Q. I’ve read several suggestions for hot flashes. My chiropractor recommended a vegetarian supplement derived from rhapontic rhubarb. After the first month of taking it, my hot flashes decreased in severity, and shortly after that they disappeared altogether. So did the night sweats. I haven’t experienced either in months.
The brand I take, Estrovera, costs a dollar per tablet, but I feel it is worth it.

A. A standardized extract of rhapontic rhubarb (Rheum rhaponticum) has been used in Germany to treat hot flashes and other symptoms of menopause for a couple of decades (Alternative Therapies in Health and Medicine, Nov-Dec., 2008). A placebo-controlled trial of 112 women found that the botanical product reduced symptoms significantly more than placebo (Alternative Therapies in Health and Medicine, Jan-Feb., 2009).
We discuss other ways to handle hot flashes in our Guide To Menopause. Some women find that vitamin E is helpful, while others prefer black cohosh and St. John’s wort extract together. Pycnogenol proved helpful in one study (Acta Obstet. Gynecol. Scand. 2007), and some women are enthusiastic about true yams. There are also prescription approaches that go beyond hormone replacement therapy, another tried-and-true treatment for hot flashes, but one that should be used at the lowest effective dose for the shortest possible time.

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  1. Renee

    The week after I turned 50, I started having problems with hot flashes, and I would also wake up 5-8 times a night, just in time to have a hot flash! I began to notice that after eating my husband’s homemade guacamole, I would feel cooler and more like my old self for several hours. Since then, I eat a small slice (1/8) of an average sized avocado every day, either with my egg whites at breakfast or with my salad at lunch. If I’m traveling and don’t have access to avocado, I take 400IU vitamin E (mixed tocopherols only) once or twice a day as I feel the need to, but avocado works better for me. I only occasionally feel a little warm here and there, and I sleep much better now – I can live with this. Hope this info helps someone else!

  2. Dr Charles

    There is another study on the use of Pycnogenol for menopausal symptoms. The results of this study correspond to my experience in treating hot flashes DUE to MENOPAUSE. But beware diagnosing menopause for all hot flash symptomatology, eg in an 86 year old. See the extensive differential diagnosis of hot flashes from http://www.diagnosispro.com below the article abstract on the use of Pycnogenol for Menopausal symptoms.
    Panminerva Med. 2011 Sep;53(3 Suppl 1):65-70.
    Supplementation with Pycnogenol® improves signs and symptoms of menopausal transition.
    Errichi S, Bottari A, Belcaro G, Cesarone MR, Hosoi M, Cornelli U, Dugall M, Ledda A, Feragalli B.
    Irvine3 Labs, Department of Biomedical Sciences Chieti – Pescara University, Pescara, Italy.
    (NOTE: this group has done quite a few studies on Pycnogenol)
    The aim of this study was to evaluate the efficacy of Pycnogenol® standardized pine bark extract for alleviation of signs and symptoms associated with menopausal transition.
    Pycnogenol® was used by 38 women as daily supplement in a dosage of 100 mg over an eight week period and menopausal symptoms were evaluated by means of a scoring system, based on a total number of 33 common signs and symptoms. A parallel control group of 32 comparable women was also followed up for the same period. Pycnogenol® was well tolerated, no side effects were reported and the compliance was very good with 98.6% of tablets used as prescribed. A range of 33 menopausal symptoms were evaluated using a scoring system with values ranging from zero (absent) to maximum 4 (very serious).
    A subset of six most common symptoms comprising hot flushes, night sweats, mood swings, irregular periods, loss of libido and vaginal dryness showed a decrease from average 2.67/4 to 1.45/4 after 8 weeks supplementation with Pycnogenol®. The control group of women showed no change from initial average 2.72/4 to 2.73/4 after eight weeks. The improvement of symptoms was statistical significant compared to the control group. Further symptoms related to fatigue, sleeping disorders, concentration and memory problems, dizziness, depression and irritability all improved significantly with Pycnogenol® compared to baseline values but did not reach statistical significance compared to the control group of women. The sensation of pain related to headaches, breast pain, the feeling of “electric shocks”, tingling extremities, burning tongue and itchy skin all improved significantly after intake of Pycnogenol® for eight weeks compared to baseline. Specifically the sensation of “electric shocks” and digestive problems improved significantly with Pycnogenol® as compared to women in the control group. The presence of elevated oxidative stress in women was investigated measuring capillary blood plasma free radicals. Oxidative stress was significantly lowered after four weeks (P but do not rely on your own differential diagnosis; see your physician for a dx and rx once a dx has been made. And as noted above “hot flashes” could really be “night sweats”, a symptom that has a different differential diagnosis, that includes Lymphoma.
    Electromagnetic, Physics, trauma, Radiation Causes
    Pelvic irradiation
    Surgical, Procedure Complication
    Neoplastic Disorders
    Carcinoid syndrome/Carcinoid metastatic
    Carcinoid tumor
    Allergic, Collagen, Auto-Immune Disorders
    Drug allergy
    Angioedema/Angioneurotic edema
    Relational, Mental, Psychiatric Disorders
    Panic attacks/Anxiety disorder
    Anxiety Disorder (GAD)
    Anxiety, acute
    Functional, Physiologic Variant Disorders
    Vegetative, Autonomic, Endocrine Disorders
    Estrogen deficiency
    Hyperthyroidism (Graves disease)
    Hypogonadism, male/androgen deficiency
    Menopause/ovarian disorder
    Ovarian failure, premature
    Hypogonadism, Female
    Idiopathic, Unclassified Disorders
    Multiple Symmetric lipomatosis
    Drug reaction/Side effect
    Disulfiram-like drug/Alcohol reaction
    Leuprolide (Lupron) Administration/Toxicity
    Niacin/Nicotinic acid Administration/Toxicity
    Tamoxifen (Nolvadex) Administration/Toxicity
    Poisoning (Specific Agent)
    Alcohol/Ethanol ingestion/intake
    Alcohol intoxication, acute
    Heroin/opiate withdrawal
    Histamine release pathophysiology
    Tyrosine containing foods
    Fish Poisoning, Scomboid
    Tyramine containing foods

  3. PR

    I think I will try Vitamin E and of course mention it to my Dr. when I have my check up. Thanks for the information

  4. Rose

    I’ve tried Black Cohosh and it brought my blood pressure up so I had to get off of it. Should I try Vit. E at night or St John Wort?
    People’s Pharmacy response: You’ll have to experiment to see which works best for YOU.

  5. linda

    your hot flashes may be due to other issues, maybe your medications, high blood pressure, etc. You should probably see your doctor.

  6. Jesse

    Better to see a primary care doctor first before trying herbs, find a Dr. who will listen to you and do blood work and other tests. A 74 year old friend started having night sweats and didn’t go to the Dr. and after a year it was too late when it was learned the night sweats were caused by non-Hodgkins lymphoma.

  7. PR

    I am an 86 year old female who had hot flashes when I was in my 40’s or 50’s, and now for more than a year I am having them again and they are worse than ever. It is so bad that it is embarrassing when I am around other people. Do you think this would help me and if so where do I buy it.
    vegetarian supplement derived from rhapontic rhubarb?

  8. RLH

    I had a terrible problem with night sweats and hot flashes. I started taking 400 mg of vitamin E at bedtime and they went totally away. If I forgot to take the Vitamin E they would come right back.

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