Many alternatives for HRT exist. You can try lifestyle changes, supplements, other therapies, and medications to help reduce and manage menopause symptoms. Talk with your doctor to start.

Hormone replacement therapy (HRT) is considered a safe and effective way to treat perimenopause symptoms, yet it carries certain risks.

Many people turn to home remedies and other holistic methods to help ease menopause symptoms.

While research backs some alternative therapies, many others have limited supporting evidence.

Always talk with your doctor before you try any alternative treatment. They can discuss possible dosage, side effects, and interactions.

When you’re going through perimenopause, you may find that what you eat triggers certain symptoms.

1. Cut down on caffeine, alcohol, and spicy food

Limiting stimulants like coffee and tea may help reduce hot flashes. Spicy food may also contribute to the feeling of heat rising in your body.

Drinking alcohol, if you drink, may also make hot flashes worse, so drink in moderation or cut it out completely.

2. Up your intake of calcium and vitamin D

As you age, your risk of osteoporosis increases.

Vitamin D, which helps your body absorb calcium, is also essential. Consuming foods rich in calcium and vitamin D will help strengthen your bones and prevent osteoporosis.

3. Use caution with soy and other phytoestrogens

Research from 2022 suggests soy isoflavone supplementation may benefit perimenopausal and menopausal women by providing hot flash relief.

But the research is conflicting. The North American Menopause Society issued a statement in 2023 against soy consumption for menopause symptoms.

You may want to play it safe and limit your intake of foods like:

  • tofu
  • edamame
  • soy milk

The benefits of exercise increase if you exercise regularly. Regular exercise may:

For maximum benefit, your exercise routine should include each of these four types of exercise:

4. Aerobic exercise

Running, taking a spin class, or going for a brisk walk are examples of aerobic exercise.

Research supports that aerobic exercise may reduce your risk of heart disease and otherwise improve your cardiovascular health.

Aerobic exercise also releases mood-boosting endorphins.

5. Weight-bearing exercise

Exercise that involves being on your feet preserves bone mass and may promote higher bone density than no-contact exercises like swimming or cycling.

Tennis, stair-climber machines, and dance classes are all great exercises for bone health.

6. Strength training

Strengthening exercises, like free weights and resistance bands, increase your metabolism and muscle mass, which people tend to lose as they age.

This kind of exercise may also help reduce anxiety and improve mental health.

7. Flexibility training

Flexibility training may improve your mobility and prevent arthritis.

Flexibility exercises include:

When you experience a stressful situation, your adrenal glands produce adrenaline to power your body through it. From menopause on, your adrenal glands are also a source of estrogen.

When stress activates your adrenal glands too often, they don’t function as well. This lowers your estrogen levels, which may exacerbate symptoms like weight gain and difficulty sleeping.

You may not be able to eliminate stress, but you can learn to manage stress in ways that won’t fatigue your adrenal glands.

8. Mindfulness meditation

Mindfulness meditation is a stress management technique that focuses on:

  • quiet awareness
  • inner peace
  • breathing exercises

Research from 2022 involving 66 postmenopausal women ages 45 to 60 suggests mindfulness-based stress reduction may help improve sleep quality.

9. Cognitive behavioral therapy (CBT)

CBT may help you reframe negative thought patterns into something more positive.

One 2022 double-blind randomized trial suggests of 50 women experiencing menopause looked at the effects of mindfulness-based CBT (MBCBT).

Researchers found that MBCBT improved vasomotor and psychological symptoms of menopause compared to the control group.

A systematic review from 2022 further supports that CBT may improve hot flashes in menopausal women.

These changes, though small, may have a big impact on how you feel.

10. Keep your space cool and ventilated

Make sure the spaces you frequent have fans and proper ventilation so you can cool off quickly once a hot flash starts.

You could also carry a small, portable fan.

11. Wear loose clothing

Looser clothing can keep you more comfortable and make it easier to ventilate your body when a hot flash starts.

12. Use a vaginal moisturizer for general dryness

If you’re experiencing vaginal dryness, consider purchasing a moisturizer made specifically for the vagina. You can use it throughout the day to help ease itching and irritation.

13. Use a vaginal lubricant for sexual activity

Vaginal lubricants add wetness to the vagina, which may help prevent discomfort during sex.

14. Avoid smoking

Smoking cigarettes may affect your fluctuating hormone levels. This may worsen and increase your frequency of vasomotor symptoms.

The association becomes stronger if you also have obesity.

Talk with a doctor about smoking cessation programs if you currently smoke.

Some nutrients are crucial for symptom management. If you’re not getting enough of these nutrients in your diet, supplements may be an option.

The U.S. Food and Drug Administration (FDA) doesn’t regular supplements, so use with caution. Only purchase from certified sellers.

Talk with a doctor before adding any supplement to your routine to avoid unwanted side effects.

15. B vitamins

B vitamins regulate energy and help your body produce new cells.

These vitamins, especially vitamin B6, may help reduce the severity of hot flashes.

A 2019 study used data from 262 women ages 40 to 65 to assess the effect of nutrients on hot flash severity. Researchers found that vitamin B6 significantly reduced the severity.

