New research shows HRT can put women at increased risk of breast cancer, but what are the alternatives? Women's Editor Christen Pears reports.

THE menopause brings misery to millions of women, with hot flushes, night sweats, mood swings and aching joints. Hormone replacement therapy (HRT) can provide relief but it may also put your health at risk.

A report in The Lancet last week suggested that long-term use of the most common combined form of oestrogen-progestogen replacement treatment doubles the risk of breast cancer. Oestrogen only treatment increases the risk from about six to eight cases in every 100.

Many women will no doubt choose to continue the treatment, believing the benefits outweigh the risks. There are, however, those who will look for alternatives.

The menopause is not an illness. There are some cultures where women experience few or even none of the symptoms we in the West are programmed to accept as inevitable. In Japan, for example, where the diet is rich in phytoestrogens found in soya, lentils and tofu, there is no word for hot flush.

Looking at other cultures has given experts an insight into the western experience of menopause, and it has shown that medical intervention is not always necessary. A recent study, inspired by the Japanese situation, found that soya supplements reduced hot flushes by at least 40 per cent.

A well-balanced diet is essential during the menopause as it enables the body to adjust automatically to hormone changes.

Darlington-based holistic therapist Vicky Clark says: "First and foremost, diet is really important. You should eat foods with high levels of nutrients and avoid processed foods such as white sugar and those with a high animal fat content. I would also advise that you include lots of B vitamins, as well as C, D and E. You should also eat plenty of brown rice, brown bread and plenty of fresh fruit and vegetables."

A good quality multivitamin and mineral supplement will help ensure the body has sufficient nutrients, while herbal remedies can be beneficial for hot flushes and night sweats. Agnus castus, black cohosh, liquorice and sage are all recommended.

Avoid spicy food, alcohol, caffeine and hot drinks as these can trigger hot flushes.

Many women experience mood swings, irritability and fatigue. By eating small amounts more frequently, you can keep blood sugar on an even level. This helps prevent surges of the stress hormone adrenaline, which can cause mood swings. St John's Wort is a natural anti-depressant and can lift your mood and increase vitality.

A decline in oestrogen during the menopausal years can also lead to reduced bone density. This can be partially countered by taking calcium and vitamin D supplements. Japanese women have half the hip fracture rate of western women, which suggests a diet rich in soya, lentils and chickpeas could help maintain healthy bones.

Regular load bearing exercise, such as walking and running, can also be beneficial. Physical activity also boosts your sense of wellbeing and helps combat insomnia.

Many women taking HRT say it makes them feel more alert but there are natural alternatives. Keep learning new things to keep your brain active. Food rich in antioxidants such as fruit and vegetables reduces the risk of furring up the arteries to the brain, while ginkgo biloba improves blood flow to the brain.

Aching joints can be eased with glucosamine and you should increase your intake of essential fatty acids, found in oily fish, walnuts, soya and leafy green vegetables.

As well as diet, there are therapies that can be used to treat the symptoms of menopause. Regular massage, for example, can relieve tension and increase feelings of wellbeing. Vicky recommends aromatherapy and reflexology.

She says: "Reflexology is very good for balancing hormone levels. Working on the glands that produce hormones such as the adrenal glands and pituitary glands, you can help with irregular menstruation. It's also a very relaxing treatment and can prevent insomnia."

Aromatherapy is also beneficial and there are essential oils that can help treat specific symptoms. Geranium oil, for example, balances hormonal flow, while camomile is soothing and an anti-depressant.

The menopause is a time of major psychological transition but studies have shown that women who approach it with a positive attitude are less likely to suffer severe symptoms. As an holistic therapist, Vicky treats the whole person, rather than prescribing a single treatment, and says it is important to talk about how someone is feeling.

She says: "One of the big problems I have found is the way the menopause is perceived. There are a lot of women who feel that it is the end of their useful life as a woman. This is often made worse because it coincides with the time children leave home.

"A lot of women can become depressed. It's important to have psychological discussion and help people see that it can actually be a new start."