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Hormone Replacement Therapy (HRT) - What are the benefits and side effects?

Safe and Effective Alternatives to HRT
Hormone Replacement Therapy (HRT) is a treatment to relieve menopause symptoms. It works by replacing hormones like estrogen that your body stops producing. Women experience a general decline in estrogen levels as they enter perimenopause, a temporary phase that usually lasts 5-7 years before menopause. For some, they experience the symptoms more than others during perimenopause than menopause.

There are two main types of HRT: Traditional and Bioidentical. At Supplement Review, we combed through more than 60 full-text articles from health authorities and trusted health publications to evaluate the effectiveness of different HRT types and explore safe and effective alternatives on the market.

HRT - What It Is, Safety, and Known Side-Effects

Traditional HRT (or standard HRT) involves taking hormones made in the lab. These hormones are usually made from the urine of pregnant horses and other synthetic hormones. HRT is safe for most women. But according to the National Cancer Institute1, HRT may carry unintended side effects such as:

1. Stroke, blood clots, and heart attack
  • Women who took either combined hormone therapy or estrogen alone had an increased risk of stroke, blood clots, and heart attack2,3.
  • For women in both groups, however, this risk returned to normal levels after they stopped taking the medication4,5.
2. Urinary incontinence
  • In study done with 16,000+ women, researchers found that women who took estrogen alone or estrogen plus progestin had an increased risk of urinary incontinence2.
3. Vaginal bleeding
  • Women who took estrogen plus progestin had more vaginal bleeding that required assessment by endometrial biopsy than women who took placebo4
4. Interactions with other medications
  • HRT can interact with other medications a person is taking, which may reduce their effectiveness or cause other health problems.
If you are concerned about the side effects, we recommend speaking to your primary care doctor about your suitability.

On the other hand, bioidentical HRT (or natural HRT) uses hormones that are chemically identical to the hormones in our body. However, these hormones are still processed in the lab.

While supporters claim that bioidentical HRT (BHRT) is safer than traditional HRT, most experts believe the risks of BHRT and HRT are similar. Compounded bioidentical hormones which are custom made in pharmacies may carry even more risks. There’s no credible evidence that BHRT is more effective than HRT.

If you suffer from any chronic medical condition or have experienced cancer, it would be wise to seek a doctor’s opinion before embarking on HRT or BHRT.

The general recommendation for BHRT is to use the lowest dose that proves effective, and follow up with your doctor regularly about whether to continue hormone therapy.

Are There Safer Natural Alternatives To HRT?

Most women are unaware of a third option until they hear about it from someone they know. This option refers to the use of natural supplements. 

During our research, we discovered 12 popular natural supplements on the market that have helped 1,000s of women manage the menopause transition quietly. We poured through 1,000s of verified customer reviews on 3rd party review sites and marketplaces to understand how they work, the science behind, and share our top 5 recommendations with you.

Taking a step back, HRT aims to treat the root cause of menopause symptoms which is the decline in estrogen levels. 

However, menopause is a transition, not a disease. By seeing it as a temporary phase, women can focus on the core implications of estrogen decline and keep their menopausal symptoms down without taking unnecessary risks. 

Dozens of major studies conducted on menopause identified 4 big conditions underlying menopausal symptoms:

Estrogen protects our joints and contains anti-inflammatory properties. Lower estrogen levels activate inflammatory processes6 that lead to symptoms such as joint pain and poor gut health, which exacerbates symptoms like hot flashes and mood changes.

Estrogen changes our body shape. As estrogen levels decline, our body deposits more fats in the belly area7 where the majority of our organs are. This leads to an unexpected weight gain especially around the midsection.
Estrogen and our gut have a synergistic relationship8. Lower estrogen levels are typically associated with poorer gut health. Conversely, our gut metabolizes estrogen and regulates the level of estrogen circulating within our body. When our gut is unhealthy, it is unable to support healthy estrogen levels in the body.
According to Mayo Clinic9, most research suggests that hot flashes occur when decreased estrogen levels cause your body’s thermostat (hypothalamus) to become more sensitive to slight changes in body temperature. When the hypothalamus thinks your body is too warm, it starts a chain of events — a hot flash — to cool you down.

Clinically Studied Supplements to Address The 4 Big Conditions

Emerging studies from the last decade revealed that our gut health plays a central role in our overall wellness. Probiotics form a key part of our gut’s microbiome and recent studies show that some probiotic strains possess weight-management and anti-inflammatory properties that can ease menopausal symptoms.

Weight-management properties: The most known example is L. Gasseri SBT2055. Two studies10,11 on 100s of adults found 4.6%-8.5% reduction in belly fats and improvements in body weight, BMI, and the waist area.

Anti-inflammatory properties: One such example is B. Lactis R101-812, which was found to lower inflammation. Other examples include B. Breve CNCM I-4035, L. Paracasei CNCM I-4034, and L. Rhamnosus CNCM I-403613.

Support hormonal balance naturally: Another 2022 study14 on L. Gasseri CP2305 conducted with 80 women aged 40 to 60 found significant relief in hot flashes and night sweats after 6 months of consumption.

