despite there being little evidence demonstrating the effectiveness of many of them. There has been a lack of studies evaluating these treatments and it is difficult to compare the results of those that have been carried out. It is also known that many of these treatments have a large placebo effect (10). That is, many women find that they work for them regardless of whether or not there is evidence to support their effectiveness. While placebo is a very effective treatment (around half of women will report reduced hot flush frequency or severity with a placebo treatment) (11), some alternative treatments can be expensive so it is important that you are aware of the placebo effect when you are evaluating your options.

If you are considering using complementary and alternative medicines to treat your menopause symptoms it is important to consult a qualified practitioner e.g. herbalist, naturopath. It is also important to always inform all your healthcare professionals of all medicines (prescription, non-prescription, complementary and alternative) you are taking as some treatments and medicines may interfere with others.

Soy foods and other dietary phytoestrogens

Many of the symptoms experienced by menopausal women are a result of declining oestrogen levels. Phytoestrogens are naturally occurring compounds found in plants which produce a weak oestrogenic effect by binding to the empty oestrogen-receptor sites in menopausal women.

There are three types of phytoestrogens – isoflavones, lignans and coumestans – with isoflavones being the most common. Linseed, soy beans and soy products (milk, tofu, tempeh and miso) have been found to be the richest sources of phytoestrogens (12). However, phytoestrogen levels in these foods can vary greatly depending upon plant variety, time of harvesting, growing conditions and processing methods.

It is generally recommended that women eat phytoestrogen foods rather than taking supplements. Phytoestrogens are part of a healthy diet and may help lower blood cholesterol levels (13). The optimal intake of dietary phytoestrogens appears to be around 50mg day (14) and a recent analysis has found that this intake level can reduce the frequency and severity of hot flushes (15).

As a rough guide, the phytoestrogen content of some foods are:

  • 250ml soy milk – 15-60mg
  • 115g block tofu – 13-43mg
  • 2 slices of soy and linseed bread – 7-15mg
  • 200g tub of tofu yoghurt – 26mg
  • 1 tablespoon of soy grits – 25-32mg (16).

Evidence – The evidence for the benefits of dietary phytoestrogens in menopause is mixed (17). Many studies have compared the experiences of Asian women (who have a diet high in phytoestrogens) with Western women (who generally have a diet low in phytoestrogens). It is reported that Asian women experience fewer menopausal symptoms, such as hot flushes. However, other factors, such as a cultural difference in how women express menopausal symptoms, could be involved (18). A North American Menopause Society report states that soy isoflavines are modestly effective in relieving menopausal symptoms and that a diet rich in soy food is associated with a lower risk of some cancers (19).

Bioidentical hormones / natural HRT

These hormonal preparations require a doctor's prescription and are made up by compounding chemists. They come as lozenges, troches, creams, pessaries and tablets. Preparations are tailor-made, often based on the results of saliva or blood tests. However, it has been argued that there is no scientific evidence linking hormone levels in saliva to menopausal symptoms being experienced. It has also been argued that hormone levels do not necessarily predict therapeutic effect of medicines (20). It is claimed that because the structure of bioidentical hormones is closer to that of hormones found in the body they have less side effects than HRT. Bioidentical hormones may contain oestrogen, progesterone, testosterone, DHEA, thyroxine, growth hormone and melatonin (21). They are not TGA approved because they are individual preparations.

The terms 'bioidentical' and 'natural HRT' are somewhat misleading as they suggest to women that the hormones are natural when in fact they are synthetically produced in a laboratory. Bioidentical hormones are currently not regulated in the same way as pharmaceutical drugs and, therefore, there is less quality control over aspects like dosage and purity. Bioidentical hormonal preparations are also more expensive than HRT as they are not available through the Pharmaceutical Benefits Scheme (PBS).

Evidence – As hormone replacement therapy and bioidentical hormones come in different doses and combinations it is difficult to compare their effectiveness with each other through trials (22) and there are few scientific studies supporting the effectiveness of bioidentical hormones for menopausal symptoms (23). There is also little known about the safety of the combinations or dosages of the ingredients they contain. For example, there is concern is that the progesterone contained in some bioidentical hormonal preparations may be insufficient to protect the uterus (oestrogen administered without progesterone can cause cancer of the uterus) (24). A decision to take bioidentical hormones, therefore, should be made with the knowledge that there is no evidence that these hormonal preparations are any safer than HRT. While they are not considered 'unsafe', they are not regulated and tested the same way synthetic HRT medications are.

