Natural alternatives to hormones for hot flashes, brain fog, joint pain & more

In my last two articles, we considered how menopausal hormone therapy (MHT) can be helpful for some, but not for everyone, and why understanding your genetics can give insights before you start MHT.

In this article, we'll cover alternatives for MHT as it relates to hot flashes, weight management, brain fog, joint pain, migraines, and low libido. 

For myself, choosing not to use MHT (specifically, estrogen therapy) long term was an easy decision. Here's why, though your reasons and your choice may be different.

First of all, I watched two grandmothers, my father, and my little sister suffer from cancer. I also know my genetics. I know my body pushes my estrogens into the more proliferative pathway and detoxes them fairly slowly. Why would I extend my overall estrogen exposure? 

Second, I was fortunate enough to understand my genetics prior to menopause, which means I have all of my lifestyle ducks in a row. I am eating, exercising, and living according to my genetics, and prioritize sleep. This greatly reduces the chance of having severe hot flashes, weight gain, osteoporosis and fractures, depression, and other symptoms associated with menopause. 

Your situation may be very different from mine, and many women are good candidates for MHT. Whether or not you have a family history of cancer, it's worth understanding your individual risks and benefits before deciding. 

According to breastcancer.org, “about 85% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.” 

This is where optional genetic testing can add useful information - we have many more environmental triggers today that can impact our DNA, and thus, our risk for breast cancer. 

Whether you have a family history of cancer, or not, there are effective alternatives to manage peri/menopausal symptoms for women who choose not to start MHT. 

Let’s talk about hot flashes. 

If you ask your grandmother or great-grandmother if menopause was unbearable, you are likely to be met with confusion because hot flashes haven’t always been such a concern. What has changed in the last few decades to make menopause more bothersome? The top factors that come to mind are stress, weight gain, alcohol consumption, sleep disturbances, dietary excess, and environmental exposures. 

Hot flashes are reported in about 75% of women in the menopause transition. For some, they are more bothersome than others - and, they tend to just last for a couple years.

Hot flashes occur because the internal thermostat inside our brain becomes more sensitive due to a combination of decreased estrogen and increased cortisol (stress hormone). The drop in estrogen leads to an increase of key neurotransmitters in our brains called neurokinin B (NKB) and kisspeptin that are ultimately responsible for creating the hot flash. There are both pharmaceutical drugs and herbal formulations that can inhibit NKB and kisspeptin, halting hot flashes. 

This means we don’t always need to use estrogen for hot flashes, when we can inhibit NKB and kisspeptin. This is great news for women who prefer a non-hormonal solution for their hot flashes, eliminating any concern for endometrial, breast, and ovarian stimulation. 

The drugs are called Fezolinetant and Elinzanetant (they are both FDA approved). They are very effective, and generally safe - although Elinzanetant may lead to side effects of headaches and fatigue. Of course you can discuss the side effects and warnings with your doctor. 

Some doctors might prescribe antidepressant drugs like Venlafaxine, but they tend to have a higher side effect profile and less efficacy. Gabapentin is also an option for some women.

Natural Alternatives to Hormones for Hot Flashes

For women who prefer a natural approach, herbal medicine is worth considering. It has been used for the menopausal transition for millennia. We know that women in other cultures who tend to live in community and use herbal medicine do quite well in menopause. 

Today, while not universally established, we have very promising research specifically studying Chinese herbal formulas on hot flashes. A couple of these herbs include:

White Peony: This herb has been shown to alleviate hot flashes likely due to its effects on our hypothalamus-pituitary-ovarian/adrenal axis. 

Rehmannia glutinosa: This herb traditional used in Chinese Medicine, has been shown to improve perimenopausal symptoms, including hot flashes due to its multi-system effects on calming and cooling the body.

We also have nutraceuticals such as:

Melatonin has been shown to have a favorable effect on hot flashes, as well as many other peri/menopausal symptoms such as mood, and of course, sleep.

Melatonin also has an added benefit for those at risk of estrogen-receptor positive cancers. It can block the 4-OH (more proliferate estrogen) receptors, thus reducing estrogen stimulation in breast, endometrial and ovarian tissue. Melatonin also has an anti-metastatic effect, provide some protection against cancer proliferation.

Lactium and L-Theonine help to decrease cortisol (our stress hormone). In peri/menopause, cortisol is likely to rise - especially for those of us who have a genetic susceptibility for this. Be addressing cortisol activity, we can keep both the brain and body quiet and happy, and less likely to trigger a hot flash. 

And let’s not forget about exercise! Research has shown that women who performed cardiovascular exercise (broke a sweat, and increased their heart rate) for 45-minutes 4-5 times per week had a 60% reduction in hot flashes. This is likely due to better training and control of their thermoregulatory system. Note that The Menopause Society does not recommend cardiovascular exercise as a treatment for hot flashes due to other research studies showing no effect.

Estrogen and Weight Management

In my experience, many women are seeking MHT because they are fearful of gaining weight in menopause and are hopeful that estrogen therapy will keep them trim. The truth is that this has NOT been well-established in the research. 

There was one quality study back in 2003 that demonstrated a VERY MODEST reduction in weight gain (about 1.4 pounds) in women who started MHT in perimenopause - over a five year period of time. This was significant, but not at all substantial. 

Menopausal weight gain is more related to cortisol (cortisol affects insulin sensitivity), inflammation, and poor sleep. 

The solution: support cortisol, balance blood sugar, address inflammation head-on, know how your metabolism works (genetics) and prioritize sleep. This is where a personalized assessment helps - with the help of a root-cause practitioner (and genetics, if you choose), you can understand your weaknesses when it comes to weight gain, and where to put your time, money, and energy. 

