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Emails and calls have poured in from across the country to health professionals and women's health organizations like the Canadian Women's Health Network with questions about the implications of these findings. "I am trying to decide whether to discontinue HT," wrote one woman. "Can you direct me to the most up-to-date information on this controversial issue?"

"I'm really uncomfortable with what I'm hearing about hormone therapy," wrote another. "Now I'm wondering if I should stop, and look into natural health products. What do you suggest?"

Others wondered if they should consider hormone therapy at all, once they enter menopause.

The reasons some women are interested in using HT vary. In making a choice for - or against HT, it's important to consider a number of personal factors, including the risks for future diseases versus the benefits of HT for an individual woman's health and wellbeing, and whether a woman is comfortable with side effects of treatment.

A good place to start is to talk with your doctor, who can also establish whether the symptoms and changes a woman is experiencing are actually due to menopause, or some other underlying health concern. Once this picture is clear, there are many things you can do to help reduce the discomforts and symptoms of menopause. If you are already using HT, check with your doctor before making a decision about whether or not to continue with it.

In both mainstream medicine and complementary and alternative health care the primary tool for handling menopausal symptoms and overall health and well being is taking good care of yourself: eating a healthy diet, especially one that emphasizes soy; exercising and reducing stress. For more detailed descriptions of options for relieving symptoms, see Help yourself: what you can do.

When, and if these measures fail to provide enough symptom relief, women often look to Natural Health Products (NHPs) such as nutritional supplements, natural hormones or herbal medicines. A lot of information is available about what may work, much of it conflicting, even from highly regarded sources.

Even before the Women's Health Initiative called off its HT study in 2002, many women were interested in more natural alternatives to HT - hoping they would be safer, while offering the same benefits. Unfortunately, there are no panaceas - natural, or otherwise - for menopausal symptoms.

Though they are derived from natural sources, natural hormones should be viewed with as much caution as conventional HT. Hormones have powerful effects in the body, and just because they are natural, doesn't mean they are safe.

Making an informed choice about NHPs means doing some research. There is far less reliable information on NHPs than on pharmaceuticals at this point. Many NHPs, including those recommended by doctors, naturopathic doctors and doctors of Traditional Chinese Medicine, are used based on anecdotal evidence and traditional use rather than on clinical trials.

Before a woman takes an NHP to treat menopausal symptoms, she should attempt to find out if:

• there are studies showing the product is effective for its recommended purpose.
• the risks of taking the product are known
• there are contraindications - risks for specific health conditions, or conflicts with certain pharmaceutical drugs - for taking the product that apply

It may not be easy to come up with answers, as the limited number of studies available disagree about the safety and effectiveness of a range of NHPs currently being promoted as HT alternatives. This situation will likely improve over the next few years, as research studies are underway looking at dietary changes and several of the most promising herbal medicines typically used to relieve symptoms such as hot flashes, memory, concentration, sexual function, and irregular bleeding. These herbs include:

• Black Cohosh (Latin name: Cimicifuga racemosa - or more currently, Actaea racemosa)
  
• Chaste Tree (Vitex agnus-castus)
• Red Clover (Trifolium praetense)
• Ginkgo (Ginkgo biloba)

• Buy standardized products. This means that every tablet, capsule or teaspoon of liquid (tincture) you take - according to the product directions - should have the same amount of what is has been identified as the active ingredient, or a particular chemical component unique to the plant, known as a marker compound.
• Look for a D.I.N. (Drug Information Number) or G.P. (General Public) number, which shows that Health Canada has reviewed and approved information submitted by the manufacturer about the product, its labeling and instructions for use.
  
• Tell all your health care providers about any herbs that you are taking, especially if you are also taking any prescription medication.
  
