These botanicals do not appear to cause side effects. However, many physicians follow certain guidelines when prescribing them. If a women is pregnant, has abnormal vaginal bleeding, thrombophlebitis or a history of this, phytoestrogens should be avoided. If she has a history of a related disorder connected with estrogen use, cancer related to estrogen use, or known or suspected breast cancer, any type of estrogen--including a natural source--should not be used (5).

At the USDA's research facility in Grand Forks, North Dakota, Forrest Nielsen, PhD has done some ground breaking studies on the effects of a relatively obscure mineral, boron. In postmenopausal women fed three mg of boron each day, estrogen rose equivalent to "levels found in women on estrogen replacement therapy" (9). Boron supplementation also decreased calcium lost through their urine by 40 percent (10). Dark green, leafy vegetables, fruits (not citrus), nuts and legumes all contain boron. If you decide to take boron supplements, consult with a physician. Too much boron could cause increase your risk of osteoporosis (11).

There's also evidence that lifestyle can influence a woman's natural estrogen levels. One study discovered smoking altered the breakdown of estrogen in the liver and subsequently lowered one form of estrogen in the blood (12). Another investigation revealed a relationship between increased caffeine intake and decreased free estrogen (13).

Bolstering hormone levels will often allay hot flushes. In addition to doing this, regular exercise, balanced eating and minimizing stress will soften the symptoms of menopause. This is particularly true for the irritability, fatigue and depression of menopausal syndrome.

Hot flushes can be cooled very simply. If a woman dresses in layers using natural fibers that breath, she will not get as hot and she can remove clothing as the flush heats her up. Avoiding or minimizing caffeine and alcohol can decrease the severity of hot flushes. Drinking plenty of water and using vitamin E may help too.

Finnish researchers noted that Japanese who ate a traditional diet low in fat and high in soy foods such as tofu and miso excreted as much as 1000 more phytoestrogens in their urine as American women. This means that Japanese women consume considerable more phytoestrogens in their diet--one reason why hot flushes and other menopausal symptoms may be less frequent in that country (14).

Hormones and Your Heart
One argument for prescribing HRT is the protection it offers against heart disease, a condition that rises in women as their estrogen levels decrease. However, Jan Vandenbroucke, MD, a Dutch professor, says that the evidence supporting this claim isn't clear cut.

Vandenbroucke states that for the past 20 years scientists have been questioning whether estrogen benefits the heart. Three situations have fueled this debate. In studies where estrogen was given to men to see if it prevented recurrence of heart problems, the results weren't good. Also, birth control pills, which contain estrogen and progesterone, tend to promote vascular disease in young women. Last, the argument that HRT or estrogen protects postmenopausal women from heart disease has its flaws. Vandenbroucke reviewed a large study investigating the effect of estrogen on death from heart disease. He found that when women who had heart problems before the investigation began were excluded from the final results, estrogen therapy didn't decrease the risk of developing heart disease. He speculates that progestagens, synthetic progesterone used in HRT, cancels out estrogen's benefits, if any.