Whether you're among the former or the latter or somewhere in between, chances are that you will at some point seek relief from the symptoms of menopause, which include insomnia, depression, stiff joints, bloating, vaginal dryness, sore breasts, and hot flashes. Hot flashes, which are characterized by a sudden increase in heart rate, peripheral blood flow, and sweating, are for many women the most uncomfortable aspect of menopause. Research suggests that about 75 percent of menopausal women are affected at one time or another by hot flashes, 15 percent of them seriously so. These figures suggest that four to five million U.S. women currently are severely affected by hot flashes.

Modern science has linked hot flashes to a decline in estrogen levels, which in menopausal women are only about 10 percent of their former levels. For the past several decades, conventional medicine has treated hot flashes and other menopausal discomforts with estrogen replacement therapy (ERT). Because ERT is contraindicated for women with a history of cancer, hormone replacement therapy (HRT), which combines estrogen with a synthetic progesterone, is often used instead. But many women don't want to take the potential increased risk of cancer associated with ERT, or they dislike the cyclical bleeding often caused by HRT, or they don't want to take pills. Some women can't tolerate the side effects associated with these treatments. Despite the high interest of women in alternatives to ERT and HRT, however, little scientific investigation of alternatives has been done.

Traditional herbal medicine has for years offered a variety of treatments to ease hot flashes. Few of them have been sufficiently researched, but black cohosh (Cimicifuga racemosa) and vitex (Vitex agnus-castus), or chaste tree--both of which contain estrogen-like compounds--have shown promise in relieving menopausal complaints. Further work is needed to determine how effective these herbal remedies are as actual substitutes for ERT. Dong quai (Angelica sinensis), an herb commonly used in traditional Chinese medicine, has been shown to relieve menopause symptoms in many women; how it works is not clearly understood.

Black cohosh
North American Indians and eclectic physicians of the nineteenth century alike used black cohosh in decoctions to treat gynecological problems. Today's herbalists and homeopaths also value it for this purpose; herbalists also prescribe it as a hormone regulator and as a diuretic to relieve water retention.

Studies carried out in Europe have verified black cohosh's effectiveness in reducing the secretion of LH, which has been implicated in causing hot flashes. Experiments with rats in the 1980s showed that a methanol extract of black cohosh contains substances that bind to estrogen receptors, causing a selective reduction in luteinizing hormone (LH), which has been implicated in causing hot flashes. Experiments with rats in the 1980s showed that a methoanol extract of black cohosh causing a selective reduction of LH. In 1991, researchers at the University of G"ttingen in Germany performed a study of a commercial ethanol extract of black cohosh called Remifemin. The study involved 110 menopausal women between the ages of 50 and 54 who had received no estrogen replacement therapy for at least six months and complained of menopausal symptoms. The researchers found that the product reduced LH, and they isolated three active, as yet unidentified compounds in black cohosh that work together to suppress the hormone.