Curcumin (Turmeric): Curcumin lowers oxidative stress15 and fights inflammation16 – two key processes that result in menopausal symptoms such as hot flashes and joint pains. A recent study15 on 81 women saw reduced hot flashes and night sweats after consuming curcumin for 8 weeks. The Arthritis Foundation also recommends the use of curcumin to manage joint pain and slow the progression of osteoarthritis.

Ashwagandha: Unlike curcumin, most people don’t use ashwagandha for its anti-inflammatory properties, but it contains compounds, including WA, that may help reduce inflammation in the body17. In one study from 2008, adults experiencing stress took ashwagandha extract for 60 days. As a result, they had significant reductions in C-reactive protein — an inflammatory marker — compared with those who consumed a placebo18.

Phytoestrogens are plant-based compounds that mimic the effects of estrogen in the body without the side effects. Researchers believe that phytoestrogens can bind to estrogen receptors in the body18, which may help to reduce the intensity and frequency of hot flashes.

Moringa

Moringa leaves are among the most nutrition-dense herb in the world, containing 90+ nutrients and 46 antioxidants. Among the nutrients is quercetin19, a phytoestrogen that exhibits weak estrogenic effects and it could be a safer alternative than taking hormones to support hormonal balance. They were also found to have therapeutical potential for preventing complications during postmenopause20

Chasteberry is commonly used to alleviate symptoms of premenstrual syndrome. But 2017 study21 suggests that it is also effective in alleviating menopause symptoms such as hot flashes and night sweats.

 

Keep in mind, not all natural supplements are created equal. Different brands use different ingredients, and some formulas are simply going to be more effective than others. 

At Supplement Review, we’ve analyzed some of the top-selling menopause supplements on the market to help guide you in the right direction. We’ll show you what to look for and what to avoid in a high-quality supplement, plus, we share our top 5 picks of the year.

Your Ultimate Menopause Supplements Checklist

The FDA doesn’t require third-party verification. However, responsible and honest supplement manufacturers get third-party verifications as an act of good faith to provide transparency and distinguish products. Certifications verify ingredients and quantities claimed on the label. Look out for these important certifications before buying a supplement – GMP, USP, NSF, Certified Organic, NON-GMO certified.

Never buy a supplement just on ‘hearsay’ or just because it has ingredients that are used in traditional medicine. Let the facts speak for themselves. Always look out for clinically-studied ingredients whose efficacy are supported by a body of evidence.

Sadly, according to the New York Times22, one in four products sold on Amazon is fake. This is especially true of nutritional supplements. Avoid buying supplements on Ebay. When you buy from Amazon, ensure you buy from the manufacturer’s Amazon store. Otherwise, buy directly from the manufacturer’s website. Buying fraudulent products may cause nasty side effects — be extra cautious about authenticity.

All supplements made in the USA are regulated by the FDA. The same applies to those made in Canada and Australia. Ensure products you buy come from FDA regulated facilities using GMP certified manufacturing processes. Many supplements, especially those purchased on eBay and Amazon come from China and abroad. One study found 60%-70% of these ‘foreign’ supplements do not contain the ingredients or quantities claimed on labels23.

A risk-free guarantee lets you try supplements without fear of losing your money. If you try the product and don’t experience the results simply contact the manufacturer for a refund. Look for companies who have a “no-bottle-return’ policy. This allows you to finish the supplements without incurring any risk. And it’s also the best sign of how confident the company is in standing behind their promises.

Best HRT Alternatives: Natural Menopause Supplements Of 2024

Overall Grade: A+
Score: 9.5/10

Why We Like Provitalize:

Provitalize by Better Body Co. is Supplement Review’s number one choice thanks to the 24,000+ verified customer reviews across TrustPilot, Amazon, and its website. It is rare to find another menopause supplement that matches the sheer number of positive customer reviews and this is an important indicator in our ranking system.

Customers have reported visible improvements in belly fat reduction, fewer and less intense hot flashes and night sweats, better sleep, more energy, and better joint health.

We believe that Provitalize is able to produce such results due to its unique combination of anti-inflammatory herbs, weight-management probiotics, and phytoestrogens. Provitalize contains 350mg of curcumin and 350mg of Moringa Leaves per serving and clinically studied probiotic strains of L. Gasseri SBT2055, B. Breve IDCC4401, and B. Lactis R101-8. No other product on the market has the same formula.

Plus, it’s third-party tested for purity.

During our research, we also discovered that Provitalize has an industry-leading money-back guarantee. While most supplement brands offer 30 or 60 return policies, Better Body Co. offers a 90-day money-back guarantee with no bottle return needed. This demonstrates the confidence in their product. Customers who don’t experience results within 90 days of purchase may write in to their 24/7 customer support team for a refund.

With that, Provitalize takes a well-deserved spot at the top.

