The Women's Health Initiative finding that taking estrogen plus a progestin for more than five years increased the risk of cardiovascular disease and breast cancer left the safety of using estrogen to treat hot flashes open to question. How low a dose and how short a duration would be safe and effective are unknown. Lifestyle changes, antidepressants, alpha-2 agonists, anticonvulsants, phytoestrogens and other dietary supplements have been tried as alternatives to estrogen, with mixed results.