About 95% of all women reach menopause by age 55, and many suffer from hot flashes and other symptoms during this hormonal change. The usual medical treatment is hormone replacement therapy, which is associated with many potential side effects such as high blood pressure, abnormal vaginal bleeding, gallbladder disease, depression, weight gain and endometrial and breast cancers. In a large study of 121,700 nurses, those taking estrogen alone, or estrogen and progestin together, had an increased risk of breast cancer compared to women who never used hormones.

Another way of relieving symptoms associated with menopause is the herb black cohosh, which has a long history of treating women's problems in both America and Europe, and was an official drug of the U.S. Pharmacopoeia from 1820 to 1926. Studies show that the plant strengthens female reproductive organs, and has hypoglycemic, estrogenic, mild sedative and anti-inflammatory effects. Extracts of the root have been found to reduce menopausal symptoms such as hot flashes and depression. One randomized, double-blind study compared a black cohosh preparation with estrogen and with a placebo. On measures of menopausal symptoms, the herb outperformed both the estrogen and the placebo.

Many studies document black cohosh's effectiveness and its safety. The herb has been used in Germany for more than 40 years with no evidence of serious side effects, contraindications, or harmful interactions with other drugs, however, use during pregnancy or lactation is not recommended. Mild nausea while taking the herb has been reported in rare cases.

Natural progesterone, usually synthesized from Mexican wild yams or soybean plants, is another alternative to conventional hormone replacement therapy. In addition to its action on menopausal symptoms, progesterone has also been found to promote bone growth, relieve PMS symptoms, and is sometimes recommended for fibrocystic breasts, endometrial hyperplasia, depression and high blood pressure. Administering progesterone through the skin is more efficient than taking it orally, because the transdermal route avoids its destruction in the liver.  Based on information in: Journal of Women's Health, 1998, Vol 7 #5; Townsend Letter for Doctors & Patients, July 1998