• Start with one herb at a time and observe its effects on your body for a few weeks
  

Some complementary and alternative health practices may provide symptom relief, improved quality of life, or a general sense of wellbeing during menopause. See What Can I Expect If I Visit An Alternative Health Care Professional? Among the resources available from the Complementary and Alternative Health section, a list of contacts for national and regional organizations representing a variety of complementary and alternative approaches is provided. These associations can provide information about practitioners' education, credentials, and the treatments available, as well as referrals to practitioners in your area.

Remember - menopause is a process that changes over time. Symptom management isn't one-size-fits-all, forever. You can change your strategy based on your changing health, changes in medical understanding and research, and new treatments in both conventional medicine and complementary healthcare.

Several excellent books are available that can help you make choices about symptom management. Keep in mind that clinical information in a book printed two years ago will not necessarily be up-to-date. This doesn't invalidate the other information, or the positive perspectives on menopause in these books, but it does mean you should check out more recent and reliable information.

Don't go it alone. Talk with and learn from other women going through menopause. Look for self-help groups, book clubs, or other ways to get together with women in mid-life. Menopause can be a time of great change and renewal in women's lives, and support from other women can be very important as a woman makes her way through this time.

Books in English:

• Menopause: A Naturopathic Approach to the Transitional Years by Karen Jensen, ND 1999
• Menopause and Homeopathy: A Guide for Women in Midlife by Ifeoma Ikenze, MD, 1998
• New Menopausal Years, The Wise Woman Way: Alternative Approaches for Women 30-90, Susun Weed, 2001
• Good Nutrition for A Healthy Menopause by Louise Lambert-Legace, 1999
• Understanding Menopause: Answers and Advice for Women in the Prime of Life by Janine O'Leary Cobb, 1993.

Online resources:

CAMLINE: The Evidence-Based Complementary and Alternative Medicine Web Site for Health Care Professionals

The F.A.C.T.S.: Web Site of the Friends of Alternative & Complementary Therapies Society - useful for paid practitioner listings.

Health Canada: Office of Natural Health Products

Books and Newsletters

Allina A. and Fugh-Berman A. "Natural Hormones: Are They A Safe Alternative? " in A Friend Indeed for Women in Menopause and Midlife. Vol.29 no.6 January-February 2003.

Boon H. and Smith M. The Botanical Pharmacy the pharmacology of 47 common herbs
Quarry Press Inc. Kingston Ontario,1999

Consensus Opinion. The Role of Isoflavones in Menopausal Health: Consensus Opinion of the North American Menopause Society. Menopause. Vol. 7 No. 4; 2000, 215-229.

Hudson T. Women's Encyclopedia of Natural Medicine alternative therapies and integrative medicine. Keats Publishing Los Angeles,1999.

Pizzorno L, Pizzorno JE, Murray M. Natural Medicine Instructions for Patients. Churchill Livingstone, 2002.

Herbmed: an interactive, electronic herbal database with hyperlinked access to scientific data underlying the use of herbs for health. A non-profit, evidence-based information resource for professionals, researchers, and general public.

Project Aware: Association of Women for the Advancement of Research and Education
What is Menopause?

U.S. Office of Dietary Supplements, National Institutes of Health
Questions and Answers About Black Cohosh and the Symptoms of Menopause

NCCAM: National Center for Complementary and Alternative Medicine
Newsletter: Complementary and Alternative Medicine at the NIH Winter 2003 Vol. 10 No. 1. "Menopausal Symptoms and Alternative Therapies."
NCCAM: Alternative Therapies for Managing Menopausal Symptoms, Consumer Advisory

U.S. National Institutes of Health Scientific workshop on menopausal hormone therapy October 23-24, 2002. The workshop may be viewed at NIH VideoCasting (go to "past events" and search on "hormone therapy.") Select "Menopausal Hormone Therapy, Day 1, October 23, 2002, or Day 2, October 24, 2002.
Speakers' slides and other print information from the workshops are posted at: http://orwh.od.nih.gov/health/menopause.html

U.S. National Institutes of Health Menopausal Hormone Therapy Information - Women's Health Initiative. Information and resources on findings from the Women's Health Initiative.