Approaches to Brain Fog

Brain fog is real in peri/menopause, but research shows that brain fog also occurs in men around the same age, and that for women - the brain fog improves post-menopause. 

We know that estrogen is very important for the brain, but - estrogen therapy alone has not been shown to improve brain fog. Progesterone can help brain fog due to its benefit on sleep. Some women may choose to use progesterone for sleep (oral micronized progesterone does not seem to carry the risks that estrogen has when it comes to blood clots and breast cancers). 

Before deciding whether MHT is right for your brain fog, it's worth evaluating other areas too. Thyroid, sleep, blood sugar issues, cortisol, neuroinflammation (all issues that tend to amplify during peri/menopause). 

MHT may help with sleep, and thus have an indirect benefit on brain fog. Some women find their brain fog doesn't improve on MHT. Other women do feel clearer on hormones. That's why it helps to look at the whole picture first, so you can choose what's right for you. 

Bottom line: address the root cause which may involve pharmaceuticals, cortisol support, blood sugar support like berberine, inflammation-decreasing supplements, or even anti-viral support if necessary. 

Managing Joint Pain

If you are experiencing joint pain in peri/menopause - this is a signal that your body is inflamed. We know that inflammation goes up during this time. The main target here is usually inflammation, though estrogen can play a role for some women. Here are some helpful tips and natural alternatives to hormones for decrease inflammation. 

1. Stay moving! In the Physical Medicine world, we say “motion is lotion”. Make sure you have a great mobility routine that you incorporate into your day. 

2. Maintain a healthy weight. We know that increased weight will exacerbate joint pain. Weight management does get more difficult in peri/menopause, but it IS absolutely possible (see above). 

3. Try a quality collagen supplement. Some of us break our collagen down too quickly, and need more of the building blocks to make collagen. 

4. Know how much protein your body needs and don’t eat much more than that. Excess protein can increase both inflammation and fat in our body. 

5. Photobiomodulation: look for local doctors or PT clinics that offer this therapy to help reduce inflammation in your joints. 

   
   

Addressing Migraines

Migraines can absolutely be hormonal. Some women really struggle with migraines during perimenopause due to the hormonal fluctuations. But please do know that there are other causes for migraines and these should always be evaluated by your doctor.

To address hormonal migraines, we often need to stabilize hormones. MHT can be beneficial for some women here, specifically transdermal estradiol - but there are other approaches to try. 

Quercetin: This polyphenol can dampen the histamine response over time, and histamine can further destabilize estrogen. Also note, that addressing gut health is important because some gut bugs increase histamines. 

Riboflavin: Riboflavin has good research for migraine prevention due to its ability to supply consistent energy to the brain. 

CoQ10: This nutrient helps your brain and body to make energy and has been shown to be helpful in migraine prevention.

Improving sleep: Sleep is crucial for our brain’s ability to heal, repair, and function. Supports like sleep hygiene, nervine herbs and melatonin can be very helpful.

Low libido

Many women in peri/menopause experience low libido. This can be directly due to the adjustment in hormones, but more often (in my experience), the culprit is increased cortisol. When our body thinks we are running from a bear (in fight or flight mode), reproduction is not the priority. 

Let’s also face the fact that in this season of life, marriage may look different, with less time with your partner due to busy lives. And, of course, we need to address vaginal dryness. 

For some women, using low-dose vaginal estrogen can really help. Alternatively, there are many vaginal suppositories, lubricants, and moisturizers to help the quality of the tissue that don’t involve estrogen. Hyaluronic acid is a favorite. 

There is some research using testosterone to help libido in postmenopausal women, but The Menopause Society does not recommend using testosterone in perimenopause.

The solution: support cortisol with lactium, l-theonine, ashwaghanda. Support sleep. Reconnect with your partner. Use a low-dose vaginal estradiol or non-hormonal vaginal lubricants that include moisturizers like Hyaluronic acid.

Conclusion

I wrote this series because I want women to have the full picture on Menopausal Hormone Therapy: it's a valuable tool when it fits, it isn't without risk, and its benefits are sometimes overstated on social media. 

The menopausal transition is a normal part of life, and not every woman needs exogenous hormones to feel well. 

There are many natural ways to address the main symptoms of peri/menopause including prioritizing sleep, getting exercise, reducing stress, dialing nutrition in, taking herbs and supplements, and getting a proper assessment.

Some women may just need to adjust their lifestyle. Others may need support from a health care professional such as a naturopathic doctor to evaluate their physiology in order to understand the source of their symptoms. And some women will decide that hormone therapy is the right tool for them. 

MHT isn't the only way to address peri/menopausal symptoms, and it isn't the wrong way either. The best choice is the one you make with full information, and it's yours to make. 

To learn more about my approach to peri/menopausal care, please visit https://avra-health.com. I am licensed in Arizona, Washington State, and Colorado.

Ready to talk it through? Book your first visit, in person in Longmont, CO, or virtually in Colorado, Arizona and Washington.

About the Author: Dr. April Graham is a Naturopathic Doctor and Exercise Physiologist, Owner of Avra Health. She is passionate about helping women transition through menopause healthfully and gracefully.

Acknowledgments:

I credit Dr. Penny Kendall-Reid for enlightening me in these matters through her GeneRx.ca platform and her mentorship.

Resources:

Many resources are linked directly in the article.

Kendall-Reid, P. (2025, July 11). Moving Through Perimenopause/Menopause: Why we need to rethink treatment![Conference presentation]. AANP 2025 Convention, Palm Springs, CA, United States.

Disclaimer:

This isn’t medical advice — just information. Please talk with your healthcare provider before making changes to your health plan.