The health risks of combination hormone replacement therapy (HRT) documented in the Women’s Health Initiative (WHI) study published in July 2002 led millions of American women who had been taking HRT for menopausal symptoms to abandon the regimen. A more recent study delivered another blow to HRT, showing that women who take it for five or more years run a higher risk of developing dementia or Alzheimer's.

Today, HRT may still be prescribed for women with severe menopausal symptoms, especially hot flashes, but long-term use of the therapy is no longer the norm. "We now recommend that women take HRT for only a few years, then stop and see whether symptoms return,” says Duke internal medicine physician Lori Bastian, MD. “If that happens, we’ll try other interventions.”

Because a “cold turkey” approach may aggravate symptoms, Bastian suggests that women taper off HRT gradually. For a non-hormone pharmaceutical therapy for hot flashes, Bastian sometimes prescribes an antidepressant such as Paxil or Effexor.

In the post-HRT world order, what other means can women use to ease their path through “the change”? Soy, with its wealth of estrogen-like substances called isoflavones, continues to earn kudos for its proven power to ease menopausal symptoms. Even though it’s a natural product, soy should be taken in moderate amounts, warns Claude Hughes, MD, who has studied soy’s effects extensively: “Excessive use of soy may stimulate diseases such as fibrocystic breast disease, breast cancer, uterine fibroids or endometriosis.”

Regular exercise, including weight-bearing, resistance, and aerobic components, can be especially beneficial during menopause and beyond. According to exercise physiologist Shan James, fitness manager at the Duke Center for Living, “Exercise helps protect bone mass, lowers the risk of cardiovascular disease, and releases endorphins that help ease mood swings.”

To help prevent osteoporosis -- the one thing that HRT clearly did well -- increasing calcium intake is a key strategy. For those who don’t like or are allergic to milk products, says Duke dietitian Marilyn Sparling, green vegetables such as broccoli, kale, and turnip greens, and canned salmon or sardines (with their edible bones) offer a good alternative, as do the increasing variety of foods supplemented with calcium.

Aim for about 1,000 to 1,500 milligrams of calcium a day from all sources, including calcium supplements; excess amounts (more than 2,500 milligrams per day) can cause harmful effects. Because the body requires Vitamin D to metabolize calcium, 15 minutes of sunlight daily and/or Vitamin D supplementation are also often recommended.

Bastian and Hughes also recommend that women coping with menopausal symptoms avoid alcohol, which may trigger hot flashes, and give up smoking -- the nicotine in tobacco suppresses estrogen metabolism and can worsen menopausal symptoms. For easing stress, time-honored techniques such as deep breathing and yoga can be very effective indeed -- and blissfully free of side effects.