Perimenopause Relief Beyond HRT

Dr Shawn M. Carney
Sep 3
6 min read

Perimenopause can last 2-8 years and cause symptoms like hot flashes, sleep disturbances, mood changes, weight gain and more. And while safety concerns limit the use of Hormone Replacement Therapy (HRT), other time-honored therapies remain options for relief!

In the U.S., approximately 40 to 50 million women suffer from menopausal symptoms, and many turn to complementary and alternative medicines, including herbal supplements. Perimenopause can last 2-8 years and bring a cascade of changes, some of which may follow into menopause itself. Though perspectives differ about how an individual mentally and emotionally approaches transitions which accompany different life stages, when the quality of one's health is suffering, relief is something that people should seek.

However, given the awareness around the risks associated with conventional therapeutic options, many women have been going back to botanical medicines and therapies used for centuries.

Risks with Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) has been associated with an increased risk of both blood clots (1) and breast cancer (2) in multiple studies. Research indicates that prolonged use of combined estrogen and progesterone therapy can elevate the likelihood of developing breast cancer, particularly after several years of use. This risk is higher in women who start HRT around menopause and continue it for an extended period.

Additionally, HRT has been linked to an increased risk of blood clots, especially in the legs (deep vein thrombosis) and the lungs (pulmonary embolism). The risk is particularly concerning for women who are already predisposed to clotting disorders or who are older. Both risks—breast cancer and blood clots—are factors that need to be carefully weighed by healthcare providers when prescribing HRT, and the benefits of symptom relief from menopause must be balanced against these potential health dangers.

The Use of Botanical Medicines for Perimenopause Support

Botanical medicines have long been used to help manage the physical and emotional symptoms of perimenopause. And research published this year has again shown the synergistic benefits of combining several of potential therapies when being being used (3). Black cohosh, a popular herb in this category, is especially well-regarded for its ability to ease hot flashes, night sweats, and mood swings. It has been studied for its estrogen-like effects on the body, though it doesn't contain estrogen itself. Black cohosh is thought to work by influencing serotonin and other neurotransmitters that regulate mood and temperature, offering a natural option for women seeking relief from these common perimenopausal symptoms.

Vitex, or chaste tree berry, is another botanical remedy that may help balance hormones during perimenopause. Often used to address irregular menstrual cycles, it works by acting on the pituitary gland to regulate the production of key hormones such as progesterone. By supporting hormonal balance, Vitex may alleviate some of the mood swings, irritability, and menstrual irregularities that many women experience during perimenopause. Some studies also suggest it may help reduce symptoms like breast tenderness and bloating (3, 4).

Ashwagandha, an adaptogenic herb, is known for its ability to help the body manage stress, which can be heightened during perimenopause due to hormonal changes. This herb is believed to help stabilize cortisol levels, the hormone associated with stress, and promote a sense of calm and well-being. In addition to reducing anxiety and fatigue, ashwagandha is also thought to support adrenal health, which can be compromised during this life stage. Together, these botanical remedies offer a holistic approach to perimenopausal support, addressing both physical and emotional symptoms naturally.

New Research Supports Use of Acupuncture for Menopause-Related Insomnia

A 2025 systematic review and meta-analysis by Zhang et al. (5) explores the efficacy of acupuncture in treating menopausal insomnia, either as a standalone treatment or in combination with standard therapies. The study synthesizes data from multiple clinical trials to evaluate whether acupuncture can improve sleep quality and reduce the severity of insomnia in menopausal women. Results suggest that acupuncture, particularly when used as an adjunct to conventional treatments such as HRT or cognitive behavioral therapy, offers significant improvements in sleep outcomes. The analysis also indicates that acupuncture may be effective in reducing the frequency and intensity of menopausal symptoms, including hot flashes and mood disturbances, which often exacerbate sleep problems during this life stage.

Furthermore, Zhang's research highlights acupuncture's potential as an independent therapy for menopausal insomnia, particularly for women who are unable or prefer not to use hormone-based treatments. While the overall quality of the studies included in the review varied, the results consistently show that acupuncture significantly improves sleep duration and quality compared to placebo or no treatment. The meta-analysis also discusses the need for more rigorous, high-quality trials to confirm the long-term benefits and underlying mechanisms of acupuncture for menopausal insomnia. However, the findings contribute to the growing body of evidence supporting acupuncture as a safe and effective complementary therapy for managing menopausal sleep disturbances.

Black Cohosh with Physician Oversight to Avoid Liver Damage

Herbal supplements like black cohosh have a long history of use, particularly for women's health, with a focus on relieving menstrual and menopausal symptoms. Black cohosh is widely available in various forms, such as powders, liquid extracts, and pills, and is commonly used by women experiencing menopausal symptoms. While these products are popular, concerns about their safety have been raised, particularly regarding their potential to cause liver damage.

While black cohosh is generally considered safe for most users, there have been reports of adverse effects, with liver toxicity being a significant concern. A new literature review was published just this year on this very topic (6). Side effects can range from mild symptoms like headaches, nausea, and muscle pain to more serious issues, including liver damage, which can vary from mild liver irritation to severe conditions like liver failure. This has led health agencies in countries like the U.S., U.K., Canada, and Australia to issue warnings about the potential risks of using black cohosh, especially for people with pre-existing liver conditions or those at risk for hormone-related cancers. It should be noted that some of the studies where black cohosh was associated with bodily harm, the users had been on other treatments as well and causality was not found with near certainty (7).

Thus while black cohosh products are commonly used for their potential health benefits, the few reports with negative effects have not always been conclusive. The exact mechanisms behind its effects are not fully understood, and there is still much to learn about the active ingredients that cause both its beneficial and harmful actions. Evidence suggests that black cohosh may cause liver toxicity, ranging from mild to severe, and these risks raise concerns, particularly for vulnerable groups such as people with liver disease or hormone-sensitive cancers. This is an example of where physician oversight and monitoring can often be helpful to avoid confusion and watch for potential adverse implications.

In summary, though there are potential risks with any treatment, women facing transitional challenges with perimenopause have multiple safe options apart from HRT, including largely safe nutritional supplements, botanical medicines and acupuncture.

References:

The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.

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