Wild yam cream

Wild yam cream is said to have hormone balancing properties, assisting with menopausal symptoms like hot flushes. Some manufacturers claim that their product either contains progesterone or can increase progesterone levels in the body. This is incorrect as products containing progesterone are only available on prescription. Similarly, the human body is not capable of converting the ingredients in wild yam (e.g. diosgenin) to progesterone.

Evidence – There is currently no quality evidence to support the use of wild yam cream in relieving menopausal symptoms (25).

Herbal medicine

In menopause, herbal medicine is used to both influence hormonal changes as well as treat individual symptoms. Herbal medicine is administered in a number of forms including extracts, infusions, capsules, tablets and creams.

Herbs such as black cohosh (actaea racemosa), chaste tree (vitex agnus castus), dong quai (angelia polymorpha) and maca (lepidium meyenii) are used for their hormone balancing properties. Other herbs like ginseng and licorice are used to ensure the optimal functioning of the adrenal glands. Herbs used in the treatment of individual symptoms include sage (night sweats and hot flushes), valerian and hops (insomnia) and calendula and evening primrose oil (vaginal dryness).

Although herbal remedies are natural they contain powerful ingredients and, therefore, need to be taken with the same care as other medicines. If you are interested in using herbal medicine it is important to consult a qualified health practitioner for an individualised assessment and consultation.

Evidence – While there is some evidence to support the effectiveness of black cohosh in treating hot flushes, further studies are needed (26) (for more information on black cohosh see the Non-prescription supplements section below). There is little evidence to support the use of other herbs in the treatment of menopausal symptoms.

Traditional Chinese Medicine (TCM)

Chinese herbal medicine

Chinese herbal medicine uses a combination of herbs that are individually tailored for each woman. Sometimes animal products or minerals are also included in preparations. Chinese herbal medicine can come in the form of powders, pastes, tablets or lotions.

Evidence - Chinese studies have found TCM preparations to be effective in helping menopause symptoms (27). However, these studies are carried out very differently to western clinical trials. In Chinese studies the herbs are blended and changed according to the situation of the woman throughout the trial while in western studies a single herb is studied at a time and the dose unchanged. This makes it very difficult to compare results.

Acupuncture

Many women find acupuncture helpful for reducing hot flushes associated with menopause. Acupuncture involves inserting fine needles into the skin at particular points. Sometimes other techniques such as cupping or pressure are used instead of needles to manipulate pressure points.

Evidence - It is not known exactly how acupuncture works but many studies have found it effective in increasing general wellbeing. It can be particularly helpful in reducing hot flushes in women, especially in severe cases (28). Interestingly, 'sham' acupuncture, where the acupuncture needle is inserted but not necessarily into an acupuncture point, has been found to be as effective as traditional acupuncture in some studies (29).

Non-prescription supplements

Phytoestrogen (isoflavone) supplements

These products contain extracts of either soy or red clover. They are predominantly promoted as reducing hot flushes. Isoflavone supplements are considered to be a reasonable initial treatment choice for women who are experiencing severe hot flushes (30). It is thought that supplements that contain high doses of genestein, a type of soy isoflavone, may provide more benefits for relief of menopausal symptoms (31). If there is no improvement after 12 weeks other options should be considered.

Evidence - Results from trials suggest that isoflavone supplements are moderately effective in reducing hot flushes (32). However, as the long term safety of phytoestrogen supplements has not been established they are not recommended for women with a history of breast cancer (33). If you choose to take these supplements you should be careful to follow the recommended dose.

Black cohosh (Cimicifuga racemosa) supplements

These supplements are predominantly promoted for reducing hot flushes.

Evidence - Studies of black cohosh supplements for menopausal symptoms have produced mixed results. While a recent review of 16 trials found that there is currently not enough evidence to support its use it also noted that there is justification for more studies on the effectiveness of black cohosh for relieving menopausal symptoms to be conducted (34). The Therapeutic Goods Administration requires products containing black cohosh to carry the following warning: Black cohosh may harm the liver in some individuals. Use under the supervision of a healthcare professional (35).

Other supplements

Other popular non-prescription supplements consist of a combination of herbs and/or vitamins and minerals. The concern with these supplements is that they may not contain enough of any one ingredient for them to be effective or that the safety of combining particular ingredients is unknown.

