Today in Germany, black cohosh is a main ingredient of three commercial drugs used for menopausal discomforts. Germany's Commission E, a governmental panel that studies and makes recommendations about medicinal herbs, has found black cohosh to be a safe and reasonably effective treatment of nervous conditions associated with menopause. However, the U.S. Food and Drug Administration in 1986 found no pharmacologic evidence of therapeutic value in black cohosh and cautioned against its overuse.

Vitex
Hippocrates recommended vitex in the fourth century b.c. to treat injuries, inflammations, and swelling of the spleen. Its common name, chaste tree, is derived from the belief that it would suppress libido; European Catholics placed blossoms of the plant at the clothing of novice monks. Like black cohosh, contemporary herbalists value vitex for its hormone-regulating action and often prescribe it to treat not only hot flashes, but depression and vaginal dryness as well.

Vitex is believed to act on the hypothalamus and pituitary, regulating progesterone levels. Most of the clinical studies of vitex have been done in Europe and were noncontrolled. Two surveys of gynecological practices in Germany investigated the effect of vitex on 1,542 women aged thirteen to sixty-two with gynecological complaints. The women took forty drops of a commercial vitex product for an average length of 166 days. Physicians and patients agreed that the vitex product relieved fluid retention, bloating, breast tenderness, headache, and fatigue. Two percent of the patients reported side effects that included nausea, other gastric complaints, and diarrhea. Symptoms improved after an average of 25.3 days of taking the vitex drops. Additional anecdotal clinical reports indicate that vitex may help manage hot flashes, although further investigation is needed.

In Europe, vitex has been used for about forty years in a commercial alcohol-based tincture of the fruits known as Agnolyt; 100 mg of the solution is standardized to contain 9 g of the fruit. Recommended dosage is forty drops with liquid in the morning for several months to offset fluid retention and other discomforts. A solid extract equivalent of the tincture has been developed for those who are sensitive to alcohol.

Side effects from using vitex are rare, and there are no known interactions with other drugs. Commission E has supported the use of chaste-tree berries to treat menstrual disorders and mastodynia (painful breasts).