Relizen/Bonafide vs. HRT

The only thing worse than hot flashes are their timing: in the middle of an important work meeting or at 3 a.m., just as you’ve finally fallen asleep

If you’ve been researching treatments, you may have come across Relizen, a nonhormonal supplement made with a purified Swedish flower pollen extract, and wondered whether it’s a good nonhormonal alternative to hormone replacement therapy (HRT).

Major menopause guidelines consider HRT the most effective treatment for hot flashes and night sweats, while supplements like Relizen, which aren’t FDA-approved for effectiveness the way prescription treatments are, don’t have the same quality or amount of evidence behind them.

Still, if you can’t or just don’t want to take HRT, a supplement may seem like an appealing alternative. Here, we break down what you need to know about Relizen, how it compares with HRT, and other options for managing hot flashes.

Why Hot Flashes Deserve Treatment

Hot flashes are one of the most common perimenopause symptoms, which can last anywhere from two to 10 years before you enter menopause.

Sometimes they’re brief, isolated moments of feeling like you’ve entered an oven you can’t escape. Other times, they happen back-to-back or wake you repeatedly throughout the night, leaving you drenched, exhausted, irritable, and foggy the next day.

An occasional mild hot flash may not bother you enough to seek treatment, but if you’re waking up several times a night or planning your life around when you might spontaneously combust, there’s no reason to grit through it.

HRT Remains King for Hot Flash Management 

HRT is the most effective treatment for hot flashes and night sweats. The Menopause Society agrees. For many healthy women younger than 60 or within 10 years of menopause onset, the benefits generally outweigh the risks.

HRT works by replacing some of the estrogen your body is naturally losing during the menopause transition. If you still have a uterus, your doctor will often pair systemic estrogen with progesterone or another progestogen to protect your uterine lining.

That said, just because HRT is deemed the most effective option for treating hot flashes and night sweats doesn’t mean it’s your only option. There are also evidence-based nonhormonal prescription medications that can reduce hot flashes, including low-dose paroxetine (an SSRI), gabapentin (an anti-seizure medication), and fezolinetant (an NK3 receptor antagonist that helps block a brain signal involved in temperature control). 

Supplements like Relizen just don’t have the same caliber of evidence. In its 2023 position statement on nonhormonal treatments, the Menopause Society didn’t recommend supplements and herbal remedies for hot flashes due to a lack of consistent evidence showing that they work.

How Effective Is Relizen Compared With HRT?

The two options aren’t in the same league. That’s largely because research on Relizen is limited, and we don’t yet have robust clinical trials directly comparing it with HRT.

One 2016 study of 324 perimenopausal and postmenopausal women treated by 90 gynecologists did report promising results. All the women took Relizen for three months, and researchers compared their symptoms with their starting scores. By the end, 85.5% reported fewer hot flashes and 91% reported reduced severity. But because there was no placebo group, the study can’t separate Relizen’s effects from the placebo response, which tends to be strong with hot flashes.

What Should You Know Before Trying Relizen?

Supplements come with some risk because the FDA doesn’t evaluate and approve them for safety and efficacy in the same way it does prescription medications. That often means there’s less information available about how well they work, potential drug interactions, and the effects of long-term use.

Because of that, it’s worth checking in with your doctor to make sure a supplement won’t interfere with another medication or negatively affect a health condition you may have.

Who Is a Good Candidate for HRT?

There’s no universal HRT prescription for managing menopause symptoms. The hormones you need, how you take them, and whether HRT is appropriate in the first place depend on your medical history and where you are in the menopause transition.

A menopause-specialized doctor will consider factors such as a history of certain cancers, blood clots, stroke, cardiovascular disease, or liver disease when determining whether HRT is appropriate for you.

The type of HRT also matters. Estrogen can be taken in different ways. If you have a uterus and take systemic estrogen, you’ll generally also need progesterone or another progestogen to protect your uterine lining. Transdermal estrogen, which is delivered through your skin via a patch, gel, or spray, bypasses the liver and may be preferred based on your individual risk factors.

