To HRT or not to HRT?
That is the question for many women, approaching mid life and wondering how they are going to make it across to the shores of post-menopause without drowning in the waves of hot sweats or grounding in the shallows of self doubt and sleep deprivation.
On the one hand we hear stories of HRT being linked to breast cancer, with breast cancer rates falling as HRT use declines. On the other are suggestions that this link is exaggerated and the risks blown out of proportion. Women with breast cancer or cardiovascular disease (heart disease, clots and strokes) in their personal or family medical history are, however, still considered as unsuitable for HRT, reinforcing the doubts.
Unsurprising, then, that many women turn to complementary and herbal remedies whilst shooting the rapids of menopause, with as many as 50-75% of postmenopausal women using herbal remedies to treat hot flushes. 
Ms Iris Tong, director of women’s primary care at the Women’s Medicine Collaborative, the Warren Alpert Medical School of Brown University, Rhode Island, conducted a study of the use of non-pharmacological agents (i.e. not medication from the doctor) used by women through their menopausal years.
She concluded that due to the numbers of women turning to these products for the treatment of postmenopausal symptoms and prevention of diseases that occur at an increased incidence after menopause, it is vitally important for healthcare providers to be aware of and informed about the non-pharmacological therapies available for women looking for an alternative to HRT.
While hormone replacement therapy is highly effective in the treatment of postmenopausal symptoms, it is associated with health risks and is not considered first-line treatment, according to the study, published in the Obstetrician & Gynaecologist journal.
Ms Tong flags up the lack of side effects associated with non-pharmacological treatments, such as soy isoflavones, which research has shown causes a reduction in hot flush symptoms from 20-55%. For this reason, she advises these products be taken seriously when considering menopausal issues.
 Tong IL. The Obstetrician & Gynaecologist 2013: 15 (1):19–25