The herb Cimicifuga racemosa, also known as "black cohosh" or "squaw root," is a safe and effective natural agent that relieves the symptoms of menopause. C. racemosa was introduced to American Medicine by Native Americans to treat uterine disorders and has been used for decades in Germany for women with menopausal symptoms. Cimicifuga comprises naturally occurring triterpene, flavonoid, and aromatic constituents. The compounds responsible for the effectiveness of Cimicifuga are collectively referred to as 'phytoestrogens.' The use of black cohosh. is not contraindicated in hormone-sensitive mammary carcinoma or endometrial carcinoma, malignant melanoma, or other conditions for which estrogen replacement is contraindicated.

J Womens Health 1998;7:525-529.

COMMENT: The perimenopausal period is one of the most challenging times to provide hormone replacement therapy. The foundation, of course, is natural progesterone. If you do not own a copy of Dr. Lee's book What Your Doctor May Not Tell You about Menopause, I would strongly encourage you to obtain one for your library. It is a classic and is one of the top five books in natural medicine. Frequently, natural progesterone will not be sufficient to control the vasomotor hot flushes that accompany this period. I have found black cohosh to be quite effective, for most, but not all women. I use a product called Phtyomens from Ortho Molecular. There are many other brands available. The dose is normally one three times a day. If that works, then one decreases to two or one, or the least amount of pills that will relieve the symptoms. If three does not work, the dose is normally increased to six per day. If six per day does not work, higher doses are not likely to be beneficial. In those women who still suffer with the hot flushes, estrogen will usually be required for some time. Normally, this is given at the lowest dose to relieve symptoms and gradually tapered over a few months or years to zero. The natural progesterone and time will eventually provide relief in all women with no estrogen.