Some women in perimenopause may still need birth control, in which case your doctor may recommend a low-dose birth control pill instead. Not only can it provide contraception, but it can also help ease hot flashes and unpredictable periods.

Your age, symptoms, medical history, whether you have a uterus, and whether you still need contraception can all carry weight in this decision. HRT is primarily used to treat bothersome menopause symptoms rather than prevent conditions like heart disease or dementia. 

Also, the treatment you start with doesn’t have to be the one you stick with for life. It can be reevaluated over time as your health, symptoms, and needs change.

When Is It Time To Reassess Your Treatment?

If you’ve been taking Relizen or another supplement and you’re still throwing the covers off every night, losing sleep, or arranging your wardrobe around the possibility of your internal thermostat going haywire, you don’t have to keep waiting for it to work.

Talk to a menopause-specialized doctor about what you’ve tried, how often you’re having hot flashes, and how much they’re affecting your quality of life. If HRT is appropriate for you, they can help determine the dose and delivery method that makes the most sense. If hormones aren’t an option, or you simply don’t want to use them, evidence-based nonhormonal treatments, such as low-dose paroxetine, may be worth discussing.

If you’re already taking HRT and still having significant symptoms, bring that up, too. Your treatment can always be adjusted.

“If symptoms that once improved after an intervention return, it’s time to reassess whether an adjustment is right for you,” says Kudzai Dombo, MD.

The bottom line is this: If hot flashes are disrupting your life, ask about treatments backed by the strongest evidence and work with your doctor to find one that fits your health history, symptoms, and preferences. Alloy Health connects you with a menopause-specialized doctor who can help you weigh your options and find relief that fits.

Frequently Asked Questions

How does Relizen compare to hormone replacement therapy (HRT) for treating hot flashes?

Major menopause guidelines, including those from The Menopause Society, consider hormone replacement therapy (HRT) the most effective treatment for hot flashes and night sweats. Relizen, a nonhormonal supplement made from purified Swedish flower pollen extract, lacks the same quality and volume of clinical evidence and has not been compared directly to HRT in robust trials. While a 2016 study of 324 women showed that 85.5% reported fewer hot flashes and 91% noted reduced severity after taking Relizen for three months, the study lacked a placebo group, making it impossible to separate the supplement's effects from the strong placebo response common with hot flashes. Because of inconsistent evidence, The Menopause Society does not recommend supplements or herbal remedies for hot flashes.

What should you know before trying Relizen, and what other nonhormonal options are available?

Unlike prescription treatments, supplements like Relizen are not evaluated or approved by the FDA for safety and efficacy, meaning there is limited information regarding how well they work, their long-term effects, and potential drug interactions. You should always consult your doctor before starting a supplement to ensure it will not interfere with existing medications or health conditions. If you cannot take HRT or prefer to avoid hormones, there are evidence-based nonhormonal prescription alternatives available, including low-dose paroxetine (an SSRI), gabapentin (an anti-seizure medication), and fezolinetant (an NK3 receptor antagonist that targets temperature-control signals in the brain).

Who is a good candidate for HRT, and when should you reassess your hot flash treatment?

For many healthy women who are younger than 60 or within 10 years of menopause onset, the benefits of HRT generally outweigh the risks. A menopause-specialized doctor will tailor treatment based on your age, symptoms, medical history—including any history of blood clots, stroke, cardiovascular disease, liver disease, or certain cancers—and whether you have a uterus, which requires pairing systemic estrogen with progesterone or another progestogen. If you are still in perimenopause and need contraception, a low-dose birth control pill may be recommended instead. You should consult your doctor to reassess your treatment if supplements fail to provide relief, if hot flashes continue to disrupt your sleep and daily life, or if symptoms return after previously improving on HRT.