Chapter 11 – Menopause

Alternative and herbal treatments

Herbal preparations

Many women use natural therapies to manage hot flushes and will often have tried these before they see a clinician to discuss their symptoms. Natural therapies include black cohosh, red clover and soy products, wild yam cream, flaxseed and ginseng. Black cohosh has been linked to rare cases of abnormal liver function, hepatitis and liver failure.(52) There is no consistent high-level evidence for the efficacy of these products, and their safety profile is unclear, so unless evidence for safety becomes available, their use cannot be recommended.

It is important to ask patients if they are using herbal preparations since there may be herb-drug interactions.


Bioidenticals are mixtures of hormones prepared by compounding pharmacists and supplied as lozenges, troches and creams. There is inadequate scientific evidence to show that these are effective or safe, and there is a lack of regulatory control of their manufacture. There is particular concern about the risk of endometrial hyperplasia due to inadequate endometrial protection. There is no advantage of using bioidenticals over conventional hormone therapy, and their use cannot be recommended.(53)

The Australian Menopause Society factsheet on Bioidentical Hormone Therapy can be useful to share with patients as it gives a clear explanation for why they ... Buy now