Integrative medicine: Soy offers natural estrogens

However, a more recent assessment of the data from the Women's Health Initiative was more favorable: It suggested that hormone replacement for younger women, ages 50-59, may not pose the cardiovascular risk that it does for older women. Women in this age group who took both estrogen and progesterone had no increase in cardiac mortality.

Specifically, the analysis showed that mortality and heart disease in women were reduced when hormone therapy was initiated within six years of menopause, started before age 60 and continued for five years or more.

It may still be too early to make recommendations for hormone therapy based on the above findings, and the FDA maintains its stance that:

"Estrogens and progestins should be used at the lowest doses for the shortest duration to reach treatment goals, although it is not known at what dose there may be less risk of serious side effects."

Given this confusion, it is not surprising that many women still shy away from hormones and go the natural route, relying on nutrition or other interventions to navigate the menopause. Here are a few things that may be helpful:

• Soy foods. Soy contains plant estrogens that act similar to estrogen, although they are weaker than estrogen. The most well-known plant estrogens are the isoflavones. If you want to give soy a try, eat enough soy food to get about 30-60 milligrams of isoflavones per day, which should provide you with at least 15 milligrams of genistein. High doses of isoflavones (up to 150 milligrams per day, usually taken in pill form) have been associated with precancerous changes in the uterus. High doses are also potentially risky for women with breast cancer. We encourage you to stick with soy foods only, such as tofu, tempeh or soy milk. Soy may also affect thyroid function, so talk to your doctor if you take thyroid medication.

• Breathe! Paced breathing can be very effective for reducing hot-flash symptoms. Simply sit quietly and take slow deep breaths in and out of your nose, filling your lungs and allowing your belly to expand during inhalation.

• Maintain a healthy weight. Women who are overweight or obese have a higher risk of hot flashes. Regular vigorous exercise will help to maintain weight and may also reduce hot flashes.

• Try topical natural progesterone cream. Adding a little progesterone may help to reduce hot flashes and may also help women sleep better. Topical natural progesterone is available over the counter; look for a product that contains about 20 milligrams of progesterone per dose. It should be applied before bedtime to an area of the skin that won't be exposed to sunlight.

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