Supplemental and complementary alternatives to hormone replacement therapy.

Tables 1 and 2 offer a summary of information currently available on the sources, dosages, and proposed health benefits of the supplemental and complementary nutritional therapies that can be suggested as alternatives to hormone replacement therapy. These therapies have the additional benefit of being broadly available to women of all socioeconomic strata, and should be acceptable to women of various ethnicities and cultures. Adequate intakes (AI) of vitamins are recommended based on observational or experimentally determined approximations of the average nutrient intake, by a defined population or group, that appears to sustain a defined nutritional state (Food and Nutrition Boar, Institute of Medicine, 1997). Reviewing the empirical evidence concerning the use of vitamin supplements leads to the conclusion that doses higher than AI or recommended daily requirements is not warranted. For those individuals who choose to supplement, counseling should be provided to caution about tolerable upper limits, those maximum levels of nutrient intake judged unlikely to pose a risk for adverse health effects (Food and Nutrition Boar, Institute of Medicine). Supplemental and complementary therapy directed at ameliorating symptoms or reducing the risk of menopause related illness (osteoporosis and CHD) becomes a decision balance of the woman's preferences, risk and health history, and personal and financial resources. There appears to be some protection of morbidity and mortality from CHD with antioxidant dietary intake. Osteoporosis appears to be delayed with calcium supplementation. Menopausal symptoms, CHD risk, and osteoporosis risk appears to be reduced with phytoestrogen supplementation, although doses have not been established. Research concerning the safety and efficacy of these therapies continues. Findings from current clinical trials, such as the Women's Health Initiative may render these and additional alternative therapies to HRT more precise in the near future.