Prescription medications

Several non-hormonal prescription medications including antidepressants, hypertension drugs and epilepsy drugs are also used to control menopausal symptoms such as hot flushes.

Antidepressents including SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine re-uptake inhibitors) can be helpful in reducing hot flushes (36). Side effects of these medications can include headache, nausea, insomnia, drowsiness, constipation, dry mouth or libido changes. Another possibility is that in higher doses sweating and hot flushes can get worse (37).

Gabapentin is an epilepsy and pain relief drug that can help reduce hot flushes and night sweats (38). Possible side effects are drowsiness, loss of muscle control, confusion, fatigue, dizziness, rash, palpitations and swollen feet and ankles. Usually these symptoms settle down in about 4 weeks (39).

Clonidine is a blood pressure medication some women find useful for managing hot flushes (40). Side effects can include dry mouth, insomnia, drowsiness, dizziness, constipation and difficulty sleeping (41).

Your experience of menopause will depend on a number of factors and will be different to that of other women. You may experience symptoms that are mild, symptoms that are severe or no symptoms at all. If you are experiencing symptoms, talking to your health professional may help you to decide the right options for you.

Further information

Menopause fact sheet

Middle years - Women's Health booklist

Australasian Menopause Society

Menopause and complementary medicine - Better Health Channel

HRT and menopause treatments - Choice Australia

Complementary and herbal therapies for hot flushes - Australasian Menopause Society

Preparing for a healthy menopause (available in 16 languages) - Health Translations

For help understanding this fact sheet or further information on menopause, call the Health Information Line on 3216 0376 or 1800 017 676 (toll free outside Brisbane).