16. Vitamin E

Vitamin E helps your body neutralize oxidative stress.

A 2020 triple-blind randomized controlled clinical trial found that supplementation with 200 international units of vitamin E tablets daily significantly reduced hot flashes in postmenopausal women.

17. Vitamin D

  • maintains your bone structure
  • helps you absorb calcium
  • may improve hormone regulation and vaginal dryness

It’s recommended that anyone ages 1 to 70 consumes 15 micrograms (mcg) of vitamin D daily. People over the age of 70 should consume 20 mcg.

18. Omega-3s

Omega-3 fatty acids may help improve vasomotor symptoms during menopause, according to a 2018 research review.

But the research on the connection between omega-3s and menopause symptom relief is limited, and more studies are needed before drawing a conclusion.

Some herbal supplements claim to help manage perimenopause and menopause symptoms.

The FDA doesn’t regulate supplements. Research on use is often limited and more is required.

Always talk with a doctor before adding a supplement to your routine. Dosing guidelines vary widely. Some products may also interact with over-the-counter and prescription medication.

19. Black cohosh

Black cohosh (Actaea racemosa) may help with vasomotor symptoms of menopause, a 2022 research review suggests.

20. St. John’s wort

In a randomized controlled trial published in 2019 on postmenopausal women, St. John’s wort (Hypericum perforatum) was found to reduce:

  • hot flashes
  • menopausal symptoms
  • depression

21. Dong quai

The benefits of dong quai (Angelica sinensis) to treat menopause symptoms are unclear.

Newer research from 2019 suggests that dong quai combined with other herbs may help reduce night sweats and hot flashes.

22. Chasteberry

A 2019 randomized double-blind study on chasteberry (Vitex agnus-castus) suggests it may reduce anxiety and hot flashes.

23. Maca

Maca (Lepidium meyenii) may help relieve hot flashes and interrupted sleep.

24. Red clover

Red clover (Trifolium pratense) may help relieve menopause symptoms, but research on this connection is limited and inconsistent.

25. Sage

A systematic review of four studies suggests that sage (Salvia officinalis) may help reduce the frequency of hot flashes in postmenopausal women.

26. Milk thistle

Milk thistle (Silybum marianum) extract significantly reduced the frequency and severity of hot flashes over 12 weeks in a 2020 randomized, double-blind, placebo-controlled trial of 80 women.

27. Valerian root and hops

Valerian root (Valeriana officinalis) and hops (Humulus lupulus) are herbal sleep aids.

A 2018 triple-blind randomized clinical trial found valerian to improve the severity of hot flashes better than a placebo.

But research from 2021 suggests that currently available data don’t support the use of valerian and hops to help reduce menopausal symptoms.

28. Evening primrose oil

Evening primrose oil is made from the seeds of evening primrose (Oenothera biennis).

Some research supports its use for reducing hot flashes, while other research finds little to no effect.

29. Ginseng

Ginseng (Panax L.) contains glycoproteins, which were associated with improved sleep quality in a 2019 animal study on mice.

30. Licorice

Licorice (Glycyrrhiza uralensis) contains compounds that interact with estrogen receptors to relieve menopause symptoms.

Research published in 2020 and performed in vitro found that licorice fermented with Monascu was associated with menopause symptom relief.

Some people turn to alternative therapies to help with symptom management.

31. Acupuncture

Five weeks of acupuncture was found to reduce menopause-related:

  • hot flashes
  • night sweats
  • mood changes
  • sleep disruptions

32. Tai chi

In a 2024 review of 11 randomized controlled trials on peri- and postmenopausal women, tai chi, among other mind-body exercises, significantly improved:

  • bone mineral density
  • sleep quality
  • anxiety
  • depressive mood
  • fatigue

HRT isn’t your only option for clinical treatment of menopause symptoms.

33. Antidepressants (SSRI and SNRI)

Certain antidepressant medications are prescribed to treat hot flashes and other symptoms.

34. Clonidine

Clonidine (Catapres) is a blood pressure medication that causes your blood vessels to dilate. This may reduce hot flashes and night sweats.

35. Gabapentin

Gabapentin (Neurontin) is a drug often prescribed for pain relief and seizures. It may also help reduce hot flashes.

36. Bioidentical hormone replacement therapy (BHRT)

Bioidentical hormones are made in a lab from chemicals found in plants. They’re chemically and structurally similar to hormones your body naturally produces.

FDA-approved BHRT includes:

  • estradiol
  • estrone
  • micronized progesterone

Currently, evidence doesn’t suggest BHRT is safer or more effective than traditional HRT.

Talk with a doctor if you’re interested in BHRT. They can discuss your options and may be able to prescribe an appropriate pill, patch, or cream.

Several alternative treatments are available that can help you reduce and manage your menopause symptoms. This includes lifestyle changes, dietary and herbal supplements, medications, and other alternative therapies.

If you’re considering trying any of the above alternatives, work with a doctor to make a treatment plan.

They can help you assess your benefit and risk level and advise you on dosage.