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Pros and Cons of Non-Drug Approaches to Managing Hot Flashes

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Q. Recently you discussed black cohosh for hot flashes. I used it when I had that problem, but my liver enzymes became elevated and I needed further tests.

A. We have heard from other readers that black cohosh can sometimes affect the liver, so it is wise for women to have their liver enzymes monitored if they decide to take this herb for hot flashes. There have been cases of liver failure that have led to liver transplantation after the use of black cohosh (BMJ Case Reports, July 5, 2013).

Other natural options for easing hot flashes include Pycnogenol (Journal of Reproductive Medicine, Jan-Feb 2013), maca root (Maturitas, Nov., 2011) and rhapontic rhubarb, sold as Estrovera (Alternative Therapies in Health and Medicine, Nov-Dec, 2008). 

We discuss many ways to make hot flashes and other symptoms less disruptive in our Guide to Menopause.

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I recently had a physical exam and was warned by my doctor that the Black Cohosh would cause problems with Blood Pressure. I promised to finish my current supply through the holidays and not purchase any more. I read that Pycnogenol is good, but what are the side effects? My doctor has no recommendations.

People's Pharmacy response: WebMD reports dizziness, headaches and mouth ulcers. Keep in mind that nearly any natural product may cause allergies in some individuals.

I have found relief with pycnogenol. I'd previously posted that it hadn't worked but I was wrong - I reduced the dose too soon and thought cruciferous vegetables had made the difference but it was actually the pycnogenol all along. I worked my way up over a few weeks to 200 mg per day (100 am and 100 pm; 150 lb. bodyweight). Thank goodness for relief!

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