References

  1. J. Pitkin, 'Alternative and complementary therapies for the menopause', Menopause International 2012 Mar 18 (1): pp 20-7
  2. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Hormone Replacement Therapy Advice, College Statement, July 2012 available at http://www.ranzcog.edu.au/womens-health/statements-a-guidelines/college-... (link no longer active) accessed 30 January 2013
  3. National Health and Medical Research Council, Draft Australian Dietary Guidelines, December 2011 p8
  4. M. Glenville, Natural Alternatives to HRT, London, Kyle Cathie, 2002, p63
  5. L. Rose, Osteoporosis: The Silent Epidemic Sydney, Allen and Unwin, 1994, p178
  6. A. Daley, H. Stokes-Lampard, C. MacArthur, 'Exercise for vasomotor menopausal symptoms', Cochrane Database of Systematic Reviews 2011 Issue 5. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub3
  7. E. Farrell, 'Menopause therapy beyond HRT', Medical Observer 13 August 2010 p29
  8. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Management of the menopause, College Statement, November 2011, p2
  9. C.H. Kroenke et al., 'Effects of a dietary intervention and weight change on vasomotor symptoms in the Women's Health Initiative', Menopause 2012 July 9 PMID:22781782
  10. National Health & Medical Research Council, Making decisions: Should I use hormone replacement therapy? (HRT), Commonwealth of Australia, 2005, p29 http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh37.pdf accessed 29 January 2013
  11. Australian Menopause Society, Non Hormonal Treatments for Menopausal Symptoms (information sheet) p1 http://www.menopause.org.au/images/stories/infosheets/docs/NonHormonal_Treatments_%20for_Menopausal_Symptoms.pdf accessed 29 January 2013
  12. L. Howes, 'Isoflavone phyto-oestrogens', Medical Observer, March 5 1999 update, pp 1-3
  13. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753
  14. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753 and R. Rouse, 'Relief from hot flushes can be found in soybean-rich products', Medical Observer 27 April 2012 p12
  15. R. Rouse, 'Relief from hot flushes can be found in soybean-rich products', Medical Observer 27 April 2012 p12
  16. P. Lyons-Wall, P. 'A nutritional perspective on soy phytoestrogens for menopausal women - controversies, uncertainties and practicalities', Health Journey Issue 1 2002 p1
  17. A. Lethaby et al, 'Phytoestrogens for vasomotor menopausal symptoms' (Review) The Cochrane Collection 2010, Wiley
  18. L. Howes, 'Isoflavone phyto-oestrogens', Medical Observer, March 5 1999 update, pp 1-3
  19. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010),' Menopause 2011 Jul;18(732-53) PMID 21685820
  20. J. Files, M. Ko, S. Pruthi, 'Bioidentical Hormone Therapy' Mayo Clinic Proceedings 2011;86(7):673-680 pp678
  21. A. H. MacLennan and D.W. Sturdee, 'The "bio-identical/bioequivalent" hormone scam' (editorial), Climacteric 2006 (9) pp1-3
  22. J. Files, M. Ko, S. Pruthi, 'Bioidentical Hormone Therapy' Mayo Clinic Proceedings 2011;86(7):673-680
  23. A. H. Maclennan, 'Evidence-based review of therapies at the menopause' International Journal of Evidence Based Healthcare 2009 Jun;7(2):1112-23 PMID21631851
  24. A. H. MacLennan and D.W. Sturdee, 'The "Bio-identical/Bioequivalent" hormone scam' (editorial), Climacteric 2006 (9) pp1-3
  25. A. Nedrow et al. 'Complementary and alternative therapies for the management of menopause-related symptoms', Archives of Internal Medicine 2006 166 pp1453-1465
  26. T. Low Dog, 'Menopause: a review of botanical dietary supplements', American Journal of Medicine 2005; 118:12B:98S-108S
  27. L. Chen et al., 'A pilot study comparing the clinical effects of Jia-Wey Shiau-Yau San, a traditional Chinese herbal prescription, and a continuous combined hormone replacement therapy in postmenopausal women with climacteric symptoms', Maturitas, 44(2003): 55-62
  28. P. Aidelsburger et al., 'Alternative methods for the treatment of post-menopausal troubles' GMS Health Technology Assessment 2012 Vol8 & E. Borud et al., 'The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial', Menopause 2009 PMID 19423996
  29. S. Cho, W. Whang, 'Acupuncture for vasomotor menopausal symptoms: a systematic review', Menopause 2009 PMID 19424092
  30. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753
  31. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753
  32. North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753
  33. The Cancer Council of New South Wales, Position Statement: Soy, phyto-oestrogens and cancer prevention, update August 2009, http://gp.cancercouncil.com.au/pdf/PS_Soy_phyto-oestrogens_and_cancer_Se... (link no longer active) accessed 31 January 2013 & Herbal Medicines Research and Education Centre, 'Herbs used in menopause', Complementary Medicine 2004; 4:50-56 & North American Menopause Society, 'The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Transnational Science Symposium in Chicago, IL October 2010', Menopause 2011 18:7;732-753
  34. Leach, M.J and Moore, V. 'Black cohosh (Cimicifuga spp.) for menopausal symptoms (Review)', Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No. CD007244. DOI: 10.1002/14651858.CD007244.pub2.
  35. Therapeutic Goods Administration, Black Cohosh (Cimicifuga racemosa): New labelling requirements and consumer information for medicine containing Black cohosh (29 May 2007) http://www.tga.gov.au/safety/alerts-medicine-black-cohosh-070529.htm accessed 31 January 2013 2013
  36. National Health & Medical Research Council, Making decisions: Should I use hormone replacement therapy? (HRT), Commonwealth of Australia, 2005, p29 http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh37.pdf accessed 29 January 2013 & C. Ede, 'Study backs SSRI use for hot flushes', Medical Observer 28 January 2011 p5 & J. Pitkin, 'Alternative and complementary therapies for the menopause', Menopause International Vol 18 No 1 March 2012.
  37. E. Farrell, 'Menopause therapy beyond HRT', Medical Observer 13 August 2010 p29
  38. J. Pitkin, 'Alternative and complementary therapies for the menopause', Menopause International Mar 18 (1): pp 20-7.
  39. E. Farrell, 'Menopause therapy beyond HRT', Medical Observer 13 August 2010 p29
  40. National Health & Medical Research Council, 2005, Making decisions: Should I use hormone replacement therapy? (HRT) http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh37.pdf pg 29 accessed 29 January 2013
  41. E. Farrell, 'Menopause therapy beyond HRT', Medical Observer 13 August 2010 p29 & Australian Menopause Society NonHormonal Treatments for Menopausal Symptoms Information Sheet p4 http://www.menopause.org.au/images/stories/infosheets/docs/NonHormonal_Treatments_%20for_Menopausal_Symptoms.pdf accessed 29 January 2013

Last Updated: 5 April 2013

© Women's Health Queensland Wide Inc. This fact sheet was originally published in December 1997. It was revised in October 1999, January 2003 and January 2007 and by Lorraine Pacey and the editorial committee in April 2013.

 

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