What is the best alternative to HRT?

There are several alternatives to hormone replacement therapy (HRT) that people can consider. Each option has its own potential benefits and risks that should be discussed with a healthcare provider. Some options to explore include:
Lifestyle changes such as eating a nutritious diet, exercising regularly, managing stress, and getting enough sleep. Small changes can help mitigate bothersome menopausal symptoms. Foods rich in phytoestrogens, like soy, may also help.

Herbal remedies such as black cohosh, red clover, and chasteberry fruit may help relieve hot flashes, night sweats, irritability, and other symptoms. However, herbal products are not regulated by the FDA for safety and efficacy like prescription medications.

Prescription medications such as low-dose antidepressants and anticonvulsants may help with hot flashes. Vaginal estrogen creams can treat vaginal atrophy symptoms without significant systemic absorption. Gabapentin is also used off-label to manage hot flashes.

Mind-body practices like yoga, meditation, hypnosis, and acupuncture may help with menopause symptoms. Some research suggests these practices can decrease perceived intensity and frequency of hot flashes.

Vaginal laser therapy treats genitourinary syndrome associated with menopause using laser energy to help restore vaginal tissue. Evidence on efficacy is limited but ongoing.

Over-the-counter options like gynecologic lubricants and moisturizers can temporarily relieve vaginal dryness and dyspareunia associated with atrophic vaginitis. Long-term safety data is lacking.

Bioidentical hormone therapy uses customized hormone preparations from compounds identical to those produced by the body. Evidence on safety/efficacy compared to synthetic hormones, however, is limited and debated.Some key considerations when weighing alternatives: scientific evidence on effectiveness and safety risks, out-of-pocket costs, ease of access/use, personal preferences and symptoms, preexisting conditions, and advice from healthcare providers. Most alternative therapies pose fewer health risks than long-term HRT use, but benefits may be less significant. Discussing all options can help identify the most suitable approach based on each individual's needs and risk tolerance.

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