Are you a candidate for HRT? Menopause is finally breaking through the silence on this very normal season of life for anyone born with ovaries. Our grandmothers and moms weren’t as lucky – stuck in cultural narratives centered on jokes, shame, and “just deal with it, you’re being too sensitive.”
While many of us experience common symptoms of the menopause transition, how we choose to deal with symptoms can be vastly different. There’s not a one-size-fits-all prescription for getting through to your final menstrual period and a few years beyond.
BTS. I have a lot of breast cancer in my immediate family. My calculated risk of getting breast cancer before I’m geriatric is about 30%. Even though I lead a fairly healthy (not perfect) lifestyle, the genetic cards I was dealt are what they are. Will I take HRT to manage my increasing list of perimenopause symptoms?
If you asked me this in the Fall of 2025, I would have said no. Even as I was waking up with heat waves every couple of hours, falling off emotional cliffs, and experiencing the worst acne of my life – with random dizzy spells on the side.
I considered my life choices, as my friend Mary would say. Until I went to my annual OBgyn appointment and shared the miserable existence I tried to sustain for the past 4 months. The doc knows my family history, and she’s supportive of me going the natural route for as long as possible. Then she read my DEXA scan results.
“I hear your concern about breast cancer,” she said.
“But given what we know from current research on breast cancer risk, including the updated interpretation of the WHI Study from the early 2000s, I’m more concerned about your bone health. This DEXA scan result isn’t good.”
She has no problem being straight with me. Good for her! I ask LOTS of questions and share my frustrations.
“Why is it that as women, we’re forced to choose between breast cancer and hip fractures? Is that really the best we can do with modern medicine?”
Needless to say, I did not take the hormonal prescription she gave me right out of the gate. And again, I had to sit with my life choices. Until May of this year.
The night sweats came back. I couldn’t eat anything with salt in it, or I’d blow up like a balloon with water retention. The body and mental fatigue started to affect my work. And controlling my moods felt like a second full-time job. I couldn’t keep going like this.
At the same time, I read more research on breast cancer risk and bone protection with HRT. With an active lifestyle, hopefully for years to come, I chose to protect my bones and started taking the prescribed hormone support. At least for now.
I get regular mammograms and breast MRIs every 6 months. And honestly, I’ve made peace with the decision to take medication.
But I still strongly believe lifestyle interventions for menopause symptoms are a must-do. Here’s why.
For the past almost 3 years, I supported women going through the menopause transition as part of the dietitian team at Gennev.
I’ve witnessed the vast array of experiences with HRT – the good (better sleep, less meno-rage, more energy), bad (irregular bleeding, breast tenderness), and the ugly (rapid weight gain). Ugly is the word the women use, not mine.
I soaked up as many evidence-based recommendations regarding HRT from the OB-GYN team. Including the updated science on the risks of developing breast cancer with HRT or what to do if you’ve already had breast cancer.
What options are available to manage menopause symptoms if you can’t or don’t want to take HRT?
If HRT isn’t for you, consider a food-first approach. Start slowly adding more phytoestrogen-rich foods into your daily eating routine.
What are phytoestrogens?
Phytoestrogens are plant-based estrogen-like compounds called isoflavones that are found in beans, lentils, soy, flax, and herbs like red clover. They can help reduce estrogen fluctuations during perimenopause and reduce symptoms like hot flashes, night sweats, vaginal dryness, and irregular moods.
How are phytoestrogens different from HRT?
There are 2 types of estrogen receptors in our bodies. Estrogen receptor (ER) alpha is associated with cellular growth, including cancer cell growth, like breast cancer. Estrogen receptor (ER) beta acts like a counterbalance to ER alpha.
While isoflavones look similar to estrogen in their chemical structure, they preferentially bind to the ER beta receptor and only weakly bind to the ER alpha receptor.
Depending on how much estrogen you have floating around in your body, isoflavones will either increase or decrease estrogen binding to the alpha receptor. In this way, isoflavones are considered “selective estrogen receptor modulators.” Which is a good thing – especially if you’re concerned about breast cancer!
Bonus! As your estrogen levels become more erratic during perimenopause and decline in menopause, isoflavones are likely to bind to the estrogen receptors to offer relief from symptoms such as hot flashes, night sweats, irregular moods, and vaginal dryness.
How can you add more phytoestrogens to your diet?
Research studies suggest using 50-100 mg daily, typically only achieved through supplementation. However, 25-50 mg/d is more realistic for everyday eating.
This looks like:
- 1 cup of soy milk (preferably unsweetened)
- ½ cup of edamame
- 2-3 Tablespoons of miso paste
- 3-5 oz of Tofu or tempeh
- 1 Tablespoon of ground flax seeds
- ½ -1 cup of beans or lentils (start low, add gradually)
Here’s a sample phytoestrogen-rich menu:
- Breakfast: overnight oats made with ½ cup of oats, 1 cup of soy milk, ½ tsp of cinnamon, ¼ cup dried cranberries, 2 TBSP hemp seeds, 1 TBSP ground flax seeds
- Lunch: brown rice Savor Bowl with roasted root vegetables, sautéed dark leafy greens or spinach, ½ cup edamame, ¼ cup toasted sesame seeds, and miso sesame dressing (1 Tbsp light miso + 1 TBSP toasted sesame oil + 1 TBSP olive oil + 1 TBSP rice vinegar + ½ tsp ground ginger)
- Dinner: Tempeh fajitas with sautéed bell peppers, onions, zucchini, and black beans wrapped in 2 whole-grain corn tortillas
Remember to use the add-in approach to incorporate more phytoestrogen-rich foods in your diet. Think of it as adding more variety to your meals – a key component of the gentle nutrition framework.
When you use the add-in approach, you won’t feel deprived by eliminating other foods, and you won’t feel obligated to eat phytoestrogens to be healthy in this season of life.
