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Three stand-out herbs for hot flashes and other symptoms

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Menopause is a normal part of aging for every woman. This phase of life arrives when ovaries no longer produce an egg every month, periods stop, and a woman is no longer reproductive. Most people think of menopause as the changes a woman experiences just before she stops menstruating, such as hot flashes and night sweats. Officially, however, menopause is the time when a woman experiences her last menstrual period, and it isn’t diagnosed until a woman has gone without a period for 12 consecutive months. Symptoms can be uncomfortable, but many women will verify the benefits of natural remedies for these persistent symptoms.

One remedy stands out as the most popular herbal treatment for menopausal symptoms. Over the past few years, scientific evidence for black cohosh (Actaea racemosa) has been mixed, but it has remained popular as an alternative to hormone replacement therapy in the treatment of hot flashes. On the whole, recent studies have confirmed what millions of American women already know from experience—that this root extract is a pretty good remedy for a plethora of menopausal problems.

A 2008 analysis of 32 combined scientific studies concludes that black cohosh can significantly reduce the frequency or severity of hot flashes. And the evidence continues to accumulate. In 2012, Holistic Nursing Practice reported on a placebo-controlled clinical study that investigated the efficacy and various safety aspects of a popular, standardized extract of black cohosh (Remifemin) in 304 women. Researchers confirmed the efficacy for menopausal symptoms, particularly hot flashes, and the extract was well-tolerated.

Black cohosh has recently been implicated in some liver damage case reports. In 2011, the journal Menopause decided to look at that concern. In a meta-analysis of five randomized, double-blind, and controlled clinical trials, involving a total of 1,117 women, results showed no evidence that an extract of the root has any adverse effect on liver function.

Preparations of black cohosh root vary widely, and women differ so much as individuals, that it is tricky to suggest a standard dose. Herbalists often say that the dose used in studies is on the low side, so you might want to try starting at a lower dose and gradually increasing the dose until you see results.

Sage leaf (the kitchen spice Salvia officinalis, not to be confused with sagebrush) has been used in Europe for centuries as a spice and a medicine, especially for mood, and this herb has one of the best records of scientific validation for menopause symptoms.

Several years ago, a preparation of sage leaves was found to eliminate hot flashes and night sweats in two thirds of subjects, and the remainder had good response or a reduction in symptoms. Sage contains compounds that may have mild estrogenic activity, and other constituents are anti-inflammatory. Recent papers have stated that this fragrant herb improves mood, cognitive performance and memory, alertness, and feelings of calm and happiness.

In 2011, scientists administered extracts of sage in a double-blind, placebo-controlled study, and again found that the herbal extract reduced mental fatigue and increased alertness, cognitive performance, and mood. And recent studies show that sage also helps to decrease bone loss. Most recently, a clinical trial in Switzerland found a significant decrease in hot flashes—by 50% within four weeks and by 64% within eight weeks. Sage is delicious as a tea, and is also available as an extract and in formulas. Take according to label instructions.

Shatavari root (Asparagus racemosus) is a popular sexual rejuvenating tonic for women in Ayurveda. It is a close cousin to the asparagus we eat as a vegetable, which has similar properties. It is used to treat menopausal complaints, including hot flashes and vaginal atrophy. Shatavari root is thought to sharpen the intellect and enhance physical strength. A recent study found that an Ayurvedic combination containing shatavari reduced the effects of stress substantially. Numerous studies have found plant hormonal constituents (steroidal saponins) in the herb that presumably account for its benefits. A 2012 study revealed that shatavari contains phytoestrogens. Shatavari is available in capsules. For menopausal symptoms, dosages range from 400 mg–7 gm per day.

Karta Purkh Singh Khalsa, DN-C, RH, is president of the American Herbalists Guild and author of The Way of Ayurvedic Herbs. He teaches at the National College of Natural Medicine in Portland, Oregon.