Pros

  • Clinically studied L. Gasseri SBT2055, B. Breve IDCC4401, and B. Lactis R101-8 probiotic strains.
  • 350mg of Curcumin (Turmeric Root Extract)
  • 350mg of Moringa Leaves (Moringa Oleifera)
  • 100% natural with no filler
  • Trademarked delayed-release capsules for protection against stomach acid
  • Bioperine® for better absorption of curcumin
  • Stimulant and caffeine-free, GMO-free, hormone-free
  • Keto-friendly, vegan-friendly, and paleo-friendly
  • Made in a certified GMP facility in USA
  • 90-day money back guarantee (no bottle return needed)

Cons

  • Sold exclusively online

*Results are based on users’ personal experiences collected on this page and do not necessarily reflect typical results of using these products. Please see the product website for more information.

Overall Grade: A
Score: 9.1/10

We couldn’t pass up the opportunity to mention the Slim Gut Bundle by Better Body Co. because of the Previtalize prebiotic included in this bundle at a discount.

Previtalize contains burdock root, a phytoestrogen that mimics estrogen in our body without the nasty side effects. It is also studied for its anti-inflammatory properties and it has shown promises in alleviating joint pain24.

In addition, probiotics work best with prebiotics, as prebiotics serve as the nutrients for probiotics to thrive in our gut. We like that Better Body Co. bundled these products together for a discount and offers an even steeper discount of 15% for customers who commit for the full 90-day experience.

They understand that many customers who hop from one product to another often don’t find success because they don’t give the product enough time to work. To assure customers, they have an industry-leading 90-day money-back guarantee. Unlike most supplement companies, they do not require customers to return the bottles to them to qualify for a refund.

Given the well thought-out formulation and bundling offer, the Slim Gut bundle deserves the second spot on our top 5.

Pros

  • Plant-based estrogens from Moringa leaf and Burdock root
  • Clinically studied L. Gasseri, B. Breve, and B. Lactis probiotic strains.
  • 350mg of Curcumin (Turmeric Root Extract)
  • 100% natural with no filler
  • Stimulant and caffeine-free, GMO-free, hormone-free
  • Keto-friendly, vegan-friendly, and paleo-friendly
  • Made in a certified GMP facility in USA
  • 90-day money back guarantee (no bottle return needed)
  • Further 15% discount on minimum 90-day Autoship subscription

Cons

  • Due to popular demand, frequently out of stock
  • Sold exclusively online

*Results are based on users’ personal experiences collected on this page and do not necessarily reflect typical results of using these products. Please see the product website for more information.

Equelle for Menopause
Overall Grade: A-
Score: 8.7/10

Equelle contains S-equol, which is a phytoestrogen that mimics the function of estrogen. It is said to be backed by 20 years of research. We like the transparency on their website as they claim to not meddle with customer reviews.

According to their Amazon reviews, Equelle received a similar percentage of satisfied and unsatisfied customers as other menopause supplements, which suggests limited advantages over other formulations.

With that said, because no supplement works for everyone, we think that given the sound scientific studies conducted to support its effectiveness, Equelle deserves the #3 spot on our list.

Pros

  • 120mg of Calcium
  • 5mg of S-equol
  • Hormone-free

Cons

  • Limited safety data on S-equol
  • Only sold within USA

*Results are based on users’ personal experiences collected on this page and do not necessarily reflect typical results of using these products. Please see the product website for more information.

Overall Grade: B
Score: 8.1/10

We like Relizen’s plant-based formulation and the scientific approach they took to test the product’s efficacy. Relizen contains only two ingredients – its proprietary blend.

However, Amazon reviews show that Relizen does not enjoy higher ratings than other hot flashes and night sweats supplements despite the scientific approach. It also takes roughly 90 days to work, which is similar to other health supplements. Given its scientific efficacy and time needed to work, it may not deserve its high price.

On the other hand, we like that Relizen has taken a non-hyped and science-first approach, and customers don’t seem to be complaining about any side-effects. For this reason, we think Relizen deserved the fourth spot in our top 5.

Pros

  • 320mg of Purified Cytoplasmic Blend
  • Plant-based
  • Made in a certified GMP facility in USA

Cons

  • Contains fillers
  • Formula is not known to public
  • One of the most expensive options on the market

*Results are based on users’ personal experiences collected on this page and do not necessarily reflect typical results of using these products. Please see the product website for more information.

Overall Grade: B-
Score: 7.7/10

We like that Happy Mammoth has combined multiple ingredients backed by scientific studies to improve menopausal symptoms.

However, Hormone Harmony seems to have a higher than average number of customer complaints about customer service. For this reason, we have ranked it as #5 as we think that a product sold exclusively online needs to have above average customer satisfaction.

Pros

  • 100% natural and plant-based
  • Contains 12 ingredients

Cons

  • Some reported side-effects seem more serious than usual
  • Costs substantially more than the other options

*Results are based on users’ personal experiences collected on this page and do not necessarily reflect typical results of using these products. Please see the product website for more information.

OR
Nancy Grace
Researcher and Science Writer
Nancy specializes in science journalism and factual information in the fields of health, medicine, and nutrition. She spends hours each week pouring through 100s of medical journals and research studies to increase accessibility to the depths of information by the everyday person.