When the National Institutes of Health shut the book on a long-term study of hormone replacement therapy, it opened the door for some 6 million women to explore alternative treatments for menopausal symptoms.

"There are a lot of women sitting around saying, 'I don't want to have hot flashes, but the only thing I've heard of is hormone replacement therapy. What am I supposed to do, lock myself in a padded room until it goes away?'" says Marty Baird, president of Nutritional Marketing in Phoenix, Ariz.

"This opens up sales opportunities for the retailer like mad," he says.

Risks Outweighed Protection
NIH called off the study of combination estrogen and progestin hormone replacement therapy three years ahead of schedule, saying the risks of the therapy—including increased chances of blood clots, invasive breast cancer, heart attacks and strokes—far outweigh the protection HRT offers against problems such as osteoporosis and colorectal cancer. Two other studies also dealt blows to hormone therapy. One led by San Francisco State University researchers concluded that estrogen alone does not protect older women against heart disease. Another study suggests estrogen replacement therapy may cause ovarian cancer.

In the week after NIH announced it had stopped the combination-hormone portion of the Women's Health Initiative study, calls to Transitions For Health Inc.'s toll-free hotline were up 40 percent.

"We are getting calls from doctors, as well as medical centers, inquiring about our products as options," says Tom Hose, president of Transitions For Health. The Portland, Ore., company makes women's wellness products, including black cohosh and red clover supplements and phytoestrogen and progesterone creams, marketed under the Emerita and Women's Group Formula brands.

There are plenty of natural products on the market to treat both annoying and clinically serious side effects of menopause. The challenge is attracting and retaining a new customer who may never have set foot in a natural foods store.

"For some of those people, no way would they have ever thought of going into one of those 'voodoo' shops," Baird says. "There is a fear there. [Retailers] want to make sure to bring down as many of those barriers as they possibly can."

Start with outreach and education, he advises.

Once the HRT story hit CNN, you could pretty much guarantee local television and radio stations and newspapers soon would follow with stories of their own. Baird says a good outreach strategy includes presenting yourself as someone who is available to comment on the news. "As a local retailer, you want to be contacting every major local media outlet with your statements, views and what this means to women in your area," he says. "You don't necessarily need to comment on the study, but you do want to comment on the confusion and the fear and let people know they can come to you to relieve the confusion and fear."

Confusing Issues
Women considering tossing their prescription hormones in the garbage likely are wrestling with some complex and confusing health issues.

Nancy Montgomery, a 53-year-old health care Web site editor from Berkeley, Calif., had already decided to begin tapering off her combination HRT, but moved the timetable up when the WHI study was cancelled. "If you look at the studies, the actual numbers are pretty small," she says. "But I think I'll be more comfortable doing something else."

Before she stops taking the medication, though, she'll undergo a bone density test to make sure she doesn't need medication to slow osteoporosis. And she's worried that she may still suffer hot flashes.

Montgomery says she'll attempt more weight-bearing exercise and will try hard to take calcium supplements every day. If she still suffers hot flashes after she stops taking the HRT, she'll listen to a friend's recommendation and start taking Remifemin, an herbal supplement by GlaxoSmithKline derived from black cohosh.

"I don't feel like I ever gave other options a chance," Montgomery says. "I kind of glommed on to HRT because there wasn't any reason not to at the time. Now I think if I were starting again today, I would look for other things first."

Stores that have an education center can help with that search by offering regular seminars during which alternative therapies can be explained, either in one-time events or during ongoing seminars.

"Invite the local media to attend. Invite local female personalities from the market—women DJs, writers from the major papers and magazines in the area," Baird says. "You want to be positioned as the educational resource. That way you'll be differentiated from everyone else in the market—everyone else just has product on the shelves."

Most women looking for HRT alternatives will first visit their mass-market grocery or drugstore, Hose says. There they may find some natural remedies, but probably won't get the kind of help choosing appropriate products that they would in a natural grocery or supplements store. If they're lucky, they'll ask the pharmacist, who will direct them to a supplements or natural foods store, Hose says.

This means the education and customer-service portion of the equation must continue beyond the media moment, Baird says.

The floor staff must be educated to do more than just point the potential customer to the corner where menopause remedies are shelved. "They may want to say something like, 'You may have heard some of the negative stuff going around about HRT. Well, here are some remedies that we have.' They'll want to look at vitamins, calcium and diet," Baird says. "Depending on the retailer, it could be that this kind of media moment in time could turn into a customer for life."

Supportive Literature
For a fair share of women, exploring HRT alternatives will be their first time in the supplements department, and they may be nervous about taking an herbal remedy. "If I were a retailer, I would get all of the products into one place and focus on selling the brands that have credible, scientific research behind them," Transitions For Health's Hose says.

Back up the products with related books. "One of the things about any of these products, whether they are prescription, natural or over-the-counter, is that they require a certain amount of education," Hose says.

Hose says women looking for health information are some of the top Internet users, so it may help to offer a few good Web resources. The Christiane Northrup, M.D., site, www.drnorthrup.com, is a good start. The author of The Wisdom of Menopause: Creating Physical and Emotional Health During the Change (Bantam Doubleday, 2001), Northrup includes links to her HRT interviews and references to helpful herbs and supplements a woman might take if she's decided to taper off of the prescription hormones.

"Retailers have to be nimble. Grocers always have their end caps planned out weeks in advance, but this is an opportunity to take some of that space and put up a display. In a case like this, you might want to put up a permanent menopause end cap," Hose says, noting that the 2000 U.S. Census estimated there are 52 million women between the ages of 35 and 65.

"Of that number, 65 percent of the female population is in or is entering menopause," he says. "It's a big number."

Natural Foods Merchandiser volume XXIII/number 9/p. 14, 16, 20