Hot Enough for You?

Black cohosh. A member of the buttercup family, this herb gets the hot-flashiest headlines. Alas, while early studies were promising, more recent ones haven't been. The verdict? "Conflicting data," according to the Web site of the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

Northrup, however, insists that it works. "Black cohosh decreases hot flashes, elevates mood and can increase moisture in the vaginal area," she said.

Santoro, also an OB-GYN and the lead editor of the Menopause Society's report, is more skeptical. "Try black cohosh for eight weeks," she recommends. "After eight weeks, if it's not helping, stop wasting your money."

Supplement surprise. What about dong quai, chasteberry, wild yam, evening primrose, valerian root, ginseng, licorice, Chinese herb mixtures and vitamin E? Most medical researchers say they don't work.

But Northrup said many of the studies she puts stock in "don't tend to appear in Western, peer-reviewed literature." She said women "wouldn't risk anything" by taking a supplement containing her top five ingredients: black cohosh, mother wart, licorice, dong quai and chasteberry.

"My favorite thing to do if you possibly can is work with someone who is trained in acupuncture and Chinese medicine," said Northrup. "You'll get herbs that are prescribed specifically for your condition, and that would be ideal."

Remember, herbs aren't subject to the same sort of regulation you find in prescription drugs or even over-the-counter drugs. You don't know if the label accurately represents what's in the pills, the maker rarely tells you about possible side effects and dangerous interactions, and no one knows whether there are long-term negative effects.

Things You Can Wipe On Yourself

Progesterone cream. If your estrogen levels are surging, the theory goes, boost your progesterone to restore balance. You can theoretically do that with nonprescription or "natural" progesterone cream, which is made from plant-based sources like soybeans and wild yam and smeared on your skin. One randomized, double-blind, placebo-controlled study found it effective; two didn't. Full disclosure: I tried it for PMS symptoms (in both nonprescription and prescription varieties) and didn't notice any significant benefit. It's nice for your skin, though, and certainly some women find it helpful.

Baby wipes. If you're going to sweat, be prepared. In his book, "Amazing Kitchen Cures: 1,150 Ways To Prevent and Cure Common Ailments with Brand-Name Products" (Rodale, 2002), my college chum Joey Green suggests that women plagued by hot flashes "carry a handful of Huggies Baby Wipes in a gallon-size Ziploc Storage Bag. Wipe your forehead to ease the intensity of the hot flash." If that doesn't help, at least you're ready for picnic clean-up.

Things You Can Do

Give up things you love. If you cut out caffeine, refined carbohydrates and alcohol, Northrup said, "you will be able to get rid of more hot flashes with that lifestyle change than from just about anything else you can do, other than pop estrogen." Sugar and alcohol, she said, increase insulin levels in the blood, which "for whatever reason, contributes to hot flashes." And, she said, caffeine boosts stress hormones, which also leads to hot flashes.