Soy has received attention as a dietary alternative to HRT largely because it is a unique source of isoflavones. World wide soy consumption is highest in Japan, where urinary levels of phytoestrogen metabolites are extremely high and reported frequency of hot flushes is extremely low. The majority of clinical studies examining this inverse relationship have shown soy isoflavones to significantly reduce hot flashes.

There have been some concerns about the safety of soy isoflavones in women with a history of estrogen receptor positive breast cancer. These questions stem in part from limited research that showed soy increased the growth of isolated breast cells. However, the weight of evidence shows that soy supports healthy cell growth and, therefore, most practitioners feel confident recommending soy isoflavones to their patients with a personal or family history of breast cancer.

I usually begin with 100 mg soy extract and increase to 300 mg as needed. While a decrease in hot flashes begins almost immediately, maximum benefit may not be apparent for as long as 12 weeks.

DHEA (dehydroepiandrosterone) is a steroid hormone produced in the adrenal cortex. Serum levels of DHEA decline with age, peaking at age 25 to less than 20% of peak at the 70th birthday. DHEA levels are also reduced in inflammatory diseases (rheumatoid arthritis, systemic lupus), as well as cancer and acquired immunodeficiency syndrome (AIDS). Clinical research has shown that DHEA supplementation reduces menopausal symptoms as effectively as HRT (Genazzani 2003). Most research used 25mg of DHEA per day for at least 3 to 6 months.

Mood, Energy, and Wellbeing
While menopause has been identified as a time of depression and irrational behavior, the data does not support this perception. Research has consistently shown that depression is much more common in women who are in their third and fourth decades, not at mid-life. There are no associated increases in suicide, suicide attempts, or psychiatric hospitalizations among menopausal women. Energy, however, or the lack thereof, can be problematic, sometimes profoundly so. Low adrenal reserve or adrenal insufficiency can be contributing factors. Many women enter menopause with chronic nutritional depletion and sub-optimal adrenal function. In milder degrees of adrenal insufficiency and low adrenal reserve, the adrenal gland still produces sufficient hormones to maintain health.

Adrenal Extracts/Adrenal Support Supplements formulated with adrenal supportive botanicals can restore vitality, increase feelings of energy, increase mental and physical performance, and improve the body's response to stress. Adrenal polypeptide fractions provide small amounts of adrenal hormones and promote improved adrenal function.

Panax Ginseng - Women experiencing lack of energy due to fluctuations or depletions in their reproductive hormone levels will benefit from Panax ginseng. A double blind, placebo controlled study of postmenopausal women showed overall symptom relief and improvement in mood and wellbeing after ginseng supplementation (Wiklund 1999). I've found great success using Ginseng Phytosome, ginkgo formulated with a patented process that results in superior absorption: one part Panax Ginseng Extract, standardized to contain 37.5% ginsenosides, bound to two parts phosphatidylcholine.

Green Tea (Camellia sinensis) - Green tea is a rich source of flavonoids and polyphenols that have been studied for their support of immune system health. Green tea also contains small amounts of caffeine, which supports stamina and reduces fatigue. There is some evidence that green tea supports daily energy expenditure and may be beneficial in weight management. An effective dose for women is 250mg of Leaf Extract standardized to contain 35mg of caffeine.