Red clover(Trifolium pratense)

• What it is: A common wild plant found growing in most back yards, red clover is one of the richest sources of isoflavones, the same estrogen-like plant compounds found in soybeans. Although red clover doesn’t appear to help consistently with hot flashes or mood disturbances, it can help to maintain a healthy heart—a significant concern for women after menopause.
• How it works: Red clover seems to improve cardiovascular health by helping to keep arteries supple during menopause. As estrogen levels decline, blood pressure often increases, which over time can damage the heart and arteries. Researchers believe that the isoflavones in red clover help to relax the smooth muscles that line arteries, which helps to keep blood pressure in a healthy range (Journal of Clinical Endocrinology and Metabolism, 1999, vol. 84, no. 3).
• Dosage and safety: 15–30 drops of liquid extract three times a day. If taking standardized extracts, follow manufacturer recommendations. Red clover should not be used with blood-thinning drugs.

Vitex/Chasteberry (Vitex agnus-castus)

• What it is: The dark purple, aromatic berries from the vitex shrub historically have been thought to suppress sexual desire (hence the common name “chasteberry”). Although there’s no truth to that belief, vitex does affect hormonal balance. It’s one of the most popular herbal remedies for easing premenstrual syndrome complaints and helps relieve symptoms of perimenopause, as well.
• How it works: Vitex contains no hormonal compounds. Instead, it acts on the hypothalamus and pituitary gland, both of which regulate estrogen and progesterone. Too little progesterone (in relation to estrogen) causes most PMS and perimenopausal complaints. By helping to increase progesterone, vitex calms hormonally driven symptoms such as anxiety, depression, irritability, and bloating. Also, vitex lowers prolactin levels, which at high levels causes PMS symptoms. In a German study of 1,634 women, 93 percent reported that PMS symptoms decreased or disappeared after three months of taking vitex (Journal of Women’s Health & Gender-Based Medicine, 2000, vol. 9, no. 3).
• Dosage: Try 30 drops of liquid extract or one cup of tea three times a day. If taking standardized extracts, follow manufacturer recommendations. Because vitex works indirectly to increase progesterone, it generally takes at least three months to notice benefits; best results are obtained after a year of continuous use.

Black cohosh(Cimicifuga racemosa)

• What it is: Native to the forests of the eastern United States, black cohosh is a beautiful woodland plant with tall spikes of white feathery flowers. Used for centuries in folk medicine for menopausal complaints, black cohosh has garnered modern medical support as a natural alternative to hormone replacement therapy, or HRT. In a 2005 review of research on herbal and dietary supplements commonly used during menopause, researchers named “safe and effective” black cohosh their top alternative choice (Journal of Women’s Health, 2005, vol. 14, no. 7).
• How it works: Although strong evidence backs black cohosh’s effectiveness at easing menopausal symptoms—such as hot flashes, mood swings, and vaginal dryness—scientists don’t yet understand the herb’s mechanism. One thing is clear: Unlike HRT, black cohosh doesn’t raise blood levels of estrogen. Excess estrogen, taken in combination with progestin, increases the risk of breast cancer. In a recent study, black cohosh compared favorably to HRT in maintaining bone strength, a primary concern for postmenopausal women. Although estrogen therapy inhibited osteoclasts, the cells that break down bone, black cohosh stimulated activity of osteoblasts, the cells that create bone (Menopause, 2006, vol. 13, no. 2).
• Dosage and safety: Aim for 40 mg daily of standardized black cohosh extract. When taken in larger amounts, black cohosh can cause headache or nausea. Don’t take black cohosh if you’re pregnant.

Herbalist and author Laurel Vukovic lives in Ashland, Oregon, and has published nine books, including Herbal Healing Secrets for Women (Prentice